The ‘criminal’ negligence that’s killing SA's heroin users
The potentially lifesaving legal drug methadone – used to wean heroin users off the narcotic – is just too expensive. And nobody’s doing anything about it
Thousands of South African heroin users who want to kick the habit are unable to do so because the potentially lifesaving legal drug methadone – used to wean heroin users off the narcotic – is just too expensive.
Used in Opioid Substitution Treatments (OST), the drug can only be prescribed by a doctor and cannot be dispensed by state hospitals or rehab centres because it is not recognised as an essential medicine. Many medicals aids do not cover the costs because addiction is not seen as a disease.
Countrywide there are nearly 1,000 people on OST treatment, most within the City of Tshwane which funds a programme that helps 600 people through the University of Pretoria.
A monthly methadone dose costs roughly R980, say narcotics specialists. Other OST drugs, such as suboxone, are almost as expensive. On the streets of Pretoria, the country’s heroin capital according to according to Tshwane’s health MMC, Sakkie du Plooy, a heroin pinch [small bag] costs as little as R30.Academics, researchers and drug treatment experts have labelled the cost of methadone as “criminal”, saying South Africa’s prices are 30 times higher than international prices.
A report by the Global Initiative Against Transnational Organised Crime and Interpol, released on July 2, shows South Africa is one of the world’s biggest international heroin transit routes.
The report says over 75,000 South Africans inject heroin daily – the greatest number in Africa.
Researchers, health and drug NGOs, and rehab centres, with the support of the Central Drug Authority and Tshwane’s health administrators, are advocating for OST drugs to be made affordable.
For Yeoville resident Tshephang Maphalla, a heroin addict since 2010, methadone means the difference between life and death. He said heroin saw him lose his family, friends and job.
“I tried rehab several times, but always ended up back using heroin. It’s a killer.”Methadone treatment turned his life around.
“I’m getting a job. Methadone takes away the cravings and withdrawal symptoms.
“If it wasn’t for Anova Health, I don’t know what I would do. I cannot afford methadone and would be back on the streets.”
Drug policy advocate Shaun Shelly, who helped establish methadone pilot programmes in Cape Town, Durban, Johannesburg and Tshwane, said in South Africa methadone is up to 30 times more expensive than anywhere else.
“We need to make it easier for people to get methadone rather than heroin.”
Shelly said the problem was methadone was not listed on the government’s essential drugs list.
“Methadone can either be used as a short-term detox for heroin or long-term maintenance therapy, which is internationally recognised. In South Africa the maintenance therapy is not recognised.
“The result is prices for methadone cannot be reduced because you cannot get state tender prices. There is just one price and that’s the pharmaceutical price.”Shelly said generic pharmaceutical companies produced much cheaper methadone.
“These are needed here. If it went out to tender the price would drop dramatically. Our price per millilitre is R2. Internationally you pay 6c.”
He said methadone killed cravings which meant people would not inject.
“Exchanging needles and syringes gets users in contact with health services and talking. Talking means education about OST,” said Shelly.
Dr Relebohile Ncha, Anova Health’s OST medical officer, said their programme had positive results.
“The health implications are huge, especially around the reduction of HIV. Among our patients, 46% are HIV-positive, which shows that within the drug injection population there’s high HIV prevalence.”
Ncha said methadone stayed in a person’s system for up to 36 hours.
“That means they are less likely to experience withdrawal symptoms and more likely to be focused and adhere to their HIV treatment programmes.”
David Bayever, chairperson of the Central Drug Agency, which advises the government, said there were multiple reasons for methadone’s high price.
“It’s a Schedule Six drug and tightly regulated. Because it’s a very specific drug for a very specific target audience, it’s not necessarily attractive for others to import it.”He said this could be changed if the government decided to make it more readily available and medical aids reimbursed users who bought it.
Bayever said for some medical aids, addiction treatment was an exclusion because it was not seen as an illness.
“This speaks to why many heroin users don’t go for OST because medical aids don’t pay for it. Medical aids which do pay only pay for short periods, but heroin users require long-term maintenance treatment plans.”
He said by getting these drugs on the essential medicines list, government funding would become available, and hospitals and rehab centres could dispense these drugs, creating a larger and more accessible market.
Du Plooy said not providing users with affordable methadone was “criminal”.
“We are mobilising organisations to advocate government to declare OST drugs essential medicines.
“This is about seeing drug users as human beings. By running needle exchanges you eradicate serious health issues, including the spread of HIV and hepatitis C. We have 4,500 heroin injectors in Tshwane; 43% have HIV. Needle exchange programmes make sense. OST makes sense.”