Insights into the value of the market for cocaine, heroin and methamphetamine in South Africa

Scheibe, Andrew; Shelly, Shaun; Stowe, M. J. Article Insights into the value of the market for cocaine, heroin and methamphetamine in South Africa Journal of Illicit Economies and Development (JIED) Provided in Cooperation with: LSE Press, London School of Economics and Political Science (LSE) Suggested Citation: Scheibe, Andrew; Shelly, Shaun; Stowe, M. J. (2024) : Insights into the value of the market for cocaine, heroin and methamphetamine in South Africa, Journal of Illicit Economies and Development (JIED), ISSN 2516-7227, LSE Press, London, Vol. 5, Iss. 3, pp. 1-17, https://doi.org/10.31389/jied.156 This Version is available at: https://hdl.handle.net/10419/320680 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. 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If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by/4.0/ RESEARCH CORRESPONDING AUTHOR: Andrew Scheibe University of Pretoria, ZA [email protected] KEYWORDS: Drug market; illicit markets; valuation; South Africa TO CITE THIS ARTICLE: Scheibe, A, Shelly, S and Stowe, MJ. 2024. Insights into the Value of the Market for Cocaine, Heroin and Methamphetamine in South Africa. Journal of Illicit Economies and Development, 5(3): pp. 1–17. DOI: https://doi. org/10.31389/jied.156 Insights into the Value of the Market for Cocaine, Heroin and Methamphetamine in South Africa ANDREW SCHEIBE SHAUN SHELLY M. J. STOWE ABSTRACT The illicit drug trade generates billions of dollars and sustains transnational criminal organisations. Drug markets can destabilise governance and undermine development. Data indicate increasing drug use in South Africa. However, information on the size and value of the drug market is limited. This is the first study to estimate the market value of cocaine, heroin and methamphetamine in South Africa. People who use drugs were meaningfully involved in all aspects of implementation. We used focus group discussions, ethnographic mapping, brief interviews, and the Delphi method to estimate the number of users, volumes consumed, and price for each drug in South Africa in 2020. Nationally, we estimated there to be: 400,000 people who use heroin (probability range (PR) 215,000–425,000) consuming 146.00 tonnes (PR 78.48– 155.13) with a value of US$1,898.00 million (PR US$1,020.18–US$2,016.63); 350,000 people who use cocaine (PR 250,000–475,000) consuming 18.77 tonnes (PR 13.41– 25.47) with a market value of US$1,219.86 million (PR 871.33–1,655.52) and 290,000 people who use methamphetamine (PR 225,000–365,000) consuming 60.19 tonnes (PR 6.58–10.68) and a market value of US$782.51 million (PR 607.12–984.88). The combined value was calculated at US$3.5 billion. Findings can be used to stimulate engagement to reform drug policy and approaches to mitigate the impact of the illicit drug trade. Additional studies that include people who use drugs in research design and implementation are needed to improve our understanding of drug markets. *Author affiliations can be found in the back matter of this article 2Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 INTRODUCTION GLOBAL CONTEXT The illicit drug market is big. In 2013 it was worth $426–652 billion (May, 2017); approximately 0.7% of global gross domestic product (GDP) (Statista 2022). Over the past decade there has been marked growth in the size of the drug market around the world (United Nation Office on Drugs and Crime 2021). Prohibitionist approaches have had little to no meaningful impact on drug supply or demand (The Global Commission on Drug Policy 2021). Despite expenditure of $100 billion a year in an attempt to eradicate the trade, only 1% of laundered drug money is recovered by the authorities (The Global Commission on Drug Policy 2021). Between 2015 and 2019, seizure of opioids and amphetamine type stimulants (ATS) increased more than two-fold, with less marked increases in cocaine seizures (UNODC 2021). In comparison, global production of opium and cocaine roughly doubled over the past two decades and supply has remained relatively stable (UNODC 2021). Paradoxically, efforts to control drug supply (through seizures and drug-related arrests) may increase profitability through reduced competition and increased demand (Bouchard 2007). Flexible and changing transportation solutions are employed by actors involved in the illicit drug trade to mitigate the potential effects that geopolitical events and law enforcement may have on business (UNODC 2015; Eligh 2020, 2021). Globally, in 2019 an estimated 62 million people used opioids for non-medical purposes, 27 million people used ATS and 20 million people used cocaine (UNODC 2021). Worldwide, the proportion of people who used a drug in the past year (±5%), and the proportion of people who used drugs who had a drug use disorder (± 13%) has remained relatively constant over the past 10 years (UNODC 2021). In 2019, the annual prevalence of cannabis use among people in Africa was 6.4%, and stood at 1.2% for opioids, 0.3% for cocaine, and 0.4% for ATS (UNODC, 2021). Due to Africa’s young, growing population and rapid urbanisation the proportion of people who use drugs is expected to increase by 40% by 2030 (UNODC 2021). DRUG MARKET VALUATION The valuation of drug markets requires data on volumes and price. However, the criminalised nature of drug use and the drug market complicates valuation. For example, the volume of drugs traded is sometimes calculated by extrapolating police seizure data (Werb et al. 2013). However, porous borders, out-dated technology and corruption enable illicit trade, with seizure data reflecting a small fraction of trade volume (Haysom, Gastrow & Shaw 2018; Machethe & Mofokeng 2022; Stanyard 2022). Importantly, drug seizures are influenced by law enforcement capacity, coordination, and political will (Giommoni, Berlusconi & Aziani 2022), and do not necessarily reflect changes in drug trade volumes. Furthermore, estimates of the number of people who use drugs are largely lacking or inaccurate (UNODC 2021). Many existing estimates are taken from household surveys. However, subpopulations of people with higher proportions of drug use (e.g., those experiencing homelessness and people in prison) are often excluded from these studies, contributing to an under estimation of the number of people who use drugs (Johnson 2014). Moreover, under reporting of drug use in household surveys is common due to fear of arrest, stigma, and poor questionnaire design (Johnson 2014; Global HIV Strategic Information Working Group et al. 2017). Health service data can provide insights into trends, but it is limited to those who access treatment (UNODC 2021). Drug-related arrest data is also of limited value to assist our understanding of drug demand. Incentives for arrest, the differential likelihood of detention based on demographic and socioeconomic characteristics, and political and legal factors influence policing practices, resulting in biased estimates (Lukas Muntingh 2013; Mooney et al. 2018; Scheibe et al. 2016). Similarly, it is difficult to assess the amount of drugs consumed. Estimates may be based on data collected through the approaches noted above; however, the data would likely be affected by the same biases affecting other variables. Drug market valuation estimates are more easily based on consumer price, as wholesale prices are rarely known (European Monitoring Centre for Drugs and Drug Addiction 2019). However, consumer prices may fluctuate and are influenced by purity and the addition of bulking agents (Cole et al. 2011). 3Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 Specialised methodologies can overcome the challenges noted above. For example, research conducted in partnership with people who use drugs and trusted organisations using recommended methods (e.g., respondent driven sampling) can be used to recruit people who use drugs and to obtain reliable data (Global HIV Strategic Information Working Group et al. 2017). Novel analytical techniques, such as sewage epidemiology, can be used to assess drug metabolite levels in wastewater to provide empirical insights into the volume of drugs consumed (Huizer et al. 2021). THE SOUTH AFRICAN CONTEXT Emerging data point to a large, and growing drug market in South Africa (Eligh 2020). Increasing flows of heroin,1 cocaine, and methamphetamine have been documented over the past 20 years (Haysom 2019). In 2005, 0.2% and 0.5% of men (aged ≥ 20 years) who participated in a national household survey reported opioid and cocaine use in the past three months, respectively (Peltzer et al. 2010). Programmatic data shows that the proportion of people admitted to drug treatment centres for opioid dependence increased from 16% in 2012 to 20% in 2017 (Harker et al. 2020). A 2017 household survey found that 0.3% of participants (aged ≥ 15 years) reported opioid, cocaine, and amphetamine use in the three months preceding the study (Peltzer & Phaswana-Mafuya 2018). Drug market research reflects a net decrease in the price of heroin, cocaine, and methamphetamine between 2004 and 2014 (Howell et al. 2015). In light of the increased volume of drugs flowing through the country, and increasing use, it is probable that the illicit drug economy is of significant size and value. However, to our knowledge there is no published data on the value of South Africa’s drug market. This study aimed to estimate the retail market value of cocaine, heroin, and methamphetamine in South Africa from a demand side, with meaningful engagement and participation of people who use drugs. METHODS The study employed focus group discussions (FGDs), ethnographic mapping, brief interviews, and the Delphi method to gather inputs to estimate the retail drug market value in South Africa in 2020. SETTING South Africa has nine provinces and is comprised of 52 districts. Districts are further divided into electoral wards. Fieldwork was conducted in nine South African cities across seven provinces: Bloemfontein (Mangaung District, Free State Province); Cape Town (City of Cape Town District, Western Cape); Durban (eThekwini District, KwaZulu-Natal