Com­pas­sion out­weighs crim­i­nal­i­sa­tion

Dur­ban drug so­lu­tion project a com­pelling case study

The Sunday Independent - - NEWS -

South Africa is stuck in con­ser­va­tive moral­is­tic nar­ra­tives about drug use but lit­tle is done to re­duce the as­so­ci­ated harms, ac­cord­ing to Pro­fes­sor Monique Marks, who heads Dur­ban Uni­ver­sity of Tech­nol­ogy’s (DUT) Ur­ban Fu­tures Cen­tre and a trans-dis­c­plinary project, called Path­ways into and out of street level drug use in Dur­ban.

The project is un­der­pinned by the Na­tional In­sti­tute for the Hu­man­i­ties and So­cial Sciences (NIHSS) through its Cat­alytic Re­search Projects which as­sists in and pro­motes the de­vel­op­ment of re­search un­der­taken through a net­work of re­searchers across the uni­ver­sity sys­tem in South Africa and be­yond.

The NIHSS man­date pro­motes public dis­course about cru­cial so­cial is­sues to help in­flu­ence the char­ac­ter of the South African com­mu­nity and to cre­ate a more hu­mane, re­spon­si­ble and just so­ci­ety.

Marks, ad­vo­cates that SA should fol­low Por­tu­gal and de­crim­i­nalise drug use, she says, "The war on drugs in South Africa, as in the US, has not re­duced the sup­ply or the de­mand of drugs. It has in­stead led to an in­crease in the harms as­so­ci­ated with drugs. Users once in­car­cer­ated and left with a crim­i­nal record, be­come in­creas­ingly marginalised and more likely to en­gage in prob­lem­atic drug use.

"Our work is geared to­ward find­ing so­lu­tions that sup­port drug users, rather than pun­ish­ing them. Only ten per­cent of users be­come prob­lem­atic, and the ma­jor­ity of these have gen­er­ally ex­pe­ri­enced high lev­els of trauma and/or dis­con­nect from fam­ily and com­mu­nity. More­over, most are from low in­come com­mu­ni­ties and use drugs as a so­lu­tion to an ex­ist­ing prob­lem. Yet the con­cept of drugs be­ing used as prob­lem solver is vig­or­ously con­tested in a so­ci­ety like ours. In­stead pro­hi­bi­tion and ab­sti­nence are viewed as the cor­rect ap­proach."

Crim­i­nal­i­sa­tion, Marks adds, re­sults in re­duced pos­si­bil­i­ties for users to nor­malise their lives and to rein­te­grate. "End­less pun­ish­ment, rather than sup­port, has fun­da­men­tally harm­ful con­se­quences for them, their fam­i­lies and the broader com­mu­nity. Fear of ar­rest and stig­ma­ti­sa­tion leave users and their fam­i­lies iso­lated, hope­less and vul­ner­a­ble."

The project Path­ways into and out of street level drug use has var­i­ous re­search and en­gage­ment out­puts. Heav­ily trans­dis­ci­plinary, it brings to­gether sci­en­tists from the hu­man­i­ties and medicine as well as prac­ti­tion­ers in health, so­cial de­vel­op­ment and polic­ing.

"This," she elab­o­rates, "has al­lowed for a range of knowl­edges, ex­per­tise and re­sources to make sense of drug use dis­or­ders in Dur­ban and the rest of the coun­try."

Shortly af­ter the re­search en­deav­our be­gan, the Ur­ban Fu­tures Cen­tre hosted a small sym­po­sium on drug use dis­or­ders that in­cluded Aus­tralian Pro­fes­sor of Fam­ily Medicine, Nick Croft and Ir­ish Crim­i­nol­o­gist Prof Lucy Pick­er­ing. The KZN Harm Re­duc­tion Ad­vo­cacy Net­work was formed, and has joined hands with other harm re­duc­tion ad­vo­cates in South Africa and in­ter­na­tion­ally. Since then po­lice have been en­gaged in on­go­ing di­a­logues about drug use and harm re­duc­tion by the Ur­ban Fu­tures Cen­tre be­cause they are crit­i­cal part­ners and po­ten­tial cham­pi­ons of harm re­duc­tion pol­icy and prac­tice.

She speaks of achieve­ments, "We have, for ex­am­ple, al­ready pub­lished two ar­ti­cles in lead­ing crim­i­nol­ogy jour­nals on the polic­ing of il­licit drug use. Another two, on the link between drug use and HIV preva­lence, were pub­lished in med­i­cal jour­nals. A book chap­ter on the cur­rent leg­isla­tive en­vi­ron­ment in South Africa in re­gard to drug use, drug pos­ses­sion and drug mar­kets will be pub­lished later this year. Three more ar­ti­cles are cur­rently be­ing writ­ten on var­i­ous com­po­nents of the project.

