Apology Issued After Users Blocked

South Africa’s official drug policy recognizes addiction as a chronic disease, but police still enforce a 1992 law that treats drug use as a crime. That gap between public health goals and law enforcement reality has deadly consequences, especially for people who cannot afford consistent medical care. Opioid substitution therapy — medicines like methadone and Suboxone that reduce withdrawal symptoms without producing a high — is only available at a few government clinics, and patients who need long-term treatment must pay out of pocket.

In a recent essay, Roger Young, who has spent roughly 12 years on and off living on the streets of South Africa, describes what that gap looks like from the inside.

A Policy Gap That Costs Lives

The National Drug Master Plan recommends harm reduction strategies, including clean needles, overdose prevention medicines, and substitution therapy. But police follow the 1992 Drugs and Drug Trafficking Act, which criminalizes possession and use.

Harm reduction treats substance use disorder as a public health issue, not a law enforcement one. It offers practical support regardless of whether someone is ready to quit. In South Africa, however, opioid substitution therapy is sporadic and hard to access. USAID-funded centers dispense methadone once a day and not on weekends. Sometimes it is handed out in bottles meant to last a week.

He writes that for people on the street, methadone becomes a stopgap when heroin is unavailable — a duller substitute that makes you sleep deeper but does not come with any recovery program or rehab referral. Suboxone, the other common substitution medicine, is expensive.

Just holding a prescription, the essayist says, is hope. But affording it is another matter.

Life on the Streets With Addiction

He describes living in a fallen security booth near Ponte, Johannesburg’s cylindrical skyscraper, with two other users he calls Bianca and Alan. Bianca started using heroin and opiates at an early age. She and Alan have two children living with her grandmother. Alan’s German parents occasionally send money, and when that happens the three of them book a cheap hotel and get “as high as humanly possible as long as humanly possible.”

His parents have offered him rehab, but he will not go without Bianca. She is afraid of withdrawal and distrusts methadone because of how it is given — inconsistently, without support.

Young writes: “When you start using heroin, opiates, nyaope … you sign a contract, with consequences that no amount of literature and fine print and warnings can ever adequately prepare you for.” Withdrawal, he says, builds over years into “a thousand fevers, your bones try to escape through your skin, your muscles cramp and stab, and the shit runs down your legs.” He notes that he has never come off heroin without help — only through a sustained effort by a group of people over a long period, with significant investment.

The trouble is that most people on the street never get that kind of consistent help. Bianca and Alan had tried and failed a few times. They had largely accepted that this was their life. The daily grind of survival — begging, stealing Red Bulls to trade for heroin, avoiding police — becomes a “boredom of purpose,” as the author puts it.

If harm reduction is run inconsistently, it cannot fulfill its promise. Suboxone prescriptions are useless if you cannot afford to fill them. Methadone given only on weekdays and in bottles meant to last a week creates its own cycle of scarcity and distrust. Without stable, long-term access to substitution therapy and recovery programs, the most vulnerable people remain trapped in a system that treats addiction as a crime one day and a disease the next, but never as a treatable condition with reliable care.

The Tragic Consequence of Inconsistent Care

One day at a rugby match at Ellis Park, Young was weaving through the parking lot trying to cadge money. A car alarm went off, and everyone ran. He ran up a hill, through an alley, and found Bianca lying on the ground, held down by two men while a third was on top of her. A young policeman briefly surveyed the scene. The men scattered. An older cop grabbed Bianca, searched her, found her heroin, and threw her in a police van. Alan could not go to the station to attempt a bribe.

There was only waiting. On Tuesday, news reached them. Bianca could not handle the withdrawal in prison. There is no methadone in prison.

She hung herself.