In the slums of Johannesburg in South Africa, a dangerous new method of drug-taking is catching on.
Addicts are taking nyaope (pronounced un-yop-pay), a cocktail of heroin, antiretroviral drugs and even crushed glass and rat poison, by injecting it, pulling blood back out, and taking it themselves.
They head to the dump when the sun comes up and talk about their aching joints, the vomiting and the way their stomachs buckle and cramp.
If they have the money for a fix, they will buy a wax paper packet from one of the dealers and sprinkle its contents into a marijuana cigarette – or simply find a place else to inject it.
“This is how much I need a fix in the morning, every day, every day, it’s trouble,” says a battered-looking man called Jesus.
Relief comes quickly in a slum called Diepsloot, as the drug they call nyaope starts to enter the blood stream.
It is a cocktail of heroin and other ingredients such as antiretroviral drugs, cleaning detergents and crushed glass and it has a near-instantaneous effect.
We watched a group of zombie-like figures involuntarily sway and stagger around this pockmarked place on the edge of Johannesburg.
But the high does not last for long: “Maybe an hour or two,” said Jesus. “Sometimes less than an hour.”
There are not many health workers and counsellors who work here – but there is a social worker deployed by the National Council on Alcoholism and Drug Dependence (SANCA).
Mary Mashapa estimates that one person in every five in this community uses nyaope – and she says they will try anything to get a fix.
“It is very addictive. It is very, very addictive, I must say. They are chasing the very same high they got the first time and they can never get to that,” she said.
But that does not stop the addicts in this township from experimenting in dangerous new ways with nyaope.
An articulate young man called Thabo told us drug users have started to sell – or share – their blood with other addicts in Dieplsoot. The practice is known locally as ‘bluetooth’.
Thabo, a former debt collector, offered to show us how it is done in a tidy-looking shack in “extension one”.
Thabo inserted nyaope into the vein of his friend Bennet, then immediately withdrew a small amount of his friend’s blood which he re-injected into his arm. “I’ve just bluetoothed, eh,” said Thabo with a look of relief on his face.
“I gave my friend a hit and took one from his blood, you know, shack in “extension one”.
What about your health, HIV, what about sharing needles? I asked.
“I’ll cross that bridge when I get there,” he replied.
Ms Marshapa says the practice is highly risky: “Exchanging blood without screening it, without knowing whether people are carrying disease – it’s just not safe.”
One addiction researcher in South Africa has suggested the practice may be pointless.
Shaun Shelly argues that once nyaope is diffused into the bloodstream it loses its potency – its ability to generate a high for those seeking to reinject it.
The government’s Central Drug Authority, which is charged with fighting substance abuse across the country, has very little to say.
It told us their researchers do not have any information on nyaope, nyaope users – or bluetooth.
“We do not collect any statistics on it,” said its public health spokesman, Professor Kebogile Mokwena.