The Dangers Associated with Female Adolescents Consuming Nyaope Drug in Butterworth, South Africa

Nyaope is a potent drug that is currently challenging South Africa; its ramifications have destroyed the country’s youth. The study described in this paper sought to explore the dangers associated with the consumption of Nyaope in Butterworth, South Africa. This study adopted an explorative and descriptive qualitative approach that involved the facilitation of focus group discussions and one-on-one interviews with twenty-six participants. An analysis of the findings of the study revealed the health hazards associated with consuming Nyaope and the tendency of Nyaope consumption to induce hallucinations and delusions in young people. Moreover, the study showed that Nyaope stimulated mood swings among female adolescents, its consumption created a fertile ground for conflict, and the addiction to Nyaope led to the destruction of the future of female adolescents. The researchers recommend the application of multiple approaches to preventing the initiation of Nyaope consumption. These approaches include attempts to control the peddling of Nyaope in schools and communities as well as the introduction of pro-active educational interventions regarding the dangers of Nyaope on the part of relevant institutions and government.


Introduction
Although there is an overwhelming increase in substance abuse among female adolescents worldwide, the problem is largely ignored and neglected (Alhyas et al., 2015). This quagmire, which has long existed in developed countries, has spread extensively to developing parts of the world. Currently, Africa is confronted by the problem of uncontrollable and overlooked drug abuse among female adolescents (Bala & Kang'ethe, 2020). Since 1994, South Africa has been overwhelmed by a constant increase in the consumption of several drugs, with Nyaope leading the pack. However, the world may not adequately know Nyaope, which is an illegal cocktail drug particular to South Africa. Furthermore, it has taken the South African drug market by storm, becoming the most popular illegal drug (Bala, 2017). Nyaope was first concocted in 2006 when it found a strong market in townships with a poor socio-economic background. However, it has now infiltrated every underprivileged corner of South Africa (Peltzer et al., 2010). Obviously, the prevalence of drugs like Nyaope in underprivileged communities is influenced by social exclusion, which is a violation of human rights (Jürgens et al., 2010). Although the South African Constitution embraces equal socio-economic rights, the government violates human dignity by not delivering adequate services to disadvantaged and poor communities.
Typically, Nyaope is the least expensive drug in the market, with a high potency and demand. Another factor favouring the use of Nyaope is that it can effectively be concocted in a home milieu. It is a mixture of Anti-Retro-Viral drugs (ARVs), rat poison, acid, and detergents to produce a powder (Masombuka, 2013). As its potency is high compared to other well-known drugs, it poses a great risk to its users (Mokwena & Fernandes, 2015). Nyaope is consumed in two different ways: by injection or by mixing it with dagga (cannabis) rolled into a cigarette. Injection users place the powder in a spoon and then heat it with a lighter to transform it into a liquid form (Masombuka, 2013). However, users have discovered a new method called "Bluetoothing," which is a transfusion or sharing of the blood of users who are already drugged (Bala, 2017). These methods of using Nyaope have many pernicious outcomes that include the following: unbearable stomach cramps, nausea, mood swings, a swollen face, hallucinations, appetite loss, and damage to veins (Mokwena & Huma, 2014). In addition, atypical methods, such as sharing used injection needles and drawing blood from other users, heighten the risks of HIV/AIDS transmission. According to Mahopo (2018), 45% of Nyaope users are infected by HIV/AIDS, and the "Bluetoothing" method has intensified the crisis. Evidently, the use of Nyaope has severe health ramifications, which implies the need for health care support to users. Sadly, Nyaope users are stigmatised, quarantined, and prevented from accessing their rights to health care.
According to Masombuka (2013), its inexpensive nature has made Nyaope very popular because people of a low socio-economic class easily afford the drug. Moreover, its popularity has spread to adolescents, which is wreaking havoc with school attendance and learner concentration in the classroom (Mokwena, 2016). Furthermore, addiction to Nyaope has led to adolescents engaging in all sorts of crimes to obtain money to afford a "puff." Thus, the increasing use of Nyaope might be associated with increased crime among the youth (Peltzer et al., 2010). A striking phenomenon of Nyaope from a gender perspective is that female adolescents are abusing it as much as their male counterparts (Bala, 2017). The drug has the potential to create an environment of conflict. According to Tshitangano and Tosin (2016), the majority of Nyaope addicts tend to leave their homes in pursuit of the drug. Thus, the drug has immensely contributed to the erosion and attrition of cultural values, principles, and morals, with users likely to be on the wrong side of the law (Chauke et al., 2015). Subsequently, the stigma attached to Nyaope consumption has led to the marginalisation of users and their families by communities. In addition, the stigma associated with this drug has led to users being subjected to mob justice and police harassments. Therefore, the authorities need to be aware of the dangers of this drug that threatens to destroy the minds of the country's youth.
The objective of the study described in this paper was to explore the dangers associated with the consumption of Nyaope on the part of female adolescents residing in Butterworth, South Africa. Thus, the study sought to respond to the following question: What are the dangers associated with female adolescents consuming Nyaope in Butterworth, South Africa? The ultimate goal of this investigation was to arrive at results that would yield data-driven recommendations for effective interventions to combat the Nyaope problem.

