Shaun Shelly is dedicated to the understanding of drug use, the rights of people who use drugs, and the development of effective drug policy. He brings academic, programmatic, research, clinical and lived experience together into a 360 degree-view of the complex issues that inform our understanding, and response to the use of certain drugs, and the people that use them.

Underlining Shelly’s efforts to revise drug policies is the clear understanding that beyond rules and prejudice, we’re dealing with people who have a story, who are part of a community, and who often have to live within fractured environments. By questioning obsolete practices and improving policies, Shaun hopes to bring more meaningful support to individuals and have a positive impact on society as a whole.

Q > How does where you live affect your work?

A > I live in Cape Town, South Africa, but also work in Tshwane (Pretoria) and in eThekwini (Durban). Because of where I live, I have had some unique opportunities. When I started my work with people who use drugs, there was no real harm reduction in South Africa. The response to the use of certain drugs was very much a criminal justice and prohibitionist approach. I quickly realised that I needed to do something different, and that led me into the world of harm reduction. I was one of the few people in Africa who spoke about drug policy and harm reduction at an international level. I had opportunities and a level of exposure that may have been difficult to get if I’d been living in the US or UK.

In South Africa, the systemic racial disparities of apartheid are visible, rather than obscured, as they are in many other places. Because I already saw society through the lens of race, I immediately noticed the differences in the way marginalised groups suffer as a result of drug policy. Cape Town is a contradiction. There is a part of the City that appears very cosmopolitan, integrated. At the same time, Cape Town is very segregated. There are clearly defined racial groups that are separated by cultural, social, economic and geospatial boundaries. Many of the apparently integrated and cosmopolitan spaces are the result of achieving a sanitised space through exclusion. Once you cross the boundaries, things are not always as you’ve been led to believe. I think this has helped me develop a level of critical thinking and mistrust of the status quo. It has helped me accept that contradictions are part of life, but are also often manufactured to someone’s advantage.

Q > The greatest challenge you’ve overcome?

A > I think I am very fortunate. I don’t think I’ve had to overcome that much. I’ve had some very dark times in my life, including a time where I lived on the street. But I also have a lot of privilege. Even living rough on the street: I was educated at a good school, I had white privilege, I am male and tall, but most of all, I knew “this too shall pass”. I knew there was an alternative. I somehow knew it was a learning rather than a life-long experience. Some people can’t see that. 

I think the most difficult challenge to overcome, and I’m not there yet, is self. My ego, my insecurities, my need to always be busy, my need for affirmation.

Q > Who or what inspires you?

A > Daily, I am inspired by my partner and wife, who has just finished eight months of chemo and radiation therapy. Sonja also inspires me to take on new things, to go into areas I may otherwise leave unexplored. 

My kids inspire me. All of them are amazing, have different talents, have overcome various challenges and are all doing really well in life. They are good and inspiring people.

My friend, Danny, who died of pancreatic cancer earlier this year. Danny was gay, HIV+, HCV+, lived on the street and yet never played the role of the victim. He spoke truth to power in his weekly newspaper column. He taught me so much about living and dying. 

My colleagues, especially Julie, who has been there since the start. They make me look better than I am through their excellent work.

A lot inspires me, maybe too much. My ADHD makes me curious about a lot of things. The things that keep me asking questions are dissonance, discrepancies and gaps in understanding. I want to understand how things work, how things that are seemingly separate fit together.

Q > When it comes to drugs and addiction, are there any developments that you feel are innovative, breaking new ground or that give you hope for the future?

A > In some ways, I wish the researchers and research would look backwards. We now have neuro-imaging and billions of dollars for research, but we have had no new breakthroughs. Many people who use drugs are still dying unnecessarily, people are still suffering. I think that most of the knowledge we need to solve the so-called drug problem has already been discovered. We just need to accept it, overcome the moralistic framing and manufactured stigma about drugs and their use, and apply what is previously known. We need to go back to the basics. We should return to first principles because there is way too much that is simply accepted as fact when there is no supporting data. 

We need to revisit Bruce Alexander’s seminal work on psychosocial dislocation, Howie Becker’s labelling theory, Goffman’s studies on stigma, Zinberg’s Drug, Set and Setting, and Siegel’s study of the biological drive for intoxication. We need to know more about the lives of people who use drugs, both with and without problems. Many researchers today do not spend time talking to their research participants. They know images of their brain, their numbers, their biology and more, but not who they really are as people. We need to return to basic pharmacology and compare the effects and harms of regulated versus unregulated drugs.

We should accept that what we have constructed as ‘addiction’ is not a disease. The brain adaptions and behavioural results that go into developing an ‘addiction’ are essential parts of being human, and they can be both beneficial and destructive. If the ability to become ‘addicted’ was medicated away, we would cease to be complete people. The world would be poorer. Only once we can look at the use of drugs without the constructs of moral judgement will we start to find solutions. Future generations will look back and be dismayed at how blinkered today’s society is. They will be disappointed at how many preventable deaths we have allowed, despite the data and evidence we already have. They will lament our lack of compassion.

Here are a couple of examples:

Politicians, the media and the National Institute on Drug Abuse (NIDA) continually remind us about the dangers of methamphetamine. Meth, according to the popular narrative, causes brain damage, mental health issues and psychosis. Yet all of the studies done by the US Navy on methamphetamine show that it improves cognitive ability and helps pilots overcome sleep deprivation. A meta-analysis of methamphetamine by Dr Carl Hart et al shows acute cognitive improvements and almost limited evidence of long-term effects in people who are dependent on meth. How does the rhetoric of destruction line up with the data? We all know of people whose lives have seemingly been destroyed by methamphetamine, so how do these two ‘facts’ line up? Why are the lives of people who are dependent on street methamphetamine such a mess? Firstly, we are only researching a small sub-population of methamphetamine users. No one studies the people who don’t develop problems, and that is about 80-90% of methamphetamine users. Drugs affect different people in different ways. Just like nuts can kill some people. Second, street meth is inconsistent in quality, the dose is unknown, and perhaps people are taking the wrong dosage. Or maybe the people with problems had crappy lives and poor prospects independent of their use of meth. People who use unregulated methamphetamine are marginalised and stigmatised. Stigma and marginalisation can cause and amplify health problems. And of course, it could be the sleep deprivation that people have from using meth. Sleep deprivation, independent of methamphetamine use, has been shown to cause all the harms that are assigned to meth use.

