SOUTH AFRICAN COMMUNITY EPIDEMIOLOGY NETWORK ON DRUG USE (SACENDU)

Transcription

1 SOUTH AFRICAN COMMUNITY EPIDEMIOLOGY NETWORK ON DRUG USE (SACENDU) SACENDU Report Back Meetings - May 2015 MONITORING ALCOHOL AND DRUG TRENDS July-ember Phase 37

2 South African Community Epidemiology Network on Drug Use (SACENDU) Monitoring Alcohol, Tobacco and Drug Abuse Treatment Admissions in South Africa August 2015 Phase 37 July - ember Siphokazi Dada, Cape Town Nadine Harker Burnhams, Cape Town Yolanda Williams, Cape Town Jodilee Erasmus, Cape Town Charles Parry, Cape Town Arvin Bhana, KwaZulu-Natal Furzana Timol. KwaZulu-Natal Erika Nel, Gauteng Diana Kitshoff, Port Elizabeth Roger Weimann, East London David Fourie, SANCA Three reports have been produced: a) SACENDU Update b) SACENDU Research Brief c) Monitoring Alcohol, Tobacco and Other Drug Use Treatment Admissions in South Africa (this report) For copies of these reports contact: Miss Jodilee Erasmus Alcohol, Tobacco & Other Drug Research Unit Medical Research Council PO Box TYGERBERG South Africa Tel.: +27(0) jodilee.erasmus@mrc.ac.za We are grateful to the National Department of Health (Mental Health & Substance Abuse Directorate) for their funding of this project.

3 Table of Contents Section Title Page List of presentations at SACENDU report back meetings ii Section 1: INTRODUCTION 1 Section 2: TREATMENT CENTRE DATA 3 2a. Treatment centres: Cape Town 3 2b. Treatment centres: Gauteng 14 2c. Treatment centres: Northern Region 27 2d. Treatment centres: Port Elizabeth 35 2e. Treatment centres: SANCA East London 44 2f. Treatment centres: KwaZulu-Natal 52 2g. Treatment centres: Central Region (Free State, Northern Cape & North 60 West) i

4 PRESENTATIONS AT SACENDU REPORT BACK MEETINGS (Not included in this report but available on PRESENTATION PRESENTED BY PRESENTED IN Treatment Centres: Gauteng data Ms Erika Nel Pretoria Treatment Centres: Northern Cape Ms Jodilee Erasmus Pretoria Results from the Service Quality Metrics Initiative Ms Kim Johnson Pretoria Results from the Rapid Assessment of HIV prevalence Mr Nelson Medeiros Pretoria Among People Who Inject Drugs Study Pain and OTC/Prescription Opioid Dependence Dr Hashendra Ramjee Pretoria Identifying the constituents of the street drug Nyaope Dr Aye Aye Khine Pretoria by two mass spectroscopic methods Whoonga and the abuse and diversion of Dr Janan Dietrich Pretoria Antiretrovirals Efficacy of brief motivational interviewing on Dr Goedele Louwagie Pretoria smoking cessation at tuberculosis clinics in Tshwane, South Africa: A Randomised Controlled Trial Treatment Centres: KwaZulu-Natal data Ms Furzana Timol Durban Findings from the implementation of the SQM Ms Kim Johnson Durban Initiative in the Western Cape Results from the Rapid Assessment of HIV Prevalence Among People Who Inject Drugs Study Ms Robin Ogle Durban Drug abuse in the Northern Province s Mr ember Mpanza Durban Umkhanyakude District Cannabis use among adolescents using large survey Prof Arvin Bhana Durban data Understanding and responding to codeine misuse and dependence in South Africa what can we learn from substance abuse treatment admissions? ii Dr Nadine Harker Burnhams Durban Treatment centres: Port Elizabeth data Ms Diana Kitschoff Port Elizabeth Treatment centres: East London data Mr Roger Weimann Port Elizabeth Acknowledging the gap: The scholastic problem of childhood ADHD is a risk factor for substance abuse and mood disorders Ms Judith Regnart Port Elizabeth Results from the Rapid Assessment of HIV Prevalence Ms Andrea Schneider Port Elizabeth Who Inject Drug Study A pharmacological overview of opioid analgesic with Prof Ilse Truter Port Elizabeth emphasis on the prescribing of codeine Counselling in community pharmacies: Codeinecontaining Dr Brent Knoesen Port Elizabeth analgesics The use of the possible self-tree in an in-patient Ms Sue Bond Port Elizabeth rehabilitation program Treatment Data: Western Cape Ms Jodilee Erasmus Cape Town Findings from the implementation of the SQM Dr Bronwyn Myers Cape Town Initiative in the Western Cape Results from the Rapid Assessment of HIV Prevalence Dr Andrew Scheibe Cape Town Among People Who Inject Drugs Study An evaluation of the effectiveness of the institutional Mr Sean Whiting Cape Town mechanism to manage substance abuse Social representation of alcohol use amongst women Ms Jane Kelly Cape Town

