From over-the-counter cough syrups and prescribed painkillers to street economies of heroin and fentanyl, opioid substances and uses have ignited global debates about national drug policy reform. This book is the first to focus on these issues in South Africa, through a range of disciplinary perspectives. In twelve chapters, scholars from community medicine, pharmacology, social science and the humanities, along with civic actors and researchers, present their evidence-based arguments and insights, and explore possibilities for harm reduction approaches in South Africa. Chapters cover three core areas: dilemmas of drug policy; contradictions of care and treatment; and the issue of stigma. Opioids in South Africa invites wider conversation, asking us to imagine policy responses that can better protect the constitutional dignity, health and access to healthcare of people using drugs as well as of their families and communities.