Opioid Substitution Therapy reduces harm

An independent evaluation of NACOSA’s Opioid Substitution Therapy (OST) programme, conducted by Sediba Hope Medical Centre, has confirmed the positive impact OST has on the lives and health of people who use and inject drugs.

Heroin injection remains a serious issue in South Africa, with an estimated 400,000 daily opioid users and around 82,500 injecting users. People who inject drugs are at far greater risk of diseases like HIV and hepatitis and face other serious health issues including death from overdose. Criminalization of drug use exacerbates stigma, making it harder for people who inject drugs to seek healthcare. OST is one of the most effective interventions globally, yet access remains limited across South Africa. Thanks to funding from the Global Fund, NACOSA has implemented an OST programme since 2019 as part of the national People Who Use Drugs Programme, providing access to a legal, medically supervised alternative to heroin, helping people reduce drug use and get their lives back on track.

Solid foundation

The evaluation, which included surveys, interviews and data analysis from five cities, found that the programme has a solid foundation of policies, interventions and infrastructure to drive positive outcomes. Of the harm reduction programme’s 53,381 registered beneficiaries, 2,046 were receiving OST. Most were young adult males between 33 and 36 years old, often single (76%) and unemployed (78%).

Almost half (46%) of those on OST said they had stopped using illicit drugs completely, with a further 31% reporting decreased substance use as well as significant reductions in risky behaviour, and improved daily living and social functioning. Over 64% of those on the programme reported a significant improvement in quality of life.

I knew heroin was bad for me, but I didn’t really understand how bad. Talking to a peer educator really helped. He explained how OST could help me get my life back on track. It’s still a struggle, but I feel like I have a support system now, and that makes all the difference,” said one participant.

Improved health outcomes

Opioid Substitution Therapy also had a measurable effect on health outcomes. Programme beneficiaries showed increased HIV, TB, and Hepatitis B screening rates, higher antiretroviral therapy uptake and viral suppression, and better access to mental health support. Significantly, 57% of beneficiaries reported improved health access and 40% noted better overall health.

Peer support, reliable programme staff, and a rights-based approach were cited as key to the programme’s success. However, ongoing barriers such as stigma, discrimination, limited service coverage, transport issues and under-resourced infrastructure persist. “Transportation is a major barrier for many of our clients. They have to travel long distances to get to the clinic,” said one of the service providers interviewed. Access to mobile outreach units was identified as a crucial resource for expanding programme reach: “We need to invest in mobile clinics so that we can reach clients who live in remote areas.” Other recommendations to enhance the programme include improving mental health integration, increasing psychosocial support, and addressing funding and sustainability concerns.

With over 2,000 beneficiaries accessing OST through NACOSA and its community-based partners, the programme continues to demonstrate value in reducing harm and promoting long-term health and well-being for the most marginalised people in our society.

Read the report

EXECUTIVE SUMMARY

FULL REPORT

Register for our upcoming webinar unpacking the evaluation findings: https://linktr.ee/NACOSA