5 who drank while pregnant Formative Results from the Drug-Pricing Study Dr Simon Howell Cape Town Common co-occurrence: Tuberculosis and addictive Ms Anna Versfeld Cape Town substance use Substance use and mental disorders in injured Dr Claire van der Cape Town emergency centre patients: opportunities for intervention Westhuizen Aims and objectives of the South African Alcohol Policy Alliance Ms Aadielah Maker Cape Town iii

6 SECTION 1: INTRODUCTION Ms Siphokazi Dada & Dr Nadine Harker Burnhams This report contains detailed data from specialist substance abuse treatment centres in six sites that now comprise the South African Community Epidemiology Network on Drug Use in the Western Cape, KwaZulu-Natal (mostly Durban and Pietermaritzburg), Eastern Cape (Port Elizabeth, East London), Gauteng province, Mpumalanga and Limpopo provinces (now termed the Northern Region), and the so-called Central Region (comprising of the Free State, Northern Cape and North West provinces). Data collection in Limpopo province began in July 2007 from one centre in Polokwane. Summary of Findings In general and across most provinces, alcohol remained the most common primary substance (except for the GT, WC and NR) and no doubt still causes the biggest burden of harm in terms of both communicable and non-communicable diseases. This period did see a slight decrease in the proportion of patients seeking treatment for alcohol in the WC and GT. In contrast, KZN saw a marked increase. Changes in under 20 treatment admissions in the KZN region should be monitored over the next reporting periods. Cannabis was still the most common illicit drug used, especially among youth attending specialist treatment centres, except in the CR where alcohol was the primary substance of abuse among youth. For this period, overall (<20s and >20s) treatment admissions with cannabis as a primary drug of abuse increased slightly in KZN region, with a slight decrease noted in the GT and NR regions. (MA) remained the second substance of choice among under 20 patients in the WC. Port Elizabeth continues to see a gradual increase of local patients admitted for treatment over the years. The proportion of admissions for cocaine remained fairly low and stable across sites, and was more reported as a secondary drug. Relatively few patients younger than 20 years were admitted for cocaine-related problems. Heroin use remains a growing problem across most sites, except in NR where it has remained stable. Mostly heroin was smoked although there was a steady increase of patients reporting injecting heroin. Patients from treatment centres also reported injecting other drugs, such as cocaine, methcathinone (CAT), MA and over-the-counter or prescription (OTC/PRE) medicines. This is of concern since injection use and sharing of needles is associated with health and social harms such as hepatitis and other infectious diseases, more specifically HIV. Club drugs and OTC/PRE medicines were still more common as secondary substances. The abuse of OTC/PRE such as slimming tablets, analgesics, and benzodiazepines (e.g. diazepam and flunitrazipam) continued to be an issue across sites. Treatment admissions for OTC/PRE medicine, as a primary or secondary drug of abuse, were between 1% (NR) and 14% (EC). During this reporting period, 264 (2.6%) patients across all sites reported the non-medical use of codeine, with the majority of patients coming from the EC (10.1%). CAT, a synthetic stimulant, continues to show an increase in most provinces particularly in Gauteng. Seventy-nine patients younger than 20 years reported CAT use in the Gauteng. Poly-substance abuse remains high across provinces, with between 17% and 44% of patients indicating more than one substance of abuse. 1

