Medical waste offers insights into South Africa’s use of pharmaceuticals

Editor’s Note: Today is the last piece in our six-part series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Rebecca Hodes, Director, AIDS and Society Research Unit, University of Cape Town. 

Much of what we know about human history comes from studying things that have been discarded. The archaeology of dumpsites and middens has long informed us about societies and their pasts. This has included how people survived and sustained themselves, what they gathered, made, amassed and discarded.

Histories of rubbish have also shown that beliefs about sanitation, and what makes for a clean environment, change. These changes are, in turn, influenced by developments in technology, forms of governance, and consumer norms.

I conducted a study on an archive of medical materials, collected over three years from public waste sites around South Africa’s Eastern Cape. What I refer to as ‘pharmatrash’ serves as a proxy for which medicines were provided or purchased, consumed, and then discarded. Pharmatrash in post-Apartheid South Africa shows the vast proliferation of medical waste, the result of increased access to healthcare products in both the public and private sectors – and on the formal and informal markets.

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The story of the pharma giant and the African yam

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from William Beinart, professor at the University of Oxford. 

It was a drug produced in Nottingham in the United Kingdom that led us on a journey to South Africa to visit muthi markets, archives, herbariums and nature reserves.

We spoke with traders, healers, scholars and conservationists to learn more about Dioscorea sylvatica.

Dioscorea is a wild yam. Its name in different languages connects to its appearance – its rough skin resembles a tortoise shell. It’s known as ‘Elephant’s Foot’ in English, in isiZulu ‘ingwevu’, meaning grey/old or ‘ifudu’, meaning tortoise; in Sepedi the name is ‘Kgato’ – ‘to stamp’.

In the 1950s, the yam was heavily exploited by the British pharmaceutical firm Boots for the production of cortisone. But provincial conservation officials in South Africa fought back against the plundering of a wild plant that they recognised was in danger of being exploited to extinction.

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A history of how sedatives took hold in white South Africa

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Julie Parle, Honorary Professor in History, University of KwaZulu-Natal.

In the early 1960s, pharmacists and government authorities were of the view that South Africa had experienced key aspects of a ‘pharmaceutical revolution’ over the course of the previous 40 years.

These were fulcrum decades in South African medicines’ history in which newly invented medicines became critically important. Most of the new therapeutic substances in high demand were antibiotics. But the class of drugs comprising synthetic hypnotics, sedatives and tranquillisers were also important.

As early as the 1930s these substances – especially barbiturates – posed challenges to those who sought their control. Enmeshed in multiple issues of chemical, commercial, professional, and regulatory definition, timid controls were proposed in 1937. But even these failed to gain support, facilitating a permissive market for those who could afford the new drugs. These were, by and large, white South Africans.

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Cannabis in South Africa: the duplicity of colonial authorities

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Assistant Professor of History, University of California, Santa Barbara.

The history of cannabis in South Africa contains two particular trajectories that were sometimes in direct contradiction with one another.

The one, the 100-year-old effort to prohibit its use. The other, a history of colonial governments and administrators trying to develop cannabis in order to make money out of it.

These two paths began to develop in earnest after 1916.

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The highs and lows of the opium trade in southern Africa

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Thembisa Waetjen, Associate Professor of History, University of Johannesburg.

The reach of European empires and of Indian Ocean trade networks drew southern Africa into the global politics of opium around the turn of the twentieth century. Between the late 1880s and early 1920s and there was a shift from economies of supply to regimes of control.

The colonies of Mozambique and South Africa were caught up in these big changes.

In a recent paper I highlight how official and unofficial actors shaped and responded to the global politics of opium and, in different ways, worked to benefit from these developments.

With a focus on Mozambique and, especially, South Africa, I demonstrate how the changing global politics of drug supply and suppression influenced local colonial social and political processes.

I also show how these histories influenced events worldwide, including the first efforts to use the League of Nations to control the international cannabis trade.