Literature Review
This section of the paper provides a discussion of the discourses concerning the dangers associated with substance abuse among female adolescents. The reviewed literature provided in-depth insight and information relevant to the study that was thus guided by a theoretical framework.

Substance Abuse and Human Rights
Despite social, psychosocial, and economic conditions, the role of political, civil, and societal organisations is to protect the dignity of all human beings equally (Wogen & Restrepo, 2020). However, people with substance abuse dependency suffer from stigma and discrimination, which is a violation of human rights and shows disrespect of human dignity (World Health Organisation, 2015). Subsequently, measures need to be taken to advocate against the stigmatisation and discrimination of people with substance abuse problems, which could lead to the normalisation of their human rights that have been violated. Wogen and Restrepo (2020) note that labelling with terms such as "junkie and "addict" is the most negative form of discriminating and isolating individuals who abuse substances. Specifically, in South Africa, those who use Nyaope are the most stigmatised of all, which means that they are prevented from accessing their right to health care and protection (Bala & Kang'ethe, 2020). In corroboration of the above, the UN human rights bodies and the European Court of Human Rights have raised concerns regarding the increasing denial of harm reduction services to people who use drugs (International Drug Policy Consortium (IDPC), 2015).

Nyaope Consumption Among Female Adolescents and Vulnerability to Sexually Related Crimes
Generally, substance abuse among female adolescents is associated with a predisposition to their becoming victims of sexually related crimes (Mothibi, 2014). The ingredients in the concoction of Nyaope make it the heaviest and deadliest drug on South African streets. Moreover, it quickly puts its users to sleep immediately after consumption (Mokwena, 2016). In cognisance of the above, the literature highlights that the blackout caused by Nyaope consumption among female adolescents increases their vulnerability to sexual victimisation (Bala & Kang'ethe, 2020). Predatory men look for vulnerable females to rape, and drug-consuming female adolescents are often viewed as sexually available. Moreover, many female adolescents cannot afford to buy substances and then look for men who can purchase them (Bala, 2017). These men might believe that intoxicating a female with drugs is an easy way to increase their chances of having sex with them (World Health Organisation, 2015). In fact, female adolescents usually consume Nyaope with group of males who take advantage of the situation, and gang-rape them when they fall asleep. This does not imply that women are in any way responsible for the sexual assaults perpetrated against them; but rather that their becoming victims of rape could have been prevented from happening if they were sober. However, regardless of the female adolescents' substance abuse, the above is a violation of human rights and gender-based violence.