7 The proportion of patients seeking treatment for use of Nyaope/Whooga (cheap form of heroin mixed with cannabis) has slightly increased in the NR and remains fairly low in other regions. Overall, and across all regions 13% of patients presented with a dual diagnosis at treatment admission. The majority of patients reported mental health problems at the time of admission (36%), followed by hypertension (17%) and respiratory diseases (12%). A higher proportion of patients suffering from mental health problems were found in the WC, accounting for 40%, a higher proportion of patients suffering from hypertension were found in the NR accounting for 29% of admissions. Presentations made at the SACENDU regional meetings are available. These can be accessed online at For any queries please contact Yolanda Williams at yolanda.williams@mrc.ac.za or , We hope you will find this report of value to you in your work. If you have any specific feedback or comments on the report, please contact us at nadine.harker.burnhams@mrc.ac.za /siphokazi.dada@mrc.ac.za or fax us at It remains for us to especially thank Mrs Yolanda Williams and Ms Jodilee Erasmus for their hard work in preparing the data and this report and all the provincial coordinators for their input and continued support (Arvin Bhana, Aurene Wilford and Furzana Timol in KZN, Erika Nel in Gauteng, Diana Kitshoff and Roger Weimann in the EC). Also thanks to the various members of the network who have provided data, presentations or comments, and the Mental Health & Substance Abuse Directorate of the National Department of Health and the National Department of Social Development for their financial support of this project. Their support has among other things been used to collect treatment information on almost treatment episodes annually, to facilitate hosting regional meetings attended by approximately 200 persons every six months, and the preparation and mailing of reports that are sent bi-annually to over 300 persons. 2

8 SECTION 2: Treatment Centre data 2a: Treatment Centres: Western Cape Ms Siphokazi Dada Data were collected, on a monthly basis, from 33 specialist treatment centres. Overall 3444 patients were treated across all treatment centres for the period July ember when compared to 3510 in the previous six month review period. Table 1: Proportion of treatment episodes (Western Cape) 3 % % % % % % % Claro Clinic Crescent 1 1 < CTDCC CTDCC M/Plain De Novo Hesketh King <1 1 2 Kenilworth <1 Kensington Treatment centre Ramot SANCA WC Stepping Stones Stikland Sultan Bahu Tableview Matrix Tafelsig Clinic Matrix Delft Matrix Khayelitsha Matrix Parkwood Matrix Toevlug Toevlug Youth <1 - Western Cape Youth Centre Help-me-network Hope House Helderberg CARES Houtbay CARES Lighthouse <1 1 - Living Grace Wayout Total in treatment *= Includes SANCA George

9 Table 2: First time admissions (Western Cape) In Table 2 Yes indicates a first time admission and No indicates a repeat admission. The proportion of new admissions increased to 79% in this period, a 4% increase from the last review period % % % % % % % % % % % YES NO Table 3: Type of treatment received (Western Cape) The majority of patients are treated on an outpatient basis. This finding has remained fairly consistent over the last 2 years. % % % % % % % % % % Inpatient Outpatient Table 4: Referral sources (Western Cape) During this review period, the proportions of referrals sources remain fairly stable. % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse Religious body Hospital/clinic Social services/welfare Court/correctional services School Other e.g. radio

10 Table 5: Population profile (Western Cape) Males continue to predominate consistently around 73% of patients, but a slight increase in female patients was noticed in this period (27%). A greater proportion of patients were Coloured (71%), followed by Black African patients (16%), no change has been noticed in this period. A greater proportion of the patients were unemployed for more than six months (31%), followed by those working full-time (20%) and pupils/learners at school (15%). Three quarters of the patients have completed secondary education (Grade 8-12), 13% have primary education and 8% have a tertiary education. % % % % % % % % % GENDER Male Female ETHNIC GROUP Black African Indian 1 1 <1 < Coloured White EMPLOYMENT STATUS Working full-time Working part-time Unemployed (unspecified period) Unemployed (< 6 months) Unemployed (> 6 months) Student/Apprentice/i nternship <1 - - <1 <1 <1 <1 3 8 Pupil/learner at school Disabled: not working Housewife <1 <1 <1 <1 <1 2 <1 <1 <1 Pensioner/ <1 retired MARITAL STATUS* Married, living with spouse Married, not living with spouse Living together Divorced Widowed Never married Other 2 - < EDUCATION** None <1 <1 1 <1 <1 <1 <1 <1 1 5