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Secret histories of drugs – legal and illegal – in southern Africa

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Thembisa Waetjen, Associate Professor of History, University of Johannesburg, Julie Parle, Honorary Professor in History, University of KwaZulu-Natal, and Rebecca Hodes, Director, AIDS and Society Research Unit, University of Cape Town. 

If you want to score heroin in some of the historically black suburbs, or townships, of Johannesburg, South Africa, you need to find yourself a ‘Snyman’. A ‘Snyman’ is a drug dealer. The word is used in tsotsitaal, the creole, urban dialect that emerged during the colonial and apartheid eras of segregation.

‘Snyman’ entered this lexicon in the late 1960s and early 1970s. It was around this time that cannabis smugglers supplying the gold mining compounds and nearby settlements began to diversify into pharmaceuticals. One drug of choice was methaqualone, also known as Mandrax.

Today, most young people who rely on a Snyman to supply them with a bit of a heroin admixture locally known as nyaope aren’t aware that they are invoking the name of a mid-century professor of medicine at the University of Pretoria, Dr HW Snyman. In 1961 Snyman headed a governmental commission that bore his name. Its recommendations led to the Medicines and Related Substances Control Act of 1965.

This means that, at the height of the apartheid era, black entrepreneurs trading in illicit pharmaceuticals adopted and repurposed the name of a white medical expert who enacted the state’s vision of drug regulation. In calling themselves ‘Snyman’, they showed a hefty dose of defiance as well as ironic humour.

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Call for Papers: The Moral Landscapes of Drugs in Africa

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Special issue coordinated by
Corentin Cohen (Sciences Po/CERI, OxPo) and Gernot Klantschnig (University of Bristol)

Deadline for the submission of proposals: 20 April 2020

Context
The trade and consumption of psychoactive products are not new to Africa. There are traces of cannabis cultivation dating from the sixteenth century in Eastern and Southern Africa (Duvall 2016) and records of colonial concern with its cultivation since the 1920s in Nigeria and Ghana. At least since the 1950s the region has started to be used as a transit point by some heroin smugglers (McCoy 1991) and in subsequent decades there have been reports of a clear increase in the volume of cocaine trafficking from Latin America. This has made West Africa into a socalled global hub, a place of transit for more than a third of cocaine exports to Europe and a « new » space of consumption for drugs, such as synthetic opioids (UNODC 2006, 2008, 2017, 2018). Existing data regarding heroin and crack show that consumption has also increased locally while amphetamine production capacities have developed in Nigeria and Guinea Conakry (UNODC 2012).

Most of the existing literature has been discussing these developments from state and security perspectives. Fueled by sensationalistic media reports and the proliferation of discourses on « narco jihadism », part of the literature has also borrowed from the paradigm of failed states and has thus described « weak », « fragile » or « destabilized » states as engulfed by the drug trade (Sindzingre 2001 ; Felbab-Brown 2010 ; McGuire 2010). In particular, Guinea-Bissau has been described as a « narco state » (Chabal and Green 2016), a concept that has little analytical value regarding the importance of illicit economies for the state and the role of illicit activities in countries, such as Afghanistan, Colombia, Guinea Bissau, and Morocco, but which has nonetheless gained traction in the African context (Chouvy 2016).

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Points Bookshelf: “The African Roots of Marijuana” by Chris Duvall

Editor’s Note: Today’s book review comes from Nick Johnson. Johnson holds a bachelor’s degree in journalism from Southern Illinois University and a master’s degree in American history from Colorado State University. A former freelance journalist in his home state of Illinois, Johnson now lives in Fort Collins, Colorado, and works as associate editor of the online Colorado Encyclopedia. He is the author of Grass Roots: A History of Cannabis in the American West.