Province); Johannesburg (City of Johannesburg District, Gauteng Province); Mbombela (Ehlanzeni District, Mpumalanga District); Pietermaritzburg (uMgungundlovu District, KwaZulu-Natal); Pretoria (Tshwane District, Gauteng Province); Polokwane (Capricorn District, Limpopo Province); and Port Elizabeth (Nelson Mandela Bay District, Eastern Cape Province). The most populous city in each selected province was selected for implementation. No cities were included from the North West and Northern Cape Provinces, which do not have metropolitan municipalities and are the third least and least populous provinces. An additional city was included in Gauteng and KwaZulu Natal, Provinces which are the most populous provinces (Statistics South Africa 2011). Brief interviews with people who use drugs were conducted at hotspots (locations where people who use drugs congregate or are accessible) in selected wards in each city/district. PROCEDURES Activities took place between May and November 2020. The planning, coordination, and implementation was led by the South African Network of People Who Use Drugs (SANPUD) and researchers affiliated to the University of Pretoria’s Community Oriented Primary Care Research Unit. People who use drugs facilitated FGDs and ethnographic mapping activities, conducted interviews, validated the results, and participated in population size estimation workshops. 1 Known locally as nyaope, whoonga, unga, sugars, pinch. 4Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 Broadly, the procedures involved: (1) primary data collection (FGDs, mapping and brief interviews with people who use drugs) and validation sessions; (2) population size estimation using the Delphi Method (provincial and national workshops) and (3) market valuation. 1. Primary data collection National and local stakeholders were informed of the project. In the cities where fieldwork took place, engagements focused on networks of people who use drugs and organisations providing health and harm-reduction services for people who use drugs, men who have sex with men, transgender people, and sex workers (key populations). Engagement activities sought to obtain support for the study. Engagement with other stakeholders (e.g., drug, health, social and law enforcement service providers) was advised by people who use drugs who were from the respective city. Primary data collection and validation sessions were held in each city. The fieldwork methodology was an adaptation of the Priorities for Local AIDS Control Efforts Toolkit (PLACE) methodology (USAID, PEPFAR and Measure Evaluation 2019) and rapid mapping methodologies used with people who inject drugs (Scheibe et al. 2017) and sex workers (Konstant et al. 2015) in South Africa. Table 1 provides details of primary data collection and validation activities. People who were 18 years and older who self-reported to have used cocaine, heroin, and/or methamphetamine in the past 12 months were eligible to participate. Fieldwork was done sequentially over 3–5 days in each city. Fieldworkers, identified during FGDs, underwent a halfday training on the study, covering: conducting brief interviews with their peers using standard tools; data quality; ethical considerations; safety and COVID-19 mitigation strategies. A total of 111 people received training, of whom 96% (n = 107) were people who use drugs. Activities were piloted in each city before implementation. At the end of the fieldwork in each city, structured validation sessions were held to reach agreement on (1) the cost of each drug (per gram); (2) average amount (a range, in grams) of each drug used in a 24-hour period; (3) proportion of daily and infrequent (monthly) users of each drug, and (4) population size estimates (for each drug and for people who inject) for the city. 2. Population size estimation of people who use drugs This process involved a bottom up-approach, building on the city-level estimates from the fieldwork to develop district, then provincial and finally national population estimates. Table 1 Primary data collection activities in each city. FGDs and mapping Between 6 and 12 people, purposively sampled for diversity (representing men, women, sex workers, men who have sex with men, and transgender people who use drugs), participated in a FGD at the start of fieldwork. The FGDs followed a structured guide that explored drug usage (methods, frequency, volume) and drug market characteristics (number of users, hotspots, and drug unit cost). The mapping component included the use of stickers to plot drug use hotspots on city maps. FGDs were held in private safe spaces and were co-facilitated by the research coordinator and a person with lived experience of drug use from that city. Information was captured using a FGD guide and written notes. The FGDs each took between two and three hours. The informed consent and FGD guide were in English with translations provided by the co-facilitator. Brief interviews Brief interviews were conducted with people who use drugs in locations where people who use drugs congregate or were accessible (hotspots) across diverse areas in each city. Feedback from the FGDs and mapping were used to identify locations to conduct interviews and for fieldwork planning. Based on available time and resources, as many interviews and location visits were done in each city as possible. Teams convened at the beginning and end of each day to plan and reflect on the fieldwork. Working in pairs, the fieldworkers conducted up to 20 brief interviews per day (lasting approximately 10–15 minutes each). The informed consent and questions were in English with translations provided by fieldworkers. Brief interview forms gathered information on: observations (number of people at each location visited: <10; 10–30; 31–50; >50); interviewee characteristics (gender, drug most commonly used [heroin, cocaine, methamphetamine] and peer network size [for each drug]); number of people who use drugs visiting that location at the busiest time (a range); relative proportion of types of drug used and injecting among people visiting that location (none; very few/<10%; few/10–25%; under half/25–50%; over half/50–75%; most/75–100%); the number of people who used heroin, cocaine, and methamphetamine, and people who inject drugs in the neighbourhood/ward. Validation sessions with people who use drugs Sessions took place at the end of the fieldwork in each city. FGD participants were invited, as well as up to five people who use drugs who had insights into drug use in that city (Konstant et al. 2015). The research coordinator led the sessions, which were structured and standardised. Clarity around conflicting or missing information was obtained. The research coordinator facilitated a discussion to validate the results and reach agreement on estimates. Data on the most commonly purchased form of each drug, and perceived weight of units of purchase, was obtained in each city. Considering the locations that were visited, the findings were extrapolated to the whole city. The research coordinator facilitated these sessions in English, which each took 2 to 3 hours. 5Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 Provincial workshops: Fieldwork team members, representatives of people who use drugs networks and local stakeholders (including health service providers) participated in virtual provincial estimation workshops. Seven workshops were held. Participants interrogated the city-level estimates from the validation sessions in light of programmatic and research data and their experience. The group reached consensus on district-level estimates and upper and lower plausibility bounds using the Delphi Method (Jorm 2015). This method employs four rounds of facilitated engagement among experts to reach consensus on estimates. Delphi was done virtually using an online voting application (https://pingo.coactum.de/ 2022 – coactum GmbH). Estimates were generated for the number of people who use cocaine, heroin, and methamphetamine, and the number who inject drugs in the respective fieldwork district (reference district). The district-level estimates were then used to generate proportions of people in that district (aged 15–64) who use each drug and those who inject drugs using the most recent (2011) census data (Statistics South Africa 2011). Provincial workshop participants ordered the districts in their province from the district with the largest population of people who use drugs to the smallest. The population of people who use drugs was based on the province’s most commonly used drug. Agreement was reached on the relative size of each district in relation to the reference district in that province. The relevant size was calculated as an adjustment proportion. Adjustment proportions were then applied to the general population estimate (15–64 years) of the districts that were not visited in that province. The same adjustment factor was applied across each drug type. This process resulted in district-level estimates for each drug and for people who inject drugs in the province. All of the district estimates were summed to generate initial national population estimates (point estimates and lower and upper plausibility bounds). National workshops: The research team convened a virtual national size estimation workshop over two sessions held a week apart. Participants included people who use drugs, key population representatives, development partners, researchers, health workers, social workers, government representatives, and civil society service providers. The first session was used to review the process and participants interrogated the findings of the fieldwork and the initial national population estimates (i.e., the sum of the district-level estimates) in relation to other nationallevel research (Setswe et al. 2015; UCSF, Anova Health Institute and WHRI, 2015; University of California San Francisco, Anova Health Institute and National Institute for Communicable Diseases 2018) and programmatic data (MRC 2020). During the second workshop, the process, fieldwork findings, and other available data were recapped and the Delphi method was used to obtain revised national population estimates. 