11 Primary Secondary Tertiary *we are no longer collecting data on marital status **Highest school education completed Table 6: Age distribution (Western Cape) The age range of patients in treatment was from 9 to 74 years. Forty percent of the patients in treatment were younger than 25 years, remaining stable as in the previous period. Age in Years n % n % n % n % n % n % <1 1 < < <1 12 < <1 9 <1 Table 7: HIV Tested in the past 12 months (Western Cape) Sixty-six percent of patients reported that they have been tested for HIV in the last 12 months, a slight decrease compared to the previous period. Tested for HIV in the past 12 months % % % % Yes No line to answer Table 8: Primary substance of abuse (Western Cape) was still the most common primary substance of abuse, accounting for 35% of patient admissions. has remained stable when compared to the previous period (33%). The proportion of patients admitted for heroin dependence decreased to 13% while the proportion of patients admitted for other drugs remained stable. 6

12 % % % % % % % % % % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin Ecstasy <1 - - <1 <1 <1 <1 <1 <1 <1 OTC/PRE < < Other <1 - - < Methcathinone ( CAT ) < <1 8 1 <1 <1 Inhalants <1 <1 1 <1 - Khat - - <1 <1 <1 <1 <1 <1 <1 - Table 9: Overall proportion of substances used (Western Cape) The overall proportion of primary and secondary drugs of abuse is shown in the table below., alcohol and cannabis were the most common drugs used. The proportion of cannabis admissions increased slightly, while the proportion of methamphetamine admissions remained stable compared to the previous period. A slight decrease in the proportion of heroin was also noticed during this period. % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine OTC/PRE Ecstasy <1 - Heroin Inhalants <1 1 1 <1 <1 Khat <1 <1 <1 <1 <1 <1 <1 <1 - - LSD <1 <1 - <1 <1 <1 < Other <1 1 <1 <1 1 - Methcathinone ( CAT ) <1 <1 Note: The table shows the proportion reporting each drug either as primary or secondary drug. 7

13 Table 10: Mode of usage of primary drug (Western Cape) In looking at the mode of usage of the primary drug, 25% of patients reported swallowing their substances. When alcohol was excluded, 95% reported smoking as their mode of use. Only 1% of patients reported that they injected drugs (all drug variants). The proportion of patients who specifically injected heroin remained stable in this period. e % % % % % % % % % Swallowed 30(3) 28(1) 25(1) 25 (2) 23(2) 22(3) 23(2) 22 (2) 25(3) Snorted 2(3) 2(3) 4(5) 3 (4) 2(2) 2(2) 2(2) 2(2) 1(2) Injected 1(1) 1(1) 1(2) 1 (2) 1(1) 1(1) 1(2) 1(1) 1(1) Smoked 67(93) 67(95) 70(92) 70(92) 74(95) 74(92) 74(94) 75(04) 73(95) Other/ Combination Injected Heroin <1(<1) <1(<1) <1(<1) 1(1) <1(<1) 1(2) 1(<1) <1(<1) <1(<1) Figures in brackets exclude alcohol Table 11: Mean age by primary substance of abuse (Western Cape) For this period the mean age was recorded as 29 years of age. The data shows that the mean age for patients whose primary substance of abuse was alcohol and over-the-counter or prescription medicine has decreased to late 20s compared to previous years (see Table 11). The mean age for patients with other substances remained fairly stable. YEARS Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin Ecstasy 23 50* 20* 28* 28* * OTC/PRE Inhalants Khat - 37* 29* 36* 26 27* Methcathinone ( CAT ) Nyaope/Whoonga Overall mean age * N < 5 8

14 Table 12: Gender, by primary substance of abuse (Western Cape) Cannabis and heroin (76%), crack/cocaine (77%) and the cannabis/mandrax combination (75%) remained mainly male substances of abuse as indicated in Table 12. Proportionately more females were treated for the use of heroin, CAT, and methamphetamine. During this reporting period, a higher proportion of male patients were treated for use of OTC/PRE medications. M F M F M F M F M F M F M F % % % % % % % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin Ecstasy * 67* OTC/PRE Inhalants Khat Methcathinone ( CAT ) