Under bridges in Durban: the alarming rise of heroin injection and public health risks

The area near Ematsheni. (Photo: Jesse Copelyn)

By Jesse Copelyn

3 Dec 2024

People who use heroin in Durban are increasingly switching from smoking to injecting, causing public health concerns.

Beneath overlapping highway bridges in central Durban, homeless people congregate on a gravelled strip of land, dubbed Ematsheni by locals (“place of stones” in isiZulu). The strip sits beside the sloping shoulder of a busy main road and is lined by heaps of rubbish and makeshift tents. Despite Durban’s oppressive daytime heat, several fires are lit, apparently to extract copper from scrap. Plumes of smoke whip about, carrying the heavy scent of burning rubber.

Ematsheni is a known “drug hotspot”. People can be seen injecting substances or preparing doses. Crack cocaine and crystal meth are present, but according to harm reduction staff, the most commonly used substance is heroin, known locally as whoonga.

It’s reflective of the broader drug crisis in KwaZulu-Natal, where heroin dependence remains a top reason for people to seek out rehabilitation centres – outstripped only by marijuana and alcohol dependence.

A man who used to sell heroin in Durban told GroundUp that when he began dealing in 2006, the opioid was fairly uncommon. But in the late 2000s the customer base grew steadily. Many people who use heroin in Durban told GroundUp this was when they began their journey.

Dr Monique Marks, a sociologist who has conducted extensive research on heroin use in Durban, said the real uptick happened closer to 2013. She notes, however, that in certain predominantly Indian townships, such as Chatsworth, heroin had been popular for much longer, where it was known locally as sugars.

But while it long dominated the streets of Durban, the way that heroin is consumed appears to be changing rapidly, leading to serious health concerns.

Amid the smoke in Ematsheni, a woman sitting on the floor tells GroundUp that when she started using whoonga, she would “chase” the drug: heroin placed on a piece of foil. A flame held underneath produces fumes to inhale. But now, she gets her fix by injecting it.

Numerous people who use heroin in Durban told us that the use of needles has become far more popular. South African Medical Research Council data on rehabilitation centres in KZN confirms the trend. It shows that in 2021, only 3% of people who came to treatment centres for heroin use were injecting. By 2023 that figure had increased more than fivefold to 17%. And it is set to rise further, according to harm reduction staff. In Ematsheni, virtually everyone was injecting.

This has public health implications. When people inject drugs, there is a greater risk of disease spreading, because needles are sometimes shared when people don’t have access to new ones.

A recent survey funded by the US President’s Emergency Plan for Aids Relief found that roughly half of all people who inject drugs in eThekwini were HIV-positive. Three-quarters had hepatitis C, a viral disease that attacks the liver.

Clovis Dusabe, a professional nurse at the Bellhaven harm reduction centre, also noted that people who inject drugs sometimes miss veins, creating a wound that can become infected.

“In recent times, we haven’t seen a lot of abscesses,” says Dusabe. But because “there is now a high rate of injecting… I think we’re going to start seeing that kind of issue”.

whoonga ‘In recent times we haven’t seen a lot of abscesses,’ said Clovis Dusabe, a professional nurse at the Bellhaven harm reduction centre. (Photo: Jesse Copelyn)

Why are people turning to needles?

GroundUp had several group discussions with people who either use heroin or have recently stopped.

In Durban there are currently two common whoonga products. The first is “stone heroin”, bought in small plastic packets twisted at the end. It needs to be mixed with water and then melted down, for instance on a spoon or plate. After this it can either be drawn into a syringe and injected, or crushed and left to cool before being sprinkled into a joint of marijuana. It can also be “chased” on tin foil.

The second product is a pharmaceutical-style capsule, specific to eThekwini. It contains powdered heroin mixed with bulking agents. People pull the capsule apart and empty its contents onto foil or smoke them in a joint. It’s rare for it to be injected because the powder often fails to dissolve in water.

A third product, which has gone out of fashion, was a heat-sealed straw that contained powdered heroin. This was apparently similar to the capsule in that it was primarily smoked or chased.

Because many people who use heroin previously relied on capsules or straws, it was rare for them to inject. But the straws have largely been phased out, while the price of the capsules has increased sharply. A 2021 report found that in Durban the caps cost just R15 a pop. Users told GroundUp that today it’s R40.

This means many people have switched to buying stone heroin, which they say has had a more stable price. The smallest quantity of stone heroin can be bought for R20, though R30 and R50 packets are also available, as are much larger quantities.

The amount of heroin in each packet or capsule isn’t clear. Marks says that the contents of the capsules vary because they’re manufactured by a variety of competing groups. But users generally agree that it’s cheaper to rely on stone heroin than caps.

Another reason for the switch appears to be driven by people’s views on the quality of different heroin products. The woman at Ematsheni said the caps have become weak. Others made similar claims. At one group discussion someone told GroundUp: “The capsules are not pure… but when you get the other heroin – the stones that you inject – it’s a pure heroin.” Everyone burst into agreement.

whoonga Durban The area near Ematsheni. (Photo: Jesse Copelyn)

How did the term whoonga emerge?

The term whoonga derives from the Swahili word Unga, which means flour. This has historically been a common slang term for heroin in parts of Tanzania, as the Global Initiative has highlighted. Likely influenced by Tanzanian dealers, locals in Durban began widely adopting (and mispronouncing) the term in the 2000s.

Elsewhere in the country the common name for heroin is nyaope, which has a similar backstory. It comes from the Swahili word for white – nyeupe, which is the colour of some heroin products in the country.

In part because of the new lingo, reporters and academics often assumed that nyaope and whoonga represented “novel” substances that were specific to South Africa’s townships. It was often suggested that nyaope or whoonga elicited a completely unique high and was unusually addictive (more so than heroin). This is not supported by the evidence.

A person who used heroin in Pretoria in the late 1990s and 2000s tells GroundUp that the terms emerged as useful street slang: “We used to call it that on the streets back in 1999 or 2000 as no one knew what we were talking about.” DM

First published by GroundUp.

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South Africa

Why are people turning to needles?

How did the term whoonga emerge?