"At an en­gage­ment level, the out­comes have been spec­tac­u­lar. A com­mu­nity theatre group, the Big Broth­er­hood, has a pow­er­ful new pro­duc­tion. Called Ul­wembu (isiZulu for Spi­der web) it was pre­sented at numer­ous venues in Dur­ban and re­cently at the Hill­brow Theatre in Johannesburg. Far more than a play, it is an im­mer­sive so­cial learn­ing tool, that brings to­gether di­verse cit­i­zens and civil ser­vants into a trans­for­ma­tive and trans­gres­sive em­pa­thetic space."

Ul­wembu was re­cently awarded best script, best di­rec­tor (Cop­pen), best-led ac­tress (Mthombeni) and best sup­port­ing ac­tor (Ngubane) and best new­comer (Ngcebo) at the 2017 Dur­ban Theatre Awards.

Last month Dur­ban joined 120 cities across the world in the ‘Sup­port Don’t Pun­ish’ cam­paign. This was or­gan­ised by the Ur­ban Fu­tures Cen­tre at DUT and re­sulted in the link­ing of the work with sim­i­lar harm re­duc­tion work be­ing con­ducted glob­ally. The Ur­ban Fu­tures Cen­tre and the TB/HIV Care As­so­ci­a­tion were pro­vided a Harm Re­duc­tion Net­work­ing Zone at the Aids Con­fer­ence in 2016. Placed within the Global Vil­lage, it pro­vided a num­ber of ser­vices to drug users and shared var­i­ous forms of knowl­edge with the gen­eral public.

She em­pha­sises, "By far the most sig­nif­i­cant re­search and in­no­va­tion work is the re­cently launched Opi­oid Sub­sti­tu­tion Ther­apy (OST) Demon­stra­tion Project. Fol­low­ing months of prepa­ra­tion, we re­searched best in­ter­na­tional prac­tice to in­form our very de­tailed pro­to­cols which re­ceived eth­i­cal clear­ance from the KZN De­part­ment of Health and from DUT.

"It is the first project of its kind in South Africa and is al­ready gen­er­at­ing much me­dia and gov­ern­ment agency at­ten­tion.

The aim be­ing to demon­strate that opi­oid sub­sti­tutes (in this case Methadone) im­prove qual­ity of life for peo­ple with heroin dis­or­ders (mostly Whooonga/Nyaope users).

It is also shows gov­ern­ment health work­ers how to run a low thresh­old OST Pro­gramme, which we hope will even­tu­ally be rolled out in the na­tional public health sys­tem. "

The sig­nif­i­cant in­ter­ven­tion has a va­ri­ety of ex­pected qual­i­ta­tive and quan­ti­ta­tive re­search out­puts and an eco­nomic anal­y­sis will also ad­vo­cate for public pol­icy trans­for­ma­tion. Prof Marks ad­vo­cates that South Africans should be talk­ing about bring­ing drug use and its mar­kets into the open, as Por­tu­gal did 16 years ago. "I know this is coun­ter­in­tu­itive, the Por­tuguese ev­i­dence speaks for it­self." Heroin use has de­creased dra­mat­i­cally as have the num­bers of over­dose. By con­trast, US drug use dis­or­ders and drug mar­kets are grow­ing and spread­ing.

She con­cludes, "South Africans should also be talk­ing about the treat­ment avail­able, par­tic­u­larly for those users with lim­ited fi­nan­cial re­sources. 'Our public health sys­tem of­fers no proper treat­ment for drug use dis­or­ders and it has very few public 're­ha­bil­i­ta­tion' cen­tres. Those that are op­er­a­tional have very low re­ten­tion and suc­cess rates. In Dur­ban, for ex­am­ple, there is only one. The wait­ing list is very long and it lacks the med­i­ca­tion to as­sist heroin users through with­drawal. There is also no on­go­ing med­i­cal main­te­nance."

Elab­o­rat­ing on the OST Pro­gramme, Marks says qual­i­ta­tive and quan­ti­ta­tive data is col­lected to as­sess changes in qual­ity of life of the ben­e­fi­cia­ries. Af­ter a fairly short time a range of qual­ity of life im­prove­ments have been noted and recorded. Clients, while know­ing the pos­si­ble dan­gers of methadone as a med­i­ca­tion, and the re­al­ity of long term main­te­nance, are very clear about the im­prove­ment to their lives since join­ing the pro­gramme.

"Many have re­united with fam­ily and about half have stopped all il­licit drug use. Others have re­duced their use dra­mat­i­cally." she adds.

"There is also a marked change in the per­sonal health and hy­giene of the 34 ser­vices users cur­rently re­cruited. They are gen­er­ally ad­her­ing to other chronic med­i­ca­tion. No­table im­prove­ments in­clude qual­ity of life, although it is too soon to as­sess whether these will be sus­tained. Four have found em­ploy­ment and one has gone back to school af­ter drop­ping out three years ago. Per­haps most im­por­tantly, ben­e­fi­cia­ries have found a space where they are not judged and this has al­lowed them to form strong con­nec­tions with the staff and with others on the pro­gramme who pro­vide on­go­ing mu­tual sup­port.”

Scenes from Ul­wembu theatre pro­duc­tion

Pro­fes­sor Monique Marks

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