The Outcomes of Nyaope Consumption in School Performance
Nyaope consumption among adolescents has been regarded as a cankerworm that has eaten deep into the fabric of educational programmes and has caused many setbacks for secondary school students in their pursuit of educational success (Bala, 2017). Subsequently, the National Master Plan of 2019 to 2024 established the impact of Nyaope consumption in the increased rate of school dropout amongst both male and female adolescents (Department of Social Development, 2020). Cruz et al. (2012) posit that drug abuse constitutes social ills that have been age-long problems in the secondary school system. Fernandes and Mokwena (2016) equally confirm that Nyaope has been identified as a serious constraint to effective teaching and learning processes in South African townships. Today, all underprivileged South African schools are challenged by the increase of Nyaope among female adolescents who also become violent. Sadly, for a long time, South Africa as a developing country has been faced by a spate of poor academic performance (Cuzen et al., 2015). Regrettably, all these years, the blame has been levelled against teachers for not doing their work properly, poor infrastructure, and inadequate facilities at school. However, there has been a realisation that the phenomenon of the prevalence of substance abuse among adolescents has been the underlying factor behind students' poor performance (Tulu & Keskis, 2015).

Social Work Interventions
Despite the rapid increase of substance abuse, social work interventions have continued to reduce and counteract the consequences. In addition, social workers have long been on the front line of response in the war against substance abuse (Diraditsile & Mabote, 2019). In fact, social workers have rigorously conducted a number of community advocacies and individual responses to address substance abuse. Both specialising and non-specialising social workers have served in government, non-governmental, and private organisations implementing social policies of substance abuse. Moreover, social workers have contributed to a number of treatment, rehabilitation, and health care centres to minimise the harm of substance abuse (Setlalentoa et al., 2015). However, the poor allocation of budgets and other resources has undermined the efforts of social workers in the fight against substance abuse in Africa.

Theoretical Approach: the Comprehensive Theory of Substance Abuse Prevention
The Comprehensive Theory of Substance Abuse Prevention is a model proposed by Alan Markwood (Markwood, 2011). This theory comprises a comprehensive explanation of substance abuse behaviours and advocates for interventions that correspond with the specific cause of the problem at the individual level. Alan Markwood advocates that policies and interventions should be designed with understanding of the possible outcome as well as the alternatives. Pertinently, Geyer and Lombard (2014) hold that the shallowness and incomprehensiveness of South African policy interventions have delayed progress in the fight against substance abuse. Furthermore, the Comprehensive Theory of Substance Abuse Prevention accentuates that substance abuse prevention ought largely to concern itself with interventional prevention among children and teenagers. This applies to the study described in this paper because it points to the need to develop interventions that target children and teenagers instead of interventions that remedy those already addicted. Thus, the government needs to implement rigorous proactive prevention approaches instead of the current reactional tactics. Markwood's theory also flags the importance of considering socio-environmental factors as sources of pathologies that motivate the behaviour of substance abuse. In relation to the above, underprivileged communities, especially from the rural areas and townships in South Africa, are experiencing a severe substance abuse crisis (Mothibi, 2014). This is because of horrendous and deprived living conditions. Observably, these communities are also neglected in terms of substance abuse prevention programmes. In addition, the current researchers have observed farm communities abusing substances. Therefore, farm businesses need to assist their employees as recommended by labour law policies. This is because their behaviour has also affected their children, who have learned to abuse substances at an early age.

Research Setting
The data were collected from Mission Location that is part of Butterworth, a town in the Eastern Cape. Thus, administratively, Mission Location is situated in the province of the Eastern Cape in the former Transkei region that falls under the Mnquma Local Municipality. Mission Location has approximately 7000 inhabitants who are 100% Xhosa speaking and who share the same cultural practices. It is a rural, poverty-stricken area, where young people, particularly female adolescents, can be observed to be increasingly abusing substances of different kinds.

Research Approach/Method
A qualitative research approach was employed in the study. It was considered appropriate because the study intended to explore the female adolescent participants' insights, thoughts, and feelings about drug consumption (Creswell, 2014). Fundamentally, the qualitative approach is valueattached, and there is free interaction between participants and the researchers (Bryant, 2015). This method allows the personal voices of participants to be captured, which enriched the findings. The study was also explorative and descriptive. Specifically, it followed a case study design because it entailed selecing a small sample of participants. A focus on a small geographical domain enabled the researchers to observe people consuming Nyaope directly (Babbie, 2017). Using this method and design, 17 in-depth interviews were conducted, including 10 key informants and seven female adolescents. Thereafter, the same seven female adolescents were interviewed during a focus group discussion, while a second focus group discussion was conducted with nine participants that included parents/guardians and community members. The in-depth interviews and focus group discussions were conducted in the IsiXhosa language and translated into English before the data analysis.

