How Criminalisation, Rights Erosion and Regulatory Gaps Fuel Deaths in Unregistered Rehab Centres

When recent headlines branded people who use drugs as uncaring irresponsible mothers, such judgmental coverage reignited fear, further driving women who use drugs underground and away from safe services, paving the way for unregistered rehabilitation centres to operate unchecked. By treating personal drug use as a criminal offence instead of a health issue, South Africa erects barriers that push individuals into facilities where fatalities go unrecorded and abusive practices flourish.

This enforced invisibility compounds stigma and fear of detention, convincing users and their families that any appeal for help risks prosecution. A 2024 Department of Social Development investigation found over 500 private treatment centres operating without registration under the Prevention of and Treatment for Substance Abuse Act 2008, linking multiple client deaths to unqualified detox protocols, unmonitored restraints and extreme neglect (Department of Social Development, 2024). At the same time, fewer than 13 percent of South Africa’s 75 000 people who inject opioids receive opioid substitution therapy and services distribute only 36 sterile needles per person each year—far below the 200 needles needed for HIV prevention and 300 for hepatitis C prevention (Harm Reduction International, 2024). Sensationalist media blamed “rogue rehab camps” without probing why they thrive, but the real drivers are criminalisation and regulatory gaps.

In July 2025, 28-year-old Jacob Sekgotla died at Mankweng Hospital after days of beatings and starvation in an unregistered “disciplinary camp” in Limpopo. Local outlets initially described his detention as a corrective measure rather than abuse, reinforcing stereotypes of people who use drugs as criminals. His 17-year-old brother survived but recounted being chained, struck with pipes and denied food until Jacob collapsed; police later charged the operator with murder (Times Live, 29 July 2025). This tragedy underscores how unjust laws and weak oversight create a perfect storm for lethal violence behind closed doors.

SANPUD responds by championing decriminalisation and empowering local networks of people who use drugs to advocate for themselves and shape policy. Early success came when SANPUD secured a seat in the national Drug Master Plan conversations, embedding peer expertise in high-level strategy. Through governance training across urban, semi-urban and rural districts—from QwaQwa to Phuthaditjhaba, Madadeni to Osizweni and Cape Town to the Cederberg region—SANPUD established reginal peer-led networks. Peer leaders completed modules in governance, budget management and advocacy planning, and each network received a tablet to coordinate rights-based campaigns, turning lived experience into organised influence.

Open clinic days invite marginalised individuals into regulated health facilities, transforming clinics into supportive spaces where respect replaces judgement. In partnership with local health authorities and clinic managers, SANPUD delivers sensitisation training for doctors, nurses and support staff so they communicate without stigma, offer HIV and hepatitis C testing and guide clients through treatment initiation and adherence. By dismantling negative attitudes and building trust, these events strengthen bonds between healthcare services and the communities that rely on them most.

Key recommendations for policymakers, media and stakeholders:

• Enshrine decriminalisation of personal drug use in legislation to remove the threat of arrest that silences survivors and obscures abuses.
• Strengthen registration and inspection protocols for all treatment facilities, integrating community-led monitoring to ensure accountability.
• Expand harm-reduction services to meet World Health Organization benchmarks for opioid substitution therapy and sterile needle distribution.
• Partner with media outlets to adopt non-stigmatising language, avoiding terms like uncaring irresponsible mothers or thieves, and to feature quotes from people who use drugs as experts in their own lives.

Unless South Africa abandons punitive laws, fortifies harm-reduction regulation and empowers people who use drugs to monitor and shape their care, more tragedies like Jacob’s will unfold in secrecy. Decriminalisation, robust peer networks and inclusive clinic partnerships chart a path toward a rehabilitation landscape that puts people first rather than harms.