Destitute drug users battle forced withdrawal

Covid-19 has exposed the prevalence of drug use among homeless people around the world. In Durban, it is as high as 60% – and the lockdown has made life that much harder.

“There is a massive detox going on,” said Stephen Carpenter, a medical doctor who volunteers at the Denis Hurley Centre in Durban, KwaZulu-Natal. He treats the homeless people who walk the city centre, some of whom are drug users experiencing serious withdrawal.

“They call it arrosta. I don’t know what the word means, but people going through it have severe abdominal cramps, nausea and diarrhoea.”

The coronavirus pandemic has affected drug supply chains and raised the prices of whoonga, a cheap heroin mixed with other substances that is widely used among Durban’s 4 000 homeless people.

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“The symptoms are terrible. Most are not going through withdrawal completely cold turkey but are very agitated. It is worse because they can’t get cigarettes.”

For an immediate hit, whoonga users melt the substance in a spoon. Carpenter describes the distress of watching desperate users shoot up. “They jab themselves with needles, often using the same needle over and over again, and this often causes abscesses to develop. It is a disaster.”

Anyone underestimating the severity of whoonga addiction need only spend time with Carpenter, who sees “bright, sassy youngsters, many from middle-class homes” who sink into despair.

“It can happen to anyone. I treated a young woman who had a bursary to study medicine. Within six months she went from university to living on the street,” he said. “Users say the high is like an orgasm. 

“It is terribly addictive and the rehabilitation rate is around 5%. I  took one woman to hospice three times. She was at death’s door, really sick, but the minute she felt a glimmer of life she ran away.” 

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Users forgo medical treatment for serious infections like gangrene to get drugs. But besides the physical addiction, life on the streets seems to have an emotional and psychological hold over them too. It is a sense of community and belonging, Carpenter says, as they “have burnt family bridges”.

Specialists agree that homeless drug users are alienated. “It is easy for people to want to write drug users off,” Carpenter said. “Most people believe this is self-inflicted, but you only have to see it through a parent’s eyes. I know a domestic worker whose son is a user living on the streets. Every morning she takes him a clean set of clothes and breakfast. He may have destroyed his life, but she says ‘he’s still my son and I love him’.”

Interrupted drug supplies

Boyboy Skosana, 30, has been living on the streets since 2009, mostly in an alley behind a gym in Mahatma Gandhi Road near the beachfront. A self-declared drug user, he vows he hasn’t mainlined for 11 months. “I only smoke zol now. Promise.”

He’s hustling, his days of washing cars outside the gym are over. Covid -19 has made his existence even more precarious. He darts around the city centre, running errands for tips. “Life is worse now. How am I gonna survive?”

8 April 2020: Boyboy Skosana has been living on the streets of Durban since 2009, mostly in an alley near the beachfront. Skosana says that as a former drug addict, he is grateful he doesn’t have to source drugs during the lockdown.

Skosana gets meals at one of the 13 homeless shelters recently erected by the municipality. “It’s OK, my brother, we get something to eat but it is less – only four slices of bread and one cup of porridge.”

Food is one thing, but laying one’s hands on drugs is difficult. Skosana is grateful he quit. “My friends are suffering. I feel shame for them. They are spewing and shivering. It is like they are in a hospital.”

Desperately addicted homeless users, he says, are leaving shelters to find a hit. “They run. They will steal. They will do anything to get drugs.”

Mental and physical terror

Skosana’s doomsday description is given some credence by scenes near Sydney Road, where Umbilo merges into the port area. Homeless people move around alone or in pairs. “Imagine the terror,” says recovered drug addict Andre Redinger, who runs a private rehabilitation centre in Scottburgh. 

Redinger is involved in a range of outreach programmes and knows the horrors of detox. “People will look crazed. It’s real. It’s a mental obsession and a physical craving.” 

He says homeless substance users will be worried about broken supply chains and increased police vigilance. They already have hostile relationships, especially with the police. But addicts need a hit and will often stop at nothing to get it. The high blanks out the reality of a desperately hard life. “There is so much mental dysfunction and misunderstanding.” 

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People often see homelessness as an issue and not as a situation involving individual human beings. “These are people. I hope city authorities are able to overcome bureaucracies. I hope they have enough nurses and social workers,” said Redinger. 

Lindokuhle Gumede, 23, sleeps outside the Dalton Road hostel in Durban with his twin sister Thobile, who was crippled after a car accident. If he didn’t hustle they wouldn’t survive.