Sampling Method
The study effectively used a non-probability sampling methodology, specifically the purposive sampling technique. This method allowed the researchers to obtain rich data from participants who were apparently knowledgeable about and had experience of adolescent substance abuse (Creswell & Clark, 2011). Non-probability sampling is frequently utilised when a study does not aim to generalise its discoveries. Moreover, the researcher should strive to make sure that the sample is representative of the population under study and that the outcome of the research can be depended on (Babbie, 2014).
Inclusion and exclusion criteria were observed in the process of selecting participants, which involved recruiting 26 participants through the purposive technique. The participants included seven female adolescents who were currently using or had been using substances and were residents of Mission Location, which is part of the Mnquma Municipality. Moreover, the participants included the following: nine parents/guardians of children who were currently using or had used alcohol or drugs, one community leader, three social workers, two teachers, two probation officers, and two police officers serving Butterworth. Therefore, people who did not meet the above characteristics were excluded.

Data Collection Process
The data collection process was cross-sectional, and individual in-depth interviews were utilised with a view to tapping the individual experiences and desires identified as being connected to the consumption of Nyaope (Rubin & Babbie, 2012). Lichtman (2014) maintains that cross-sectional studies offer several advantages, are relatively inexpensive, allow the study to be carried out quickly, and enable the researcher to examine multiple factors and outcomes in one single study. The quality assurance of this study was provided by the Department of Social Work/Social Development and the University of Fort Hare Faculty of Social Sciences and Humanities Higher Degrees Committee. Furthermore, the instruments of data collection and highlights of the study were submitted to the Govan Mbeki's University Research Ethics Committee at the University of Fort Hare. Subsequently, an ethical clearance certificate was received. Moreover, the researchers obtained the gatekeeper's permission from the leaders of the community concerned as well as from selected government organisations. Data were captured by the principal researcher with the assistance of a research assistant. An audio recorder ensured that all the information that the participants gave was adequately captured.

Research Instrument
The data were collected using an interview guide. According to Howell (2013), an interview guide is an instrument conveying an orderly arrangement of organised questions to be used to gather data from various participants. Pragmatically, the interview guide helped the researcher to direct the conversation toward the research topics (Rimando et al., 2015). Interview guides vary from being highly scripted to being relatively loose, with features that help the researcher to know what to ask about, in what sequence, how to pose questions, and how to pose follow-ups (Rubin & Babbie, 2014).

Sample Eligibility
It is critical that researchers consider the qualities that their samples need to embrace. This is to ensure that they are valid, reliable, trustworthy, and credible (Rubin & Babbie, 2014). A stringent sample selection ensures that the samples will embed the characteristics of the research interest (Engel & Schutt, 2010). In the study described in this paper, the researchers selected the parents/guardians of female adolescents who were abusing substances and who resided in Mission Location, Butterworth, which is part of the Mnquma Municipality. These parents/guardians were willing to take part in the research study that also included adolescents who were abusing substances or had been abusing them. In addition, the study gathered the input of community and religious leaders regarding solutions to the problem of substance abuse. Female adolescents who abused substances but did not reside in the study area and parents/guardians who were not responsible for female adolescents abusing substances were excluded.

Data Analysis
Thematic qualitative data analysis was conducted with a view to explaining, interpreting, and giving meaning to the information collected from the participants (Rubin & Babbie, 2014). Content thematic analysis is the procedure of organising large amounts of crude data in an orderly manner through structuring, arranging, and rearranging the information. Furthermore, Braun and Clarke's (2006) six steps were followed in the formulation of the themes that were derived manually from the content and sentiments expressed by the participants. In doing so, the views and opinions of the participants were interpreted by the researchers. The process of data coding and the analysis were done manually.

