Prescription drug poses new threat to South African youths

Organisation: Position: Deadline Date: Location:

PillsSouth African learners turn to anti-anxiety medication to manage stress but punishment remains the state’s primary intervention, writes Mark Hunter for the social justice publication New Frame. In July and August, he spoke with 39 groups of learners at 15 high schools across South Durban, and found the same two top drugs at schools: cannabis and Xanax.

In another comprehensive article this week, New Frame’s Nation Nyoka writes that trauma is often the gateway ‘drug’ that puts young South Africans on the path to nyaope addiction, and addiction carries a high price for them and their families.

Prescription drug poses new threat to South African youths

Nozipho*, a confident grade 12 learner, is keen to talk about drugs. Her brother committed suicide after becoming hooked on whoonga (low-grade heroin). She is now concerned for a friend who tells her he wants to “carry on with my business”. By this he means he sells drugs at their Umlazi school; he misses exams to avoid getting promoted to a higher grade.

Xanax, a drug prescribed to treat anxiety, is a goldmine for Nozipho’s friend. The tablet is nicknamed “Zen”, “Zanele”, “Zandile”, “Xany”, “Xan” or “Baby blue mylans”. It is typically bought for R5, which, to put in context, is the price of two “loose” cigarettes. Over the past two years, Xanax use has exploded not just in Durban schools but also, some reports suggest, across the country.

“You zwang,” said 17-year-old Ntombi, who lives in Umlazi Township but attends school outside, “goofed [from weed] is when you are high, but when you are zwanging you are at a point when you can’t even text on your phone.” She said that the substance is consumed “like a Tic Tac” and that on a Friday as many as 50% of learners in her class are zwanging. “You are like a zombie,” reports David, who attends a school in a middle-class suburb.

In July and August, I spoke with 39 groups of learners at 15 high schools across South Durban. Every group described the same two top drugs at schools: weed/cannabis and Xanax. What learners call Xanax is usually a generic version of alprazolam, the anti-anxiety benzodiazepine. These and other drugs move regularly across the city, like schoolchildren themselves today.

“Drug”, a word that conjures up both white-coated technicians and gun-toting gangsters, drips with moral messages. In essence though, a drug is any substance, whether legal or illegal, with physical or psychoactive effects.

Historically, most illicit drugs in KwaZulu-Natal were produced and sold in a decentralised way, partly out of necessity. Think of the shebeen queens who dodged apartheid’s police to brew and sell beer and the numerous sellers of locally grown weed.

Mandrax (buttons or ingidi) is controlled by larger dealers, though it has faded in popularity among the young. Other drugs such as ecstasy (qo), cocaine (ntashi) and alcohol are not associated with school but with nighttime parties. Cough medicine with codeine, mixed with a fizzy drink to make lean, was popular for a while, though pharmacies have cracked down on its sale.

South Africa – A major drug node

The past two decades have witnessed a reshaping of the drug world. South Africa has emerged as a major node in a southern route that moves heroin from Afghanistan via East and Southern Africa to Europe and the United States.

In Durban, heroin dealers spearhead a growing drug network, with major players not afraid to use violence to protect their territory.

What is significant about the small, light blue Xanax pills is that they are now linking the doors of learning to the gates of drug distribution.

Xanax, compared to whoonga, has far fewer withdrawal symptoms, and so its trade doesn’t appeal to some of the most established drug dealers. Yet it can still create new circles of violence that rock schools.

Mrs Slindile Bhengu, a deputy principal at an Umlazi school, exudes an energetic vibe, but much of her commitment is diverted from the classroom to addressing social issues including drugs.

“The supplier will give it to kids here,” she says. “The supplier wants to control all of the schools in the section. And whenever he hears that someone else is dealing, he will wait for them at the gate and there will be a fight.”

Drugs, schools and craving secure work

Xanax’s popularity among young people around the world is reflected in the lyrics of musicians such as Travis Scott and Drake, who sing “I did half a Xan, 13 hours ’til I land / Had me out like a light, ayy, yeah.”

