More than half of the stabbing murder victims examined at Cape Town’s Tygerberg mortuary had illicit drugs in their systems at the time of their deaths, according to a landmark forensic pathology study that challenges the long-held assumption that knife violence in the city is driven purely by alcohol.
The research, conducted by forensic pathologist Dr Magdel Smit while training as a registrar at Stellenbosch University, analysed 248 sharp-force deaths processed at the Tygerberg Forensic Pathology Service (FPS) mortuary in 2024.
In more than half of the drug-positive cases, alcohol was either below the legal limit or not detected at all. Furthermore, nearly 58% of the victims who tested positive for drugs had two or more substances in their systems—a pattern known as polydrug use. The most frequent combinations paired Mandrax (methaqualone) with tik (methamphetamine), and Mandrax with cannabis.
“With the research, I was quite surprised about how many victims tested positive for drugs, and then how many of the positives were actually negative for alcohol,” Smit said. “In Cape Town, we don’t just have a violence problem; we also have a substance problem.”
A volatile mix of stimulants and sedatives
Smit explained that the combination of stimulants and sedatives creates a highly volatile chemical mix capable of sparking fatal violence over trivial disputes. While methamphetamine can make users aggressive and impulsive, Mandrax—a sedative often used to come down from a high or to sleep—can leave individuals incapacitated and vulnerable.
She deliberately chose to study fatal stabbings rather than gunshot wounds because knife attacks are inherently interpersonal, requiring face-to-face confrontation, whereas gang-related shootings are frequently targeted hits rather than spontaneous arguments.
Tygerberg FPS, one of 16 forensic facilities in the Western Cape, processes between 3,500 and 4,000 cases annually, with trauma accounting for over 70% of its caseload. Smit, who has since relocated to Australia, noted that she had seen only one homicide in two months in her new country—a stark contrast highlighting how desensitised Cape Town has become to murder.
“As forensic pathologists, we want justice for our patient and justice for their family,” she said, expressing hope that the data will guide early interventions and strengthen prosecutions.
Over 30,000 sharp-object assaults in a single year
Figures from the Western Cape Department of Health and Wellness underscore the immense toll knife violence takes on the province. According to spokesperson Dwayne Evans, public healthcare emergency centres treated 30,884 incidents of assault involving sharp objects between 1 November 2025 and 31 October 2026.
Meanwhile, the provincial Forensic Pathology Service recorded 2,001 fatal stabbings over a period of just under two years—comprising 1,308 deaths in 2025 and a further 693 deaths between 1 January and 5 November 2026.
“The Western Cape Department of Health and Wellness recognises the devastating impact of violence on individuals, families and communities. Behind every incident is a person whose life has been affected, and in fatal cases, families and loved ones are left grieving,” Evans said.
“Violence-related injuries place significant pressure on emergency medical services, emergency centres, surgical services, and hospital resources. Our healthcare workers continue to provide care to those affected, often under challenging circumstances.”
‘The drugs and alcohol are bringing out the devil in her’
The devastating link between substance abuse and interpersonal knife violence played out in Elsies River on Wednesday, when mother Alicia Petersen was allegedly stabbed in the left thigh by her 19-year-old daughter, Loranca.
Petersen, who needed more than five stitches and is still struggling to walk, said she returned home shortly after voting at a local polling station to find her daughter holding a beer bottle and assaulting her own eight-month-old baby.
“Had I not intervened, she would have hit my grandchild with the bottle because it’s not the first time she has hit the children. She gets violent when she mixes her drinking with whatever drugs she is smoking,” Petersen recounted.
Alerted by the screaming and the baby crying, neighbour Olivia Witbooi rushed over and took the infant to her own house for safety. Enraged that the child had been removed, Loranca allegedly went inside, fetched a knife, and attacked her mother.
“She fetched a knife inside the house and stabbed me for allowing the neighbour to take my grandchild. We had to get the child away because she was hurting him so much,” a tearful Petersen said, adding that her daughter has been in and out of rehabilitation facilities. “She doesn’t understand or see how the drugs and alcohol are bringing out the devil in her.”
Western Cape police spokesperson Lieutenant-Colonel FC van Wyk confirmed that the 19-year-old was arrested and charged with assault with intent to cause grievous bodily harm after being reprimanded for hitting her baby.
National Prosecuting Authority (NPA) regional spokesperson Eric Ntabazalila confirmed that Loranca appeared in the Goodwood Magistrate’s Court on Friday and was granted conditional bail. The case was postponed to 8 December for further investigation.
Local drug labs and knives as a ‘tool of the trade’
Institute for Security Studies (ISS) crime expert Willem Els said recent police raids on clandestine drug laboratories show that methamphetamine and Mandrax are being manufactured locally on a large scale, alongside narcotics imported via the “Southern Route” through Tanzania and Mozambique.
“South Africa is one of the very few countries where Mandrax is still being abused on quite a high scale. The other country that’s been mentioned is Malawi. Since the 1950s, Mandrax has been used as a sedative. It’s been banned in almost every country, but it remains very much a go-to or a downer here in South Africa,” Els said.
Because Mandrax is cheap and readily available, consumption is heavily concentrated on the Cape Flats, and increasingly in Johannesburg and Nelson Mandela Bay.
Els noted that beyond fuelling domestic and street-level aggression—particularly around illegal liquor outlets—the lucrative drug trade drives brutal turf wars over supply routes. While illegal firearms remain the primary weapon in over 62% of Western Cape murders, quarterly crime statistics show knives are used in 13% of killings, serving as an everyday “tool of the trade” for threatening, fighting, and killing.