Ethical Considerations
The researchers adhered strictly to ethical guides and principles in order to protect the participants from harm and to maintain their human dignity. Therefore, informed consent was requested from parents/guardians, schools, and participants because ethical standards required that their participation should be voluntary (Rubin & Babbie, 2012). Moreover, the study observed the following ethical criteria: the maintaining of privacy, the ensuring of anonymity, and the safeguarding of confidentiality. This was done by assuring the participants that the information they were to give was only for research purposes, including journal articles, and would not be accessible to individuals who were not part of the research community. The researchers additionally ensured that the participants' personal details and identity were withheld and that the meeting venue was private. Furthermore, to ensure confidentiality, the researchers did not collect the participants' identifying details, such as their real names and addresses. Thus, code names were given and only the researchers knew who was connected to which code name (Creswell & Clark, 2011). Moreover, the female adolescents under the age of 18 years and their parents/guardians were required to give their informed consent. Importantly, the research tool (interview guide) for the data collection was reviewed and endorsed by the Ethical Committee of the University of Fort Hare. In addition, the Eastern Cape Department of Basic Education, the school governing body, and the school principal provided permission to collect data.

Demographic Findings
The availability of female adolescents in the study poignantly points to a possibility of the study meeting its criteria. This was because female adolescents were the main participants that were targeted by this study. Furthermore, the availability of participants who were parents/guardians could have been driven by their desire to eradicate substance abuse among adolescents. Nevertheless, the findings reflected that the gender of the parents/guardians was skewed towards females being more than males. The predominance of female parents/guardians points to a glaring lacuna in family administration and the disciplining of children due to the absence of fathers (Table 1).

Findings
Using an open coding process, the researchers discovered five themes during the analysis of the raw data that contained the perspectives and ideas provided by participants. Thus, the researchers decoded the meaning of the words and information provided by participants. Subsequently, the researchers brought together interrelated codes and combined them to form broader categories. The first phase of the analysis comprised twelve categories that tended to overlap when checked by the researchers and were thus combined to form the following themes: • Health hazards are associated with consuming Nyaope. • Nyaope consumption induces hallucinations and delusions in young people. • Nyaope stimulates mood swings in female adolescents. • Nyaope consumption creates a fertile ground for conflict. • An intense addiction to Nyaope destroys an adolescent's future.

Health Hazards Are Associated with Consuming Nyaope
The participants observed that an intake of Nyaope created a fertile ground for various diseases. There are new dangerous methods of consuming Nyaope, such as the transfusion or sharing of the blood of already drugged users who share needles to inject it. For example, two participants who were Nyaope users and a police officer mentioned that since Nyaope users did not have enough money, they used a new method called "Bluetoothing" which was the transfusion or sharing of the blood of users who were already drugged. Further findings indicated that the way Nyaope was consumed could have facilitated the spread of diseases such as HIV/AIDS. One participant observed the following: "The use of the same needle and sharing blood can spread HIV/AIDS….We share same injection equipment, syringe and needle because it is not easy to get it." Furthermore, most of the participants suggested that frequent injection damaged their veins. A participant described the situation as follows: "The daily injection harms veins so we inject it in different veins. When the vein has collapsed, we look for another fresh vein to inject." The above sentiments were supported by police officers who mentioned that the majority of Nyaope users had damaged their veins because of frequent injection. According to the participants, their smoking of Nyaope was associated with an array of diseases and health disorders. Participants confirmed that Nyaope caused unbearable stomach cramps, diarrhoea, vomiting, and swelling in the whole body. One parent shared the following: "My daughter is always having swollen face." An adolescent participant said, "When I have not consumed Nyaope I feel unbearable pains". The above comments indicate a need to prevent Nyaope abuse.

Nyaope Consumption Induces Hallucinations and Delusions in Young People
The data gathered from the participants demonstrated that the female adolescents' intake of Nyaope induced hallucinations and delusions. One participant commented as follows: "The other time immediately after I smoked or injected Nyaope I saw a cow in class." The drug affects the addicts' state of mind to the extent of stifling their cognitive functioning. Another revelation was that those who were drugged with Nyaope were constantly engulfed by fantasies. One participant stated the following: "After smoking Nyaope, I feel like I'm in Paris, the state makes me jubilant and ecstatic. Smoking Nyaope makes one feel or experience the real freedom." Many Nyaope users would hear or see things that did not exist. For example, a teacher participant said, "Sometimes Nyaope users just laugh in class without anything funny. After consuming Nyaope (a) person (may)