3. Retail drug market valuation The retail market value was calculated by multiplying total annual consumption by price (European Monitoring Centre for Drugs and Drug Addiction 2019). Annual consumption was calculated separately for the population of people who used drugs daily and those who used drugs infrequently (assumed to be once a month). These values were added to estimate total annual consumption. Figure 1 provides the formula used and data inputs. DATA MANAGEMENT AND ANALYSIS Procedures, tools, and training were standardised. Trained staff fluent in local languages who had lived/living experience of drug use conducted the activities. Fieldworkers and the research coordinator completed reviews of forms for completeness. Paper forms and written notes were concealed while in the field and securely stored. Neither personal nor detailed location data was captured. Data was consolidated into a single Excel database, exported into Stata v14 (StataCorp, College Station, Texas) for analysis. Summary statistics were generated to describe fieldwork participants and quantitative indicators. The market value was calculated using the formula outlined above. ETHICAL CONSIDERATIONS Ethical approval was received from the University of Pretoria’s Faculty of Health Sciences Research Ethics Committee (ref. 371/2020). Verbal informed consent was obtained. Participants were reimbursed for their participation ($16 for a FGD and $6 for a brief interview). 6Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 FINDINGS FIELDWORK A total of 135 participants took part in FGDs; 53% (n = 72) were men, 24% (n = 32) worked in the sex industry, and 8% (n = 11) were men who had sex with men. Heroin, cocaine and/or methamphetamine were used by 62% (n = 84), 59% (n = 79) and 24% (n = 33) of FGD participants, respectively. Overall, 897 people who use drugs (603 men, 280 women, and 14 transgender people) participated in brief interviews across 479 locations in 130 wards. Over half the interviewees at hotspots mostly used heroin (59%, n = 533), followed by methamphetamine (22%, n = 197), crack cocaine (15%, n = 133), and powder cocaine (5%, n = 46). People who used heroin had the largest peer network (median of 40 people), and people who used methamphetamine had the smallest (median of 20 people). A total of 144 people who use drugs participated in validation workshops. A validation workshop was not completed in Pietermaritzburg due to logistical complications. Table 2 outlines fieldwork participant characteristics. FGD participants reported that heroin, crack, and powder cocaine and methamphetamine were available and used in all the cities where fieldwork was conducted. They suggested that most people who use heroin concurrently used stimulants, either methamphetamine (in Cape Town and Port Elizabeth) or crack cocaine in the other cities. FGD participants believed that more than half the people who use heroin inject it, while crack cocaine and methamphetamine are mostly smoked, and powder cocaine snorted. Injecting methamphetamine was reported to be more common when mixed with heroin. However, some people were reported to inject methamphetamine on its own. Across the cities, an average of 10–30 people were observed at each hotspot where brief interviews were conducted. Generally speaking, interviewees reported that between 25 and 60 people congregated at these locations at their busiest times. Heroin was reported to be used by almost all people at the hotspots, except in Cape Town, where methamphetamine was the most widely used drug. More than 75% of people at the hotspot locations visited in Johannesburg were reported to use crack cocaine. Injecting was reported across the hotspots in all visited cities except for Bloemfontein, although injecting practices were confirmed in the validation session in that city. Figure 1 Formula and data inputs to calculate the retail drug market value (European Monitoring Centre for Drugs and Drug Addiction, 2019). 7Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 RETAIL MARKET VALUATION The validated estimates for population sizes, proportion of people with daily and infrequent use, amounts used in a day and the cost of each drug arising from the fieldwork are provided in Table 3. Details of the fieldwork districts population proportions are in Supplementary Table S1 and the adjustment factors and the population size estimates for all districts and the initial and revised Delphi national population size estimates are provided in Supplementary Table S2. For heroin, the district population size estimates ranged from 2,508 people in Bloemfontein/Mangaung District to 95,000 in Johannesburg/City of Johannesburg District. Between 75 and 100% of people were reported to use heroin daily across the districts. Amounts of heroin used by people who smoke/inhale it ranged from 0.4 g a day in Port Elizabeth to 3.75 g a day in Cape Town (median range 0.5 g–2.0 g). Among people who inject heroin, daily amounts were reported to range from 0.2 g in Port Elizabeth to 3 g in Port Elizabeth and Pretoria (median range 0.5 g–1.6 