Yet learners at schools say the biggest reason drugs are used is to relieve stress. This can be associated with schoolwork and exams, but it also stems from poverty or family problems. Nozipho says, “When my mother died, then I started [smoking weed]. It helps me sleep.” Some learners say that certain strains of weed allow them to push out problems and concentrate at school. Xanax can be taken alone or mixed with weed.

Whoonga use is particularly rife among those who attend schools in the poorest parts of the city. Around half of the 50 whoonga users interviewed last year became hooked while attending school. Most are young men who struggled at school and dropped out in grades 9 to 12.

Nompumelelo, 17, is chatting with us in a township school’s small computer room. Ugly metal bars have been attached to the inside of the roof to prevent break-ins. A chirping bird flies in and out through a broken window. Nompumelelo’s brother dropped out of school so that he could phanta (hustle) and earn regular bits of cash, for instance by cleaning yards or cars, to buy R25 capsules of whoonga. So desperate was the craving for this heroin-based drug that one day she came home to find him and a friend removing their fridge to sell.

Drug dealers’ fast cars and, just as important, support to families and neighbours, can create powerful role models. Sifiso, a grade 12 learner from Umlazi who takes Xanax, puts it like this: “You see graduates who stay at home, they got degrees and they stay at home, you see [rich] drug dealers, they have no degrees.”

Every year, 400 000 learners pass the matriculation exam, but youth unemployment sits at 56%. Around the world, the weakened connection between education and decent work feeds chronic anxiety in educational institutions.

Why we should worry about prescription drugs

In the United States, the “war on drugs” directly targeted and criminalised black communities. In contrast, the powerful pharmaceutical industry was given free rein to push opioids as well as anti-anxiety and anti-depression drugs. Several US states have now brought lawsuits against big pharma, accusing the industry of hiding the addictive nature of opioids.

In KwaZulu-Natal, underhand sales by those working at pharmacies and hospitals appear to be a major source of illicit prescription drugs. The cheap price of Xanax means that dealers high up the food chain, or smaller buyers, rely on learners to sell hundreds of pills in schools.

There is another major reason for concern: in North America and Europe the headline drug story of the last decade is the thousands of deaths from prescription drugs, especially synthetic opioids. Fentanyl, which can be 50 times stronger than heroin, is frequently mixed with heroin by dealers to boost profits. When too much is added, the result is deadly. In the United States alone, there are tens of thousands of fentanyl-related deaths annually.

This raises a frightening scenario. What if fentanyl or a similar synthetic opioid were mixed by dealers with whoonga? The country has become a node in the international drug trade. Heroin and illicit prescription drugs are already in circulation. Though some police officers work with community interests in mind, others take bribes that sustain the local drug industry.

Where’s the support?

In the 1990s, activists were quick to mobilise when HIV/AIDS exploded in KwaZulu-Natal. The Treatment Action Campaign highlighted the social causes of HIV and fought the state’s “denialism”.

However, there is no comparable social movement linking drug use to societal inequalities. Bhengu says that she has tried to bring non-governmental organisations into the school to talk about drugs, but their funders want them to prioritise HIV/AIDS education.

Despite the frightening rise of whoonga, there are only two public rehabilitation centres in the entire province, and they don’t use opioid substitution drugs such as methadone. A Durban University of Technology pilot project is one of the few places where whoonga users have been able to access care. Punishment, rather than treatment, remains the primary state intervention for substance abuse.

Of course, drugs are contested in everyday life and go in and out of fashion. Whoonga continues to take a huge toll on families in KwaZulu-Natal, but learners can shrug it off as a dead-end drug, in the same way that crack cocaine lost popularity in the 1990s in the United States.

At the same time, the situation could get much worse, especially if the rise of pharmaceutical drugs continues. The Xanax explosion is just another reason behind the need to improve poorly performing schools and strengthen the link between education and the world of work.

