Lockdown has given homeless a chance to kick addiction
A Durban methadone programme is helping 240 addicts get back control of their lives
It has taken a national lockdown for 36-year-old Mandisi Msibi to feel as if he can overcome a nearly 17-year addiction to whoonga and heroin.
Msibi is one of 240 homeless people being treated for drug addiction, using methadone, while in lockdown at one of Durban’s 13 homeless facilities.
“At first withdrawals were bad. People were vomiting, passing out and being taken to the hospital. They have pictures they took of us at the beginning and just the other day they showed them to us and we are all very proud. You can see the difference in how we look and we have gained weight,” said Msibi.
“Peer pressure and a love for the fast life is what got me hooked. When I started they used to mix it with weed and they say weed is a gateway drug. I thought I was smoking weed, then one day someone mixed it with whoonga and next thing I knew I got sick when I didn’t smoke. The most painful thing with whoonga is that people don’t understand the pain you are in when you don’t smoke. That is what forces some people to do bad things,” he said.
The most painful thing with whoonga is that people don’t understand the pain you are in when you don’t smoke. That is what forces some people to do bad things.Mandisi Msibi
Prof Monique Marks, who heads the withdrawal-management programme, said it is one of two in the country that is assisting the homeless.
“I think ours is the largest one that takes places on-site and I think the daily observed dosing ... is unique in SA,” said Marks.
“The response was let’s deal with this and make sure homeless people feel safe and protected in the safe spaces and don’t feel the need to go out in search of drugs. That was the main reason for developing the programme, but for me it’s also a human rights approach. To expect people to go into withdrawal with no support in terms of what they are feeling physically and physiologically is, to me, a denial of human rights and incredibly unkind,” she said.
Dr Shaquir Salduker, a psychiatrist and the clinician tasked with checking on those in the rehabilitation programme daily, said they had almost created an entire medical practice from scratch.
Looking past lockdown, Marks, a member of the Durban homeless task team, said they would be looking to create sustainable safe spaces for the homeless that would facilitate the continued access to drug-withdrawal programmes and health care. She noted that many of those who identified as drug users had opted for withdrawal packages which contained various medications that helped them treat the symptoms rather than going on the methadone programme.
We don’t tell people to stop using drugs, because we recognise that many people are unable or unwilling to do.Prof Monique Marks
“What we were trying to do before Covid-19 was to try to find a way to deal with substance abuse among the homeless in a way that doesn’t stigmatise and marginalise people who use drugs more than they already are. Rather we want to try a way that addresses people where they are and try to normalise their lives,” she said.
“This means we don’t tell people to stop using drugs, because we recognise that many people are unable or unwilling to do so. What we try to do is say, OK, how can we decrease your drug use to allow you to be good fathers and students, and be able to start taking care of your hygiene. With those who want to stop, we encourage that too,” she added.
Msibi said he was looking forward to continuing with the programme after lockdown.
“A lot of people are in a rush to leave, but I am not, because it is helpful here. This programme is not only to get symptoms out, but it is also therapeutic. They speak to us and tell us life can go on and you can make a new life for yourself,” he said.
“We had to start from scratch,” said Salduker. “We had to take cardboard and create files and take pictures of all the people we put on the programme. Literally from nothing we created an entire practice which can be audited by any medical body today and it would be secure. So we have informed consent forms, educational pamphlets, rating scales and methadone. We have registered nurses who are allowed to dispense. The entire system is legally and ethically above board.” Each day he visits his patients to check on their progress and evaluate the dosage of methadone they need.
“Methadone is an opium-like painkiller, but the difference is that it is considered a safe opium because it lasts about 24 hours. Harmful drugs have a short action. So what we do is take an unsafe substance and substitute with a safer one so they don’t have bad withdrawal symptoms. That, physically and emotionally, feels better and, as a result, they can be more of themselves and comply with the lockdown conditions,” he said.
“We started them off with a dose of methadone which we thought would cover a majority of symptoms. We adjusted them according to rating scales, which we used to see how severe the symptoms were. Then we started to decrease (the dosage) after the first week. As long as they are in a lockdown they will be on some degree of methadone, but in decreasing doses. We don’t want a situation where we do what we are doing and once the lockdown is over they go back in search of drugs. We want to make sure that they have one foot in the door of the road to recovery,” Salduker added.