Manifestos Unpacked: Who can solve South Africa’s drug policy problem?

We call them Nyaope Boys, druggies, addicts – and the latest popular word, iphara, which some say implies that people who use drugs are parasites while others say that the word originates from the “paranoia” that is experienced by drug users.

But either way, these labels function to dehumanise people who use drugs.

“People keep saying we have a drug problem, but actually we've got a drug policy problem,” says Shaun Shelly, head of policy, advocacy and human rights for people who use drugs at the TB/HIV Care Association. So, how do the top three political parties plan to deal with the destructive consequences of drugs in our country?

Firstly, drug use is barely mentioned in all three manifestos and when it is, it is mostly in association with gangsterism and criminal activity. This is despite a growing global movement towards decriminalising drug use. For instance, the 2016 Lancet Commission on Drug Policy and Health recommends the decriminalisation of minor drug offences such as the use, possession and small-scale selling of drugs.

This didn’t deter the close to 300,000 drug-related crimes that were reported in the 2016/17 financial year, according to the latest South African Police Service’s Annual Performance Plan. The police have also set a goal of almost 50% increase in drug-related arrests over the next two years.

The Democratic Alliance (DA) mentions creating a “drug-busting” unit in the police force that will be deployed to “gang and drug war zones” to arrest criminals, but its manifesto doesn’t mention how the unit will function or how it will be funded.

Associating drug use with crime and conflating it with gangsterism — as the African National Congress (ANC), DA and Economic Freedom Fighters (EFF) do in their manifestos — stigmatises people who use drugs and does very little to solve the problems caused by drug use, argues Shelly. “To target drugs to stop gangs or to target gangs to stop drugs is the wrong way of going about it. The old language about 'the war on drugs' doesn't help at all.”

This combative language also contradicts national health targets to reduce HIV infections in the country, especially when close to 40% of injecting drug users surveyed in a 2018 TB/HIV Care Association study were found to be HIV positive.

People who use drugs are often assaulted and threatened by the police, a recent study on South Africa’s heroin trade states. This kind of abuse further marginalises drug users and restricts their access to health services.

In its manifesto, the EFF want to “increase the number of drug rehabilitation facilities in the country by 50% by 2024”. However, the party also doesn’t explain how it would finance this.

Nevertheless, Shelly argues rehabilitation centres are a waste of money. "There is not one single study anywhere in the world that supports the model of drug rehabilitation in in-patient settings. Evidence-based rehabilitation does not exist. Taking people away from their families because they're using drugs in a way that you don't like them to be using drugs is massively problematic," he explains.

Abstinence-based treatment such as going cold turkey at rehabilitation centres can cause severe withdrawal symptoms where people trying to stop using drugs may feel physically ill. Studies have labelled expecting drug users to abstain an “all or nothing” approach which often leads them straight back to drug dependence.

Instead of abstinence, Shelly suggests harm reduction initiatives such as opioid substitution therapy and needle exchange programmes. This therapy involves health workers giving users replacement substances such as methadone to drug users to alleviate withdrawal symptoms without giving them the high. Injecting drug users often reuse dirty needles or share them with others, needle exchange programmes allow drug users to swap their dirty needles for sterilised ones.

These harm reduction programmes are supported by extensive research which shows that they decrease HIV infections and drug-related crimes and are considered international best-practice by organisations such as the World Health Organisation and the United Nations. For instance, the opioid substitution therapy helps to decrease illegal drug use, overdose deaths and new HIV infections among people who use drugs, the 2011 WHO Bulletin found.

One of the key goals of the country’s National Strategic Plan against HIV, TB and STIs is to increase South Africa’s harm reduction programmes, yet none of the political parties directly mention these strategies as a way to combat drug use in South Africa.

Meanwhile, the ANC plans to “target drug syndicates through the implementation of the National Anti-Gang Strategy and the revised National Drug Master Plan”. But South Africa’s new National Drug Master Plan, the country’s five-year policy to tackle substance use, was meant to be released in 2018 and it still hasn’t been made public.

In his 8 January address, ANC president Cyril Ramaphosa said the party will expand recreational facilities and diversion programmes through this stalled plan.

But health workers and experts fear that the version of the drug plan that will be released will be influenced by morality rather than evidence-based interventions.

“I don't know when it's going to be released, but if it does get released it will be a very different version to the one that was presented to the parliamentary review committee a couple of months ago,” says Shelly.

The DA believes that the “lack of security at our borders” leads to significant cross-border crime including drug trafficking syndicates. But Shelly describes the party's approach as disastrous and xenophobic.

Much like their shared xenophobic utterances about healthcare services, the ANC and DA have a similar strategy for dealing with drug use in schools. The DA wants learners to be randomly searched for weapons, alcohol and drugs at school, while ANC Gauteng PEC member and Education MEC Panyaza Lesufi suggests that learners as young as 13 years old — from Grade 7 and higher — should be tested for drugs in schools.

Shelly says this is dangerous and could potentially traumatise children who use drugs further. “I usually tell learners that they have a right to bodily integrity and if anybody wants to challenge that they can go to Constitutional Court.”

Many people are talking about reforming the country's drug policy behind the scenes, but in public, nobody is talking about it, he says.

“If anybody's going to get [South Africa's drug policy] right is the ANC, but we're not getting that from the manifestos at all, and we're certainly not getting it from any of the manifestos at this stage. [But] they're all pretty weak on drugs and apart from using the whole drugs situation as a politically expedient distraction from the real issues that are happening on the ground.” DM