* All names are pseudonyms.

 The lives of Ekurhuleni’s nyaope users

Trauma is often the gateway ‘drug’ that puts young South Africans on the path to nyaope addiction, and addiction carries a high price for them and their families, writes Nation Nyoka for New Frame.

I am married to nyaope, nyaope is my bride. I can’t just quit,” says a scrawny Wandile Mdlalose, 24, his voice raised for emphasis. He speaks as he loosens his grip on a piece of blue cloth he has tied around his right arm to find a vein.

After mixing water with nyaope in a syringe, he tightens the grip on his arm again, easing the needle in and drawing blood before injecting the precious liquid back into the vein. He explains that he dilutes his blood with water because blood is thick.

Nyaope is a low-grade form of heroin. It is sold in a small piece of plastic called a “tie” because of how it is fastened.

Angela McBride, the executive manager of the South African Network of People Who Use Drugs says trauma is the gateway “drug”. “People use drugs to cope with their trauma. Getting high is the only thing that is comforting,” she says. A self-admittance study from 2015 revealed that 67 000 people inject heroin.

With a R200 daily spend on nyaope, Mdlalose is aware of how difficult it will be to beat the cravings. He’s been addicted for 10 years, but he wants to quit to provide for his 11-year-old daughter.

“I’m doing nothing except nyaope … this thing makes you naughty, you do the wrong things to community members and they turn on you,” he says, removing his camouflage cap to reveal a scar on his head, burn marks on his cheek and a freshly bloodied eye. He speaks of the easy solution of crime for nyaope addicts: “We want quick money to feed this thing.”

He started smoking nyaope unaware that he would end up addicted to it, just like the other men who use the derelict toilets in Mayfield Ext 45 in Ekurhuleni.

Rubbish foragers

Early on a Saturday morning, a group of young men covered in soot, soil and ash scratch through a heap of rubbish just outside a scrapyard in Ekurhuleni.

The glazed, yellowed eyes of Simphiwe Gambu, 22, narrow as he holds up a rusty piece of copper between his dirty nails for scrutiny before throwing it into half an empty two-litre Coke bottle. A kilogram of good scrap metal can earn him R40. A “tie” of nyaope costs R25.

The young men are determined to find enough scrap metal to feed their addiction. Gambu says he needs at least R100 a day to keep his insatiable cravings at bay.

“We open at 7am, but you will find these boys here at 6am because of this thing. They must just go to rehab,” says the woman who weighs their scrap metal, often rejecting it if they give her attitude.

After acquiring his first “tie” for the day, Gambu laughs with his dealer. He goes to the tuckshop to buy a cigarette – something he says is crucial to kicking in his high – before impatiently searching for an empty toilet stall to smoke in. He is distracted by his pain, eager to relieve his morning pangs.

Smoking nyaope

Gambu uses a razor blade to pick up a small bit of nyaope, a cream-coloured powdery substance, that he drops on to a piece of dirty foil and lights up. Using an old rolled up matchbox, he inhales the vapour and holds his breath before quickly lighting up his cigarette and inhaling deeply.

“When people use drugs, their resistance builds up, especially [against] opioids … [Nyaope] is a very strong drug, people do become very dependent on it very quickly,” says McBride, explaining that three out of five people graduate from inhaling nyaope to injecting it.

The men hustle differently. Some recycle goods, some help with groceries or parking for coins, others find piecework. “The craving can get so bad you can end up doing something hurtful and unthinkable to someone you love. You just don’t think,” says Gambu, explaining that he resorts to theft when his cramps and cravings become unbearable.

The men understand the variation in needs that differ and change at each stage of craving. The aim is to get high before the dreaded “rost”, which they all describe as an unbearable craving that may include excruciating pain in the lower back, joints and muscles, intense stomach pangs and vomiting blood.

Gambu says this is the feeling that will make anyone do anything for the next fix. He started off with “skyf skyf” (cigarettes). By the time he was in grade 10, he had graduated to weed. He dropped out of Lesiba Secondary School last year when it became difficult for him to concentrate at school and he needed the time to rummage for money for his next fix.