Nyaope Stimulates Mood Swings Among Female Adolescents
The data revealed that female adolescents who consumed Nyaope could not control their feelings and experienced mood swings repeatedly. For example, a parent disclosed the following: "Since my child started consuming Nyaope, she showed rapid change in mood." These mood swings largely compromised their capacity as well as their motivation to study. Furthermore, they negatively affected their ability to relate to others in the school environment and generally derailed their social functioning. A parent said, "Sometimes Mandisa does not talk to anyone at home, she becomes illusionary treading in her own world." Thus, the Nyaope users were unable to socialise effectively, which affected the way they related to their next of kin.

Nyaope Consumption Creates a Fertile Ground for Conflict
The findings indicated that Nyaope abuse compromised any state of peace and tranquillity that the addicts might have experienced in their relationships with friends, community, and significant others. A parent stated the following: "Ever since she started consuming Nyaope, it has disturbed peace and equilibrium of the family." According to the participants, the abuse of Nyaope on the part of female adolescents had brought about conflict amongst family members. This is indicated by the following remark made by a parent: "As a parent, I was always caught in the middle of the conflict and fight between other family members and my addicted child." This conflict was often because the Nyaope users stole money as well as items such as jewellery, clothes, and cell phones from family members including their siblings.
The parents interviewed spoke about the users' tendency to steal and one parent said, "She is hugely hated by her siblings because of her pilferage nature, she steals everything at home." A social worker who participated in the study expressed the following view: They steal and sell everything to get this Nyaope." The participants observed that Nyaope users steal from neighbours to satisfy the addiction. One participant said, "My grandchildren's behaviour caused me to engage in endless conflicts in this community." The above statements made by participants revealed that the consumption of Nyaope by female adolescents abolished family relationships. This was because the parents and siblings did not trust their own children/sister, and no asset was secure around them. To parents this tendency of drug users to steal led to the burden of having to replace the assets that had been stolen from other families constantly. Furthermore, the parents/guardians of the adolescents who abused the drug had been called to schools because of the wrongs committed by their children.

An Intense Addiction to Nyaope Destroys an Adolescent's Future
Nyaope is an exceedingly harmful drug that negatively impairs the minds of the users, thereby negatively affecting their psychosocial functioning. The data demonstrated that Nyaope robbed the youths of their future, as many had dropped out of school. The following comment was made by a participant: "High addiction of Nyaope has destroyed the future of our children." Another participant said, "This new Nyaope drug is dangerous and results in youths dropping out or performing badly in schools. It impairs the user's state of mind functioning." Worryingly, the participants perceived the drug as crushing the adolescents' destiny with regard to their being able to shape both the social and economic aspects of their lives in the future. Furthermore, the findings indicated that Nyaope had led to the youths neglecting the sanitary and hygienic aspects of their lives to the detriment of the quality of their citizenship. The researchers find it imperative to challenge the government of the day to consider launching serious campaigns, especially in the rural areas, to stop the wave of drug consumption in general, and of Nyaope abuse in particular. This is because drugs rob the users of their future, and therefore compromise the quality of their citizenship.

