Prohibitionist Drug Policy in South Africa—Reasons and Effects

Scheibe, Andrew; Shelly, Shaun; Versfeld, Anna

doi:10.4000/poldev.4007

Cited by 10 publications

(11 citation statements)

References 54 publications

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“…36 Harm reduction is still not a readily accepted practice in South Africa, despite its promotion through existing policies. 37 Hepatitis B and C testing does not yet form part of the workup for substance users joining COSUP. This is in part due to resource constraints.…”

Section: Discussionmentioning

confidence: 99%

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Bhoora

Gloeck

Scheibe

2022

Afr. j. prim. health care fam. med.

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Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane’s Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response.Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa).Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data.Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants’ median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol.Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.Contribution: This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.

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Section: Discussionmentioning

confidence: 99%

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Bhoora

Gloeck

Scheibe

2022

Afr. j. prim. health care fam. med.

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“…However, drug use by the more than 75 000 injecting-drug users continues to be criminalised in SA, a situation that fuels both HIV and hepatitis transmission. 7 South Africa must move more rapidly to a clearer policy on the decriminalisation of sex work and of injecting-drug use. In addition, the SA government must give greater consideration to the flexibilities of TRIPS where medicine prices are not being reduced to affordable levels.…”

Section: South Africa’s Policy Related-progress and Response To The Hiv Epidemicmentioning

confidence: 99%

World AIDS Day 2020: Reflections on global and South African progress and continuing challenges

Pillay

2021

Southern African Journal of HIV Medicine

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Background: Reflecting on progress and challenges in meeting global human immunodeficiency virus (HIV) targets is often done ahead of World AIDS Day. This article reflects on progress and the continuing challenges in meeting targets in South Africa (SA).Objective: To review policy and implementation related progress and continuing challenges towards eliminating HIV as a public health threat by 2030.Method: Policy analysis and review of modeling data from Thembisa 4.3.Results: South Africa has made significant progress in the adoption of policies with two exceptions. While there are gaps in reaching the 90-90-90 implementation targets, progress has been made in the past decade.Conclusion: While progress has been made in the past decade towards the global targets, much work remains to ensure that HIV transmission is curtailed and those that require treatment are initiated on treatment and are virally suppressed.

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“…The expulsion of drugs was seen as a necessary element in turning 'uncivilized' people into the American vision of civilized, sovereign subjects. 10 In parallel during this period, colonial legislation imposed oppressive, restrictive and punitive drug policies in Africa, rooted in pseudoscientific racism and concepts of moral responsibility. It hinged on Western political and religious doctrines that painted most African cultural practices as 'evil' and 'backward. '…”

Section: The Colonial Origins Of Contemporary Drug Prohibitionmentioning

confidence: 99%

“…Black people comprise 57 percent of all people incarcerated in state prisons, and 77 percent of people incarcerated in federal prisons for drug offenses are Black or Latino despite these populations making up just 30 percent of the US population. 28 Around the world, punitive drug policy necessitates the surveillance, criminalization and targeting of Black, 12 Scheibe et al [10]. 13 Shelly and Howell [11].…”

Section: Post-colonial Drug Policy Is Racist and Xenophobicmentioning

confidence: 99%

Decolonizing drug policy

Daniels

Aluso²,

Burke-Shyne

et al. 2021

Harm Reduct J

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This paper reviews evidence of how drug control has been used to uphold colonial power structures in select countries. It demonstrates the racist and xenophobic impact of drug control policy and proposes a path to move beyond oppressive systems and structures. The ‘colonization of drug control’ refers to the use of drug control by states in Europe and America to advance and sustain the systematic exploitation of people, land and resources and the racialized hierarchies, which were established under colonial control and continue to dominate today. Globally, Black, Brown and Indigenous peoples are disproportionately targeted for drug law enforcement and face discrimination across the criminal system. These communities face higher arrest, prosecution and incarceration rates for drug offenses than other communities, such as majority populations, despite similar rates of drug use and selling among (and between) different races. Current drug policies have contributed to an increase in drug-related deaths, overdoses and sustained transnational criminal enterprises at the expense of the lives of people who use drugs, their families and greater society. This review provides further evidence of the need to reform the current system. It outlines a three-pillared approach to rebuilding drug policy in a way that supports health, dignity and human rights, consisting of: (1) the decriminalization of drugs and their use; (2) an end to the mass incarceration of people who use drugs; (3) the redirection of funding away from ineffective and punitive drug control and toward health and social programs.

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Prohibitionist Drug Policy in South Africa—Reasons and Effects

Cited by 10 publications

References 54 publications

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting

World AIDS Day 2020: Reflections on global and South African progress and continuing challenges

Decolonizing drug policy

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