Like Mdlalose, what began as two pulls led him to a point where he oscillates between being high and being desperate for a fix. Almost every man in the cramped toilet did not finish school. They are all unemployed.

Ruling out rehab

Rehab is possible for nyaope addicts, McBride explains, adding that there are no government-run systems in place to ensure people recover or to provide aftercare service. She says there are hardly any opioid substitution programmes.

Some private services provide methadone (a prescription medication used for heroin recovery), shelter and psychosocial services, she says. Mdlalose has approached a social worker, who told him there is a three-month waiting list for a rehab consultation. This has made him despondent about the possibility of quitting.

“There is hope. If we look at where we were five to seven years ago, we have made progress. We now have needle-syringe programmes, we have opioid substitution therapy programmes … we have people who are fighting our current drug policies,” says McBride.

Bongani Mahlangu, 23, says his mother usually gives him R20 a day in exchange for not stealing at home. “I am usually very proud of myself if I survive the whole day at home. This craving is difficult though, it will make you leave home even if you had no plans to because it’s so strong. You cannot function without it, something as small as opening the door can feel so hard,” he adds.

A week later, Mahlangu is arrested for stealing from his neighbour.

Last year, Gambu’s family bought him methadone to try and get him to stop using nyaope. But it didn’t work. Within days, he had relapsed. He thinks his family is aware he is back on nyaope.

The family of Luvuyo Khumbuza, 26, had him forcefully admitted to a local “recovery church”. “It was torture there … I would rather go back to prison than go there,” he says, smoke enveloping the fading green tattoos on his skin.

He describes how he was locked in chains, and how they had their systems forcibly cleaned out with enemas and emetics. He did not receive any pain medication.

Thokozani Mngeni, 30, who was also in a “recovery” church until he escaped, explains that the pain he experienced there was unbearable and he could not stand the place’s unhygienic conditions.

McBride knows about the existence of these churches, describing them as the “epitome of how badly people who use drugs are treated”.

Mngeni has two children and used to work as a security guard at a mall. He lost his job because of nyaope, and moved to the Eastern Cape to try and quit. He returned to Gauteng a few months later. The first thing he did was steal a cellphone to sell for a fix as there were no recreational distractions or employment prospects, and he was stuck with the same crowd, making it harder to quit.

Broken families

Above all, the young men miss being trusted, and not only by their families. They acknowledge the pain they have caused their loved ones as well as the terror they have sometimes unleashed.

Mahlangu explains what his drug addiction has done to his mother: “She stays indoors most of the time to avoid comments from neighbours, who whisper that her son is a nyaope [addict] and a troublemaker.”

Sphiwe Ndlovu, 22, has a strained relationship with his parents, who he says do not understand how difficult it is to quit the drug. He lives with his brother. “[My brother] locks his bedroom door so I am only limited to the toilet, kitchen and my room.”

The monotony is the killer for Ndlovu: “Every day, we do the same thing. It is like we have nothing to live for except this thing … Every day, we come and smoke in the toilets away from the community,” he says.

The men say some nyaope users have given themselves over completely to the drug. When that happens, Ndlovu explains, “you look like you have been hit by a nuclear bomb” but they say they want to quit before they reach this stage.

This article was first published by New Frame.

Prescription drug poses new threat to youths

This article was first published by New Frame.

The lives of Ekurhuleni’s nyaope users


Receive Medical Brief's free weekly e-newsletter



Related Posts

Thank you for subscribing to MedicalBrief


MedicalBrief is Africa’s premier medical news and research weekly newsletter. MedicalBrief is published every Thursday and delivered free of charge by email to over 33 000 health professionals.

Please consider completing the form below. The information you supply is optional and will only be used to compile a demographic profile of our subscribers. Your personal details will never be shared with a third party.


Thank you for taking the time to complete the form.