Discussion
The study featured in this paper described the problem of Nyaope abuse among female adolescents from an underprivileged background. Wechsberg et al. (2010) observe that although potent and new South African drugs like Nyaope have been associated with male adolescents, female adolescents are now competitively consuming them. The findings of study conducted by Bala (2017) revealed that the heavy consumption of Nyaope among female adolescents in underprivileged parts of South Africa is a problem. A study conducted by Bala (2017) also revealed that inequality is a human rights violation that exacerbates the increase of drug abuse among adolescents in South Africa (Mothibi, 2014). Peltzer et al. (2010) agree that inequalities remaining from the apartheid era intensified illicit drug abuse among adolescents. Thus, Nyaope is dominantly abused in the economically neglected and deprived communities of South Africa (Mthembi et al., 2018). Furthermore, children's rights are the most violated human rights in South Africa where the majority of children do not receive adequate family/parental care and where there are poor alternative care services. Obviously, the above creates a fertile ground for drug abuse among female adolescents who seek comfort and attempt to escape the strain (Bala, 2017). The South African government, especially in the Eastern Cape, has discriminated against children with special needs who are not coping in mainstream education through its slow and poor implementation of equivalent education, which has contributed to drug abuse among female adolescents (Bala & Kang'ethe, 2020).
Eclectic literature corroborates the study's highlighting of the fact that the consumption of drugs like Nyaope is linked to adverse health outcomes. In particular, the study conducted by Badwin et al. (2013) found that worldwide, 3 million people who injected drugs were living with HIV/ AIDS. Obviously, substance abuse among adolescents increases the probability of individuals engaging in unsafe sex practice that result in STIs (Asante et al., 2014). Additionally, studies have shown that Nyaope users have died from HIV-AIDS-related complications (Mokwena, 2016). Consequently, addiction to Nyaope has been shown to have a tendency to push female adolescents towards engaging in irresponsible sex in exchange for money or Nyaope, which increases the chances of sexual health-related problems. In addition to sexual diseases, Nyaope gives rise to unbearable chest pains, abdominal cramps vomiting, diarrhoea, and ulcers (Khine & Mokwena, 2016). Furthermore, according to the participants in study, the consumption of Nyaope made the adolescents confused and led to hallucinations and delusions. Nyaope affected their state of mind to the extent of negatively stifling their general functioning (Khine & Mokwena, 2016). These findings agree with those of the study conducted by Squeglia et al. (2010) who maintain that drug abuse among adolescents has long been associated with shifts in the brain's structure and function. Many female adolescents using Nyaope have been found to perform abnormal actions and to have pipedreams in public. This is a serious problem because these adolescents might commit unlawful acts that pose a danger to the community whilst their minds are not functioning properly (Nardi et al., 2011). The study described in this paper revealed that the users of Nyaope were at risk of experiencing excessive as well as permanent hallucinations and delusions that cut them off from reality. The Mangerud et al., (2014) study agrees that there is an inevitable connection between adolescent drug abuse and behaviour linked to psychiatric disorders.
The study revealed that drug abuse had an adverse influence on the brain, which tended to result in mood changes (Bassey et al., 2013). A study conducted by Van Zyl (2013) validates that drug abuse among adolescents can cause irreversible brain damage that results in emotional problems such as suicidal thoughts, schizophrenia, and mood swings. In support of this finding, Bassey et al. (2013) maintain that psychoactive substances can change consciousness, mood, and thoughts. This is because these substances affect the emotional and motivational processes in the brain. Further support of the above emanates from the work of Mokwena and Fernandes (2015) who confirm that drugs cause individuals to be engulfed by some strange emotional episode. In addition, Khine and Mokwena (2016) observe that personality disorders are common among drug abusers. They become paranoid, secretive, stubborn, and socially rigid. Some become socially withdrawn, narcissistic, and self-centred. Moreover, they lack empathy, easily flirt with others, become attention seekers, and are usually unable to maintain a close intimacy. Additionally, they exhibit mood swings, become depressed, feel lonely, resist social contact, and are engulfed by pangs of hopelessness.
A study conducted by Masombuka (2013) confirms that Nyaope consumption among adolescents has triggered a lot of disharmony and disequilibrium amongst whole communities and families. The study described in this paper revealed that Nyaope users exhibited unacceptable behaviours, such as unprovoked aggression, robbing, and stealing. The streets and homes became sites of chaos. This was because the users stole from their families and neighbours, and sold anything valuable in order to quench their craving for Nyaope (Van Zyl, 2013). Colder et al. (2013) support the notion that the homes where adolescents use drugs are usually sites of chaos. It is clear that this phenomenon of theft results in a breakdown of trust, community cohesion of community, and family unity. Ramsoomar and Morojele (2012) suggest that drug addiction compels users to deviate from societal values and principles in order to get hold of the substances. Kang'ethe's (2015) study found that Nyaope users mug ARV patients in hospitals to obtain the HIV medication that is part of the drug mixture. Mokwena and Fernandes (2015) suggest that Nyaope is a highly addictive, dangerous, and destructive drug that has deprived the future of adolescents in South Africa. This is because Nyaope takes control of their minds. The study conducted by Kang'ethe (2015) confirms that there have been reports of adolescent gangs robbing HIV/AIDS facilities in Soweto to get ARVs in order to make Nyaope. Additionally, as mentioned above, dependent users mug ARV patients to make Nyaope for themselves locally. Mokwena (2016) emphasises that Nyaope is extremely and uncontrollably addictive, which compels users to spend large sums of money per day to satisfy their addiction. Furthermore, the present study established that Nyaope made adolescents neglect their future as normal citizens and disregard the sanitary and hygienic aspects of their lives. This agrees with the study conducted by Tshitangano and Tosin (2016) who observed that young people are intended to be the eventual fate of the nation; however, because of addiction to psychoactive substances, they crush their lives before they have a chance to actualise their potential. Consequently, when users start consuming Nyaope, they tend to drop out of school, thus becoming permanently enslaved by the drug.
Regardless of the above, Nyaope users are still entitled to be treated with human dignity and to access their due rights. However, they have suffered from structural humiliation in that they have not been allowed to access health facilities owing to the perception that they use medications to concoct Nyaope. Obviously, this is a direct violation of their right to access health care. Masombuka and Qalinge (2020) add that Nyaope is destroying its users and they need support rather than being dehumanised. Nevertheless, social workers have intervened drastically in caring for drug users through treatment, rehabilitation, and aftercare services (Mahlangu & Geyer, 2018). The findings of the study confirmed Nyaope to be a serious threat to health of its users. Therefore, health policy makers need to accommodate this drug in their policies.
Limitations inherent in the study involved the recruitment difficulties of finding female adolescents who were willing to participate. To overcome this, the researchers used a snowballing approach to reach out to the requisite female adolescents. However, this approach, as well as the use of the qualitative method utilising focus groups, limited the extent to which these results could be generalised to the entire population. To increase our confidence in the robustness of the findings from the present study, other qualitative studies of this nature or studies using general population surveys would need to be conducted. Another limitation was that most of the parents/guardians who participated preferred to answer all the questions in the Xhosa language. The researchers had to translate the questions. However, the back-translation method was not utilised. Thus, some of the responses might be influenced by misconceptions or misrepresentations from the translation. In addition, most of the parents/guardians were female, and so the results of the study were gender skewed. Future studies could make a concerted effort to recruit male parents/guardians to enhance the validity of these findings.