Screenshot 2019-07-02 at 8.52.56 AMDespite a vast and ever-growing scholarly literature on cannabis, the African experience with the plant is too often glossed over or entirely neglected. One gets a sense of this reading some of Chris Duvall’s earlier work, including the global history Cannabis (2015). But in his most recent book, The African Roots of Marijuana (Durham, NC: Duke University Press, 2019), the geographer hammers this point home with an infallible rigor that should convince other cannabis scholars to more closely examine the biases reflected in their own work.

Duvall’s most pervasive and important argument in the book is that Europeans’ historic preference for hemp over drug cannabis was rooted in racist interpretations of cultural ecologies, and those interpretations became the foundation for much of what is known (or assumed) about the plant today. In Europe, where ecological conditions favored hemp, cannabis was known as the fiber-yielding plant of productive industrialists; in South Asia and Africa, where ecological conditions favored drug-producing cannabis, “the plant was valued principally to supply psychoactive drugs” (103). When nineteenth-century Europeans began traveling Africa under the oppressive shadow of colonialism, they saw the use of cannabis drugs as an unnatural corruption of the plant itself as well as an indicator of Africans’ supposed backwardness and inferiority (10-11). This perspective then became embedded in Western understandings of cannabis and remains lodged there today, despite a robust academic literature on the role of racism and colonialism in the development of scientific thought.

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The Other, Other Opioid Crisis: Tramadol in West Africa

Editor’s Note: Today’s post comes from contributing editor Dr. David A. Guba, Jr., of Bard Early College in Baltimore. 

For the past twenty years, a steady rise in opioid addiction and overdose rates across the U.S. has led to a “public health emergency,” declared by Donald Trump in October of 2017.[1] In 2017 alone, over 70,000 Americans died as a result of drug overdose, and 47,600, or 68%, of those fatal overdoses involved illicit and prescription opioids.[2] This means that opioids, whether in the form of illegal heroin or prescription pills such as OxyContin, killed more people in 2017 than car accidents (40,100) and gun violence (39,773). According to data compiled by the Kaiser Family Foundation, 37,113 of the 47,600 opioid-related deaths that year, or 78%, were of “White, non-Hispanic” people.[3] Particularly hard hit by the epidemic were the Rust Belt of the Ohio River Valley and mostly-white suburbs of Florida, New York, Pennsylvania, North Carolina, Michigan, and Massachusetts.

While the label “public health emergency” is apt given these statistics, the current media obsession with the “white prescription opioid cum heroin user”—epitomized in Chris Christies oft-repeated anecdote about his college buddy who was a “great looking guy, well-educated, great career, plenty of money, beautiful, loving wife, beautiful children, great house, and had everything” but then tragically succumbed to prescription opioid addiction after a back injury—is both unhealthy and unethical.[4] As Solomon Jones, a journalist with the Philadelphia Inquirer, recently argued, perceptions of drug addiction in America have become so “gentrified,” that what once “was primarily a black and brown problem” of morals “has been rebranded by whiter and richer” Americans as a public health crisis affecting good, white citizens deemed victims.[5]

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Addiction in African Literature

“Where is my African counterpart?” asks MaryKarr.

Where are the African tales of personal struggles with alcoholism and drug addiction?  I’ve been studying the history of alcohol use in Africa for more than twenty-five years and more recently I’ve also been looking at drug use.  Yet I can’t recall a single such story in my unsystematic sampling of African creative writing.  Here in the United States, hardly a week goes by, it seems, without publication of a memoir or fictional account (or public celebrity testimony) of the individual torments and collateral damage associated with alcohol and drug abuse and the redemption (and royalties) found in sobriety.  Why don’t we have an African Mary Karr? Why aren’t African writers cashing in?

Are Africans simply more abstemious?  This is hardly the case. Scholars have amply documented African drinking practices.  The history of drug use is much less studied, but in the recent past at least illicit drug use has become ubiquitous in many African societies.  And the fact is that African fiction and autobiography are awash in alcohol—and increasingly provide rich accounts of local drug cultures as well.  But the addiction story is mostly missing.  Why is that? Continue reading