Typically, a user rolls a joint of cannabis, pours over a bag of nyaope and smokes it.
The common street names for heroin in South Africa are nyaope, whoonga and thai. In South Africa between 60 and 90% of heroin users entering treatment facilities report smoking heroin as their main method of heroin use. Data are however limited and the papers from Kenya and Tanzania are qualitative and therefore do not report on the specific numbers of heroin-cannabis smokers. South Africa, Kenya and Tanzania have reported a significant proportion of heroin users who smoke heroin combined with cannabis. Within some contexts, however, the users’ accepted and familiar alternative to injecting heroin is smoking it in combination with cannabis. This could be a possible intervention in some African countries where there is a high prevalence of HIV and there are concerns about an increasing number of injecting heroin users. Due to the severe harms associated with injecting, there have been harm reduction campaigns aimed at helping heroin injectors transition to inhaling heroin. ‘Chasing the dragon’ is a method of heroin use whereby users inhale the vapour produced by heating heroin over a foil. Injecting heroin is reported to pose the most harmful effects due to risks of overdose, transmission of blood borne viruses, more severe symptoms of dependence, longer heroin-using careers and higher rates of criminality and homelessness. Injecting and chasing heroin are the most common methods of heroin use described in the literature. Advocating a transition from injecting to smoking heroin in an African context may pose unique challenges. Heroin users who do not inject drugs but use other routes of administration may have increased risk for relapse to heroin use after inpatient rehabilitation and should therefore have equal access to harm reduction treatment services. There were no significant differences in psychopathology, general health, criminality and social functioning between IV users and heroin-cannabis smokers at all three time points. A higher proportion of IV users was HIV positive ( p = 0.002). The median number of heroin use episodes per day was lower for IV users than heroin-cannabis smokers at both follow-up points ( p = 0.013 and 0.0019). At 9 months, heroin-cannabis smokers had a higher proportion of those who relapsed to heroin use compared with intravenous (IV) users ( p = 0.036).
Eighty-four percent were followed up at 3 months and 75% at 9 months. The sample comprised 211 (70.3%) heroin-cannabis smokers and 89 (29.7%) heroin injectors. We compared drug use, psychopathology, criminality, social functioning and general health between heroin injectors and heroin-cannabis smokers at treatment entry, and at 3 and 9 months after rehabilitation. Three hundred heroin users were assessed on admission to inpatient rehabilitation and after treatment. To compare treatment outcomes between people who inject heroin and people who smoke heroin with cannabis. There is no data exploring the impact of smoking heroin with cannabis on treatment outcomes. In several countries, especially in Africa, the dominant method of heroin intake is smoking a joint of cannabis laced with heroin.
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