We should be teaching people who use meth to reduce doses, avoid mixing drugs, check the quality, eat correctly and get some sleep. If they want to moderate or stop their use, we should listen to them and find out what makes their drug use so meaningful, and help them to explore alternatives.

In 2017 there were more deaths caused by drug poisonings and overdoses than deaths caused by car accidents. In the United States. Most of these deaths were the result of poisonings due to heroin contaminated with fentanyl-type drugs.

The opioid crisis in the United States would have killed a lot less people if they’d had access to unadulterated heroin. If the regulations didn’t prevent people dependent on pharmaceutical opioids from accessing regulated opioids many more deaths would have been prevented. But it is more than just the drug. The economic crisis left many people unemployed, economically excluded and without much hope in the future. The increased levels of psychosocial dislocation made many people vulnerable to finding meaning in the physical and mental analgesic properties of opioids.

Q > What taboo subjects should we be discussing more, and how should these conversations be ignited?

A > If something is considered taboo, we should be talking about it, whatever “it” is. This includes drugs. My slogan for the SA Drug Policy Week is “We need to talk about drugs.”

We do, but we also need to talk about inequity, politics, religion, sex, sexual identity, gender identity and a million other things that are considered too sacred, too dirty or too evil to talk about. 

We need to overcome the political correctness that makes us deaf to people who use language that we may find offensive or uneducated. We need to say the things that we feel even if it is not politically correct. We need to expose our taboos, bias and prejudice that are often rooted in fear, judgement and stigma. It is only through dialogue that we will find sustainable change. Any other means of changing people involves force and power and will usually end in violence. 

Often people avoid conflict and are too scared to challenge the status quo or speak their mind and challenge authority. I have been afraid of losing credibility because I am challenging accepted knowledge. If we are going to debate taboo subjects, we must be prepared to be ridiculed, to make fools of ourselves, and we must be ready to be wrong. 

If I am going to speak about taboos, it also helps to have someone who loves me unconditionally, who makes me feel that it is OK to be wrong. Someone who respects the fact that I am not prepared to let sleeping dogs lie.

Q > What are you most afraid of?

A > Dying too soon.
Disappointing the people I love.
Not living the good life.
Not being present in my own life.

Q > Something few people know about you?

A > I travel a massive amount, and I really don’t like flying. I am shit-scared of flying. I won’t sit at a window seat. I am always late, hoping that I’ll miss the flight.

I would trade almost everything and anything to be able to sing and be musical.

Q > Which topics do you find yourself debating these days?

A > I speak a lot about drug policy, but I am tending to speak less about drugs in isolation. I am well aware that drug use happens in a context and in a complex adaptive system. I am interested in debating broader issues such as inequity, race, human nature, economics, religion, politics and, obviously, pandemics and epidemiology. These all intersect with my work.

Hopefully, I am also listening and learning more. I love debating topics of consequence with bright people who think and share my enthusiasm. My discussions with people like Marc Lewis, Neil Woods, Stephen Rollnick, Michel Kazatchkine, Jay Levy, Ethan Nadelmann and others stay with me for years. Even discussions online and via email and Twitter, with people I have never met, challenge me. Chris Arnade, the author of the book Dignity, has taught me a massive amount despite our limited interactions.

Q > What are your dream goals, and which key changes should be implemented to achieve these?

A > In South Africa, there is only one major thing that is needed: follow the Constitution. If we could align all laws, policies and practices with the Constitution, South Africans would find themselves in a better place. We owe a lot to the people who wrote our Constitution. It is a remarkable guide to a better world. 

I long for a better world. Prohibition-focused drug policy remains one of the fundamental barriers that needs removing before we can achieve a just and equitable society. My “work” vision is to help create a world where: 

• All people are able and empowered to make well-informed, autonomous choices about their bodies and identity without being criminalised, stigmatised or excluded, so they can enjoy the highest levels of human rights and the lowest vulnerabilities to disease and marginalisation.
• Policies do not perpetuate the oppression, marginalisation and economic exclusion of ‘othered’ people. Behavioural and lifestyle choices or people’s identities are not rendered more harmful or dangerous.

This will not happen in my lifetime. 

On a more personal level, I want to be surrounded by compassionate people. People who value each other and want to make the world a better place. Looking at my life, I guess I am living my dream, and for that, I am incredibly grateful. 

To paraphrase the Talking Heads: ‘I ask myself, well / How did I get here?’

Shaun Shelly is a researcher at the University of Pretoria, Department of Family Medicine, and is the Policy, Advocacy and Human Rights lead at TB/HIV Care, where he founded SA Drug Policy Week. He is the Chair of the South African Network of People Who Use Drugs and serves on several advisory groups. 

Shaun was awarded the 2016 SASOP Special Achievement Award for advancing the field of psychiatry based on his contribution in the field of addictions, addressing the stigma and difficult socioeconomic circumstances associated with addiction as well as his contributions in lecturing and ongoing research. He was an Open Society Foundations International Drug Policy Fellow and has published several peer-reviewed articles and book chapters on subjects ranging from police culture to the neurobiology of dependent drug use. He speaks regularly at local and international conferences.