Innovative Harm Reduction

Keeping people healthy means more than just treating addiction. Needle and Syringe Programs (NSP) provide sterile equipment to stop the spread of HIV and Hepatitis. Opioid Agonist Therapy (OAT), which uses medications like methadone, gives people a stable medical alternative to street drugs. These programs are the backbone of our prevention work. They act as a bridge, connecting people whom the health system might otherwise ignore to general medical care and counselling. In South Africa, less than 1% of people who inject drugs can access OAT right now. We are working to change that.

An opioid overdose causes a person’s breathing to slow down or stop completely. Naloxone is a medication that quickly reverses this process by blocking the effects of opioids in the brain. It is not a drug that can get you high, and it is safe for almost anyone to use in an emergency. Right now, South African law makes it difficult to get because it usually requires a prescription. We believe this needs to change. Since most overdoses happen in private homes, there needs to be a focus on training friends, family, and peers to recognise the signs and use “take-home naloxone” to save a life before an ambulance arrives.

You cannot always tell what is in a dose just by looking at it. Drug checking is a simple way to test for dangerous additives before someone uses a substance. Globally, drug testing has identified powerful synthetic opioids (e.g. Fentanyl and Nitazenes) in the supply of unregulated drugs. This makes the risk of an accidental, fatal overdose much higher than before. Drug checking and surveillance have become a vital resource in managing the supply, impact and consequences of an ever-changing supply. Drug checking allows individuals to test substances for dangerous contaminants and reduce the harm related to drug use. It also provides valuable research data to reduce the availability of these drugs.

The drug market changes fast. New substances appear without warning, and we need to know about them before they cause a public health crisis. What is also true is that there are false warnings about new “Zombie Drugs” that create panic. These stories dilute the message of real dangers. The South African Early Warning System (SA-EWS) will be a community filter, helping to keep things real. TB HIV Care will work with groups like SACENDU (part of the SA Medical Research Council) to track what is happening on the ground in real time. When we find a dangerous new trend or a bad batch of drugs, we can send out alerts immediately. This data helps us put resources where they are needed most rather than relying on guesswork.

We want people to stay alive. That is the basic goal of an Overdose Prevention Site. It is a clean, supervised space where someone can use drugs they have already bought. These sites do not supply the drugs, but they do provide immediate help like oxygen or naloxone if something goes wrong. In over thirty years of these sites running globally, not a single person has died from an overdose inside one. They reduce street drug use, overdose in public spaces and help keep used needles off the streets. They give us a way to connect people with health services when they are ready.