A situational report and chemical analysis of nyaope and its use in the Tshwane District in South Africa

Abstract

Background: Nyaope is a dependence-forming street drug, reportedly used in South Africa since the early 2000s. Despite widespread use, its precise composition remains unclear. Often characterised as a mixture containing heroin, nyaope is known for including a range of additional components such as caffeine, opioids, bulking agents, and other chemical adulterants. The variability in substances used to cut nyaope creates difficulty in standardising its effects and characterising its true pharmacological impact. Misconceptions fuelled by media reports and anecdotal evidence have complicated efforts to accurately define its makeup, leading to inconsistent treatment approaches. Understanding the true nature and chemical composition of nyaope and its effects is important for formulating appropriate treatment regimens and supporting harm reduction strategies. Methodology: This study sought to clarify the chemical nature of nyaope, explore its regional variations in nomenclature, and evaluate its impact on users. To do so, both qualitative and quantitative research methods were employed. Data was collected through interviews with people who use drugs (PWUDs) and healthcare workers (HCWs) at 9 Community Oriented Substance Use Program (COSUP) sites to gain insight into local terminology, the perceived composition of nyaope and user experiences. Additionally, 62 samples of nyaope were gathered from 12 different regions within the Tshwane district at different timepoints and were subjected to Liquid Chromatography Mass Spectrometry (LC-MS) analysis. The analysis was carried out using three distinct methods: untargeted positive ionisation, untargeted negative ionisation, and targeted quantitative analysis, each designed to provide a comprehensive chemical profile of the substance. Results: Nyaope is referred to by different names in different regions of South Africa: in Gauteng, it is called nyaope or simply heroin; in Limpopo and Mpumalanga, it is known as” pinch” in KwaZulu-Natal, it goes by” whoonga” or sugars” and in the Western Cape, it is termed “unga”. The point prevalence of nyaope use among COSUP participants in 2023 was 68.02%. Questionnaire results indicated that 90% of participants identified heroin as a constituent of nyaope, while 84% mentioned rat poison, 76% antiretrovirals (ARVs), and 64% sleeping medication. Effects reported included a sense of calm, drowsiness, and flu-like symptoms, aligning closely with typical heroin effects. LC-MS analysis revealed the presence of opioids such as heroin, hydromorphone, morphine, codeine, monoacetyl morphine, papaverine and noscapine, while no ARVs, coumarins, or substances like cannabis, cocaine, or methamphetamine were detected. Additional constituents included phenacetin, caffeine, and dextromethorphan. Conclusion: Nyaope in the Tshwane district was essentially found to be street heroin with no detectable presence of ARVs, coumarins or cannabis. Its composition largely mirrors that of heroin, with additional non-opioid substances serving as bulking agents. The findings highlight a significant disparity between user and community perceptions of nyaope's composition and its actual chemical makeup, underscoring the need for targeted education and harm reduction strategies.