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Background:
World Health Organization reported 125,000 people died from opioid overdoses globally in 2019, but there is limited statistics on opioid overdose deaths in South Africa. NACOSA implements a harm reduction programme for PWUD in eight cities in South Africa under a Global Fund grant. Programme includes heroin overdose prevention and management interventions which is challenging as Naloxone is only available as an intramuscular injection, requiring a prescription.
Methods
To support advocacy for community-based distribution, NACOSA surveyed 1037 PWUD in 8 cities over 9 days to determine overdose incidence. 84% (872/1037) were male, 63% (650) were 25-35 years old and 64% (667) were homeless.
Results
66% (687) reported using multiple drugs (opiates and stimulants). Although 72% (744) indicated never overdosing; of those that overdosed, 96% reported an opiate overdose while 33% reported a stimulant overdose. Of those reporting an overdose, 84% (215) were accidental overdoses but 30% (78) were intentional; raising concerns about mental wellness. 55% (572) of the respondents indicated they witnessed or knew of someone else that overdosed with 72% (412/572) reporting those as fatal overdoses. 73% of those overdoses happened outside in the street; with most occurring during the day (56%) but 25% in the early morning or at night (19%) where limited health services are accessible; in fact 45% reported no help was available. 55% did not know how to prevent overdosing and 81% did not know about naloxone; with only 3% (31) ever using or accessing naloxone.
Conclusion
Survey confirms the need for community-based naloxone distribution programmes, improvements in peer-led overdose education, harm reduction interventions for polysubstance users and the establishment of Safe Drug Consumption rooms to reduce overdosing. While continuing its national advocacy for accessibility, NACOSA piloted naloxone distribution to its OST (OAT) patients and trained their supporters to safely administer this prescription if needed.
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