In the past ten years, the use of low-grade heroin (known as whoonga or nyaope) by people from marginalised communities in Durban, South Africa has become increasingly prevalent. Focus groups held with young homeless people who use whoonga have shown definitive rationality in their choice to use drugs, as well as high levels of a sensibility in terms of what is required to make daily living less risky. The more time we spent on the streets speaking to whoonga users, the more we became aware of the absolute need for opioid substitution therapy (OST) to be publicly available as a maintenance medication and therapy, which is currently used in South Africa in any significant way. The Urban Futures Centre at the Durban University of Technology, together with the TB/HIV Care Association, is embarking on the first non-profit OST Demonstration Project in the country as a means of advocating for the wider roll out of OST in public facilities. This agonist-based OST Demonstration Project is low threshold and is not necessarily aimed at abstinence, but rather toward the improvement of the quality of life for and the reduction of harm to users, particularly as it pertains to health and safety. This article speaks to the pathways, as described by people who use drugs themselves, into heroin use and present the initial findings regarding changes in quality of life from service users who are a part of the OST Demonstration Project. In so doing we make the case for the centrality of connections and rights-based interventions as the most effective approach to working alongside people who use drugs so as to reduce harms and to promote self-defined resolution of what they define as problematic drug use.