“They call us ‘parras’. But we are homeless. We don’t do drugs,” he said.

After food, the twins’ priority is cash to buy adult nappies for Thobile. Gumede says they have tried to stay away from city shelters because there’s not enough food and they are afraid of disease. His sister has tuberculosis and he takes antibiotics for an infection he got after a unfortunate incident, he says, offering his arms to reveal a nest of angry welts. 

“There are hundreds of us at the shelters. There is not enough food. The tablets we take make you hungry.”

Breaking out of confinement

An aid organiser, Steve Thusi, dispensed food parcels donated by businesses at Dalton Road hostel last week. While the residents gratefully queued up for food, he expressed his concern about residents clashing with the homeless drug users, which had happened even before the lockdown. The police confirmed that a man was murdered at the historic Dalton Beer Hall nearby.

“These guys are breaking into businesses and mugging the hostel residents,” Thusi said. “The residents are going out in groups now, carrying sticks. If you hang your clothes out the window, you have to sit and watch them dry or they will be stolen. I have spoken to some homeless guys and they say there is not enough food and water. I want the municipality to assist. I don’t want bloodshed.”

Hostel resident Samkele Mqadi echoed Thusi’s concerns. “Since Corona, people have been helping us, even though there is always poverty here. But I am worried – the ‘parras’ are everywhere. They come in and go out, but we are staying inside. We don’t know if they have got corona.

“We chase them but we can’t beat them. They are humans. They don’t have a home. If they beg for food and we have, we give it to them,” said Mqadi.

8 April 2020: Residents of the Dalton Beer Hall queue for food parcels. Many of them work in the informal economy and have been unable to earn a living during the Covid-19 lockdown.

The hostel dwellers say the drug users are coming from Albert Park, where the city has a homeless shelter. But police members outside the shelter scoffed at claims that the homeless weren’t being fed enough. “They are living the life,” said one policeman. “They get three meals a day and there is enough food. Look for yourself.” 

The police say they cannot confine homeless drug users. “It’s impossible. If they want to jump the fence, you can’t stop them.”

The route of drug users into the suburbs takes them past the hostel and the famous Dalton Beer Hall, where some people live in partitioned rooms. It sits beside a shack settlement widely known as a place to get drugs. 

‘Durban needs methadone’

A specialist with years’ experience dealing with homeless drug users, who did not want to be named, says the municipality is working with non-governmental agencies (NGOs) offering “withdrawal management” or alternative drug treatments to deal with cravings. The users are being given medicine for pain and cramps, and to help them sleep. 

The NGOs have nurses, psychologists and social workers – but all this is available only to homeless people who are prepared to subject themselves to quarantine at the city’s shelters. Upwards of 60% of the homeless are addicted to substances, the specialist says. 

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Carpenter believes the government should use methadone in opioid substitution therapy programmes throughout South Africa. Methadone, a substitute for heroin, provides users with the feeling of wellbeing that heroin gives them, but in a medically controlled, safe environment. It would be expensive and controversial, but would spare them the harm they cause themselves and others. “Users fuel their habits through crime and all sorts of unsavoury, antisocial behaviour,” he explained. 

Carpenter was involved in a successful methadone substitution project for Irish convicts and referred to a similarly effective programme in Rotterdam. “It’s my opinion, but I think Durban needs a methadone programme.”

New hope for cooperation

It’s not a panacea, he said. Users have become immersed in a life of hustle to feed a habit and that won’t change overnight, nor is it guaranteed that they will not return to drugs. But it might be a lesser evil, especially given the spectre of increased drug addiction in a crumbling economy. As the drug specialist said: “Cities around the world are aware there is an emergent withdrawal crisis.” 

Durban is doing relatively well, she said, praising the response of some politicians, city officials and volunteers. “This thing has made us realise how entwined our lives are.”

Raymond Perrier, director of the Denis Hurley Centre and chair of the eThekwini Team for the Homeless, says the pandemic has left the city no choice but to rethink long-forgotten policies affecting vulnerable citizens. This has resulted in a welcome change in the attitude towards them, and better collaboration and teamwork among NGOs and city officials.

Perrier says in some instances it was simply down to changing a language that “othered” people, reinforcing prejudice and stereotypes. “But, language drives perception. It’s important.”

8 April 2020: A young family of Dalton Road hostel dwellers walks to the block they call home in the industrial area near the Durban harbour.
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