Fronto-temporal cortical atrophy in ‘nyaope’ combination heroin and cannabis use disorder

Nhanisi A. Ndlovu, Nirvana Morgan, Stella Malapile, Ugasvaree Subramaney, William Daniels, Jaishree Naidoo, Martijn P. van den Heuvel, Tanya Calvey*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Sub-Saharan Africa is one of the top three regions with the highest rates of opioid-related premature mortality. Nyaope is the street name for what is believed to be a drug cocktail in South Africa although recent research suggests that it is predominantly heroin. Nyaope powder is most commonly smoked together with cannabis, a drug-use pattern unique to the region. Due to the increasing burden of this drug in low-income communities and the absence of human structural neuroimaging data of combination heroin and cannabis use disorder, we initiated an important cohort study in order to identify neuroanatomical sequelae. Twenty-eight male nyaope users and thirty healthy, matched controls were recruited from drug rehabilitation centers and the community, respectively. T1-weighted MRI images were obtained using a 3 T General Electric Discovery and cortical thickness was examined and compared. Nyaope users displayed extensive grey matter atrophy in the right hemispheric medial orbitofrontal, rostral middle frontal, superior temporal, superior frontal, and supramarginal gyri (two-sided t-test, p < 0.05, corrected for multiple comparisons). Our findings indicate cortical abnormality in nyaope users in regions involved in impulse control, decision making, social- and self-perception, and working memory. Importantly, affected brain regions show large overlap with the pattern of cortical abnormalities shown in heroin use disorder.

Original languageEnglish
Article number108630
JournalDrug and Alcohol Dependence
Publication statusPublished - 1 Apr 2021

Bibliographical note

Funding Information:
This project was funded by grants from the University of the Witwatersrand , the South African Medical Research Council and the National Research Foundation ( 118174 and 118508 ).

Publisher Copyright:
© 2021 Elsevier B.V.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Cannabis
  • Functional lateralization
  • Neuroanatomy
  • Neuropsychiatry
  • Opioids
  • Psychopharmacology
  • Substance use disorders


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