g). The cost of heroin per gram ranged from $8 in Cape Town to $16 in Bloemfontein and Polokwane (median $10 per gram). For cocaine, the district population size estimates ranged from 900 in Bloemfontein/ Mangaung District to 92,500 in Johannesburg/City of Johannesburg District. Between 75 and 100% of crack cocaine users were reported to use it daily in all cities, apart from Bloemfontein where 25–50% of crack users were reported to use it daily. Daily powder cocaine use was reported among 10–25% of people in six cities, with <10% daily use in Bloemfontein and no data obtained for Polokwane or Mbombela. Amounts of reported cocaine used varied across cities. For crack cocaine, this ranged from 0.1 g in Cape Town, Port Elizabeth and Mbombela to 0.8 g a day in Johannesburg (median 0.15 g–0.7 g). For powder cocaine, amounts used per day ranged from 0.5 g in Cape Town, Durban, and Bloemfontein to 5 g in Durban (median range 0.5 g–2 g). The price of cocaine was $65 per gram in all districts apart from Johannesburg and Cape Town, where it was $78 and $81 per gram, respectively (median $65 per gram). For methamphetamine, the district population size estimates ranged from 646 in Pietermaritzburg/uMgungundlovu District to 190,000 in Cape Town/City of Cape Town District. Daily methamphetamine use was reported among 75–100% of methamphetamine users in all districts apart from Port Elizabeth, where daily use was reported to occur among 50– 75% of people who use methamphetamine. Data was not obtained for the frequency of methamphetamine use in Pietermaritzburg. Amounts of methamphetamine reported to be used per day ranged from 0.2 g in Port Elizabeth to 2 g in Cape Town (median range 0.25 g–1.25 g per day). The cost of methamphetamine ranged from $5 per gram in Cape Town to $13 per gram in several other cities (median $13 g per gram). The national level market value inputs and results are presented in Table 4. For cocaine, 40% of people were assumed to use daily (a rounded down mid-point of the proportion of people reported to use crack cocaine daily (75%) and those that used powder cocaine daily (10%)). The median amount used in a 24-hour period (0.35 grams) was based on crack cocaine. The median cost of a gram of cocaine was taken as $65. For heroin, all people included in the population size estimate were assumed to use 1 g of heroin a day at $10 per gram. For methamphetamine, two-thirds of users were assumed to use daily. The median amount used in 24 hours was assumed to be 0.75 g, at a cost of $13 per gram. The national population size estimate of the number of people who use heroin was 400,000 (probability range (PR) 215,000–425,000), consuming 146 tonnes (PR 78.48–155.13) of heroin a year with an estimated total annual market value of $1,460 million (PR 785–1 551). The population estimate for people who use cocaine was 350,000 (including 140,000 daily users), consuming 18.77 tonnes of cocaine with a market value of $1,220 million (PR 871–1 656). The number of people who use methamphetamine was estimated at 290,000 (including 217,500 daily users) consuming 60.19 tonnes with a market value of $783 million (PR 607–985). Table 2 Fieldwork participant characteristics. CT: Cape Town; DBN: Durban; PMB; Pietermaritzburg; PE: Port Elizabeth; BLM: Bloemfontein; PTA: Pretoria; JHB: Johannesburg; MBO: Mbombela; PLK: Polokwane * details of participants not available. CITY CT DBN PMB PE BLM PTA JHB MBO PLK TOTAL FGD (n) 14 22 17 10 13 13 14 17 15 135 Gender Men 7 12 11 5 3 8 8 7 11 72 Women 6 8 5 4 9 5 5 9 3 54 Transgender 1 2 1 1 1 0 1 1 1 9 Sub-groups Sex workers 1 6 6 6 2 1 4 6 0 32 Men who have sex with men 0 2 0 7 0 0 0 0 2 11 Drugs used* Heroin (smoke/inhale) 2 8 1 1 1 9 8 8 11 49 Heroin (inject) 6 4 2 2 1 5 4 4 7 35 Cocaine (crack) 1 9 3 3 2 11 10 9 13 61 Cocaine (powder) 1 4 4 4 2 1 2 0 0 18 Methamphetamine 7 4 0 5 4 3 3 4 3 33 Brief interviewees (n) 91 85 50 44 80 216 102 131 98 897 Gender Men 68 47 29 35 58 161 67 67 71 603 Women 21 37 19 8 19 52 35 62 27 280 Transgender 2 1 2 1 3 3 11 2 0 14 Drugs used* Heroin 11 37 36 32 4 208 82 81 74 554 Cocaine (crack) 0 29 10 0 15 18 23 32 6 133 Cocaine (powder) 2 9 4 4 23 1 4 1 0 46 Methamphetamine 76 11 0 14 37 10 16 16 17 197 (Contd.) 15Scheibe et al. Journal of Illicit Economies and Development DOI: 10.31389/jied.156 AUTHOR AFFILIATIONS Andrew Scheibe orcid.org/0000-0002-3238-0699 Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, South Africa Shaun Shelly orcid.org/0000-0002-8199-876X Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, South Africa M. J. Stowe orcid.org/0000-0002-8640-6532 Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, South Africa REFERENCES Archer, E, et al. 2017. The fate of pharmaceuticals and personal care products (PPCPs), endocrine disrupting contaminants (EDCs), metabolites and illicit drugs in a WWTW and environmental waters. Chemosphere, 174: 437–446. DOI: https://doi.org/10.1016/j.chemosphere.2017.01.101 Bouchard, M. 2007. On the resilience of illegal drug markets. Global Crime, 8(4): 325–344. 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