Conclusion
Ideally, the concoction and ramifications of Nyaope have proven to be a social and health threat in South Africa. Behaviours associated with Nyaope have led to users to being distrusted and marginalised by their communities. Regardless of their substance abuse behaviour, Nyaope users should be treated with human dignity and should be rescued from this drug. This is because they have been publicly as well as structurally stigmatised and denied access to some of their rights. Furthermore, this research study draws attention to the health dangers associated with female adolescents consuming Nyaope in Butterworth, South Africa. Nyaope and its consumption methods affect the physical and psychological health of the adolescents. This drug brings disequilibrium to the family and negatively affects the future of the users. This calls for further research and investigation with regard to the problem. The government needs to launch the dissemination of information and an effective awareness programme, especially directed at adolescents in schools.

Recommendations
Government organisations need to implement proactive programmes to prevent and combat invasive drugs like Nyaope. This study's findings should compel parents/ guardians to assume responsibility for initiating early drug abuse prevention efforts through teaching and admonishing the adolescents in their care. Furthermore, the results of the study make it evident that we need multiple approaches to preventing the initiation of Nyaope consumption. These approaches might include attempts to control the peddling of Nyaope in schools and communities. This would require the vigilance of South African Police Service officers with regard to Nyaope peddlers. Relevant institutions and government should introduce pro-active educational interventions concerning the detrimental effects of Nyaope. This suggests that interventions for profoundly challenged children should first aim to address the roots of the problem. The relevant authorities need to assign social workers to assist affected individuals, families, and schools with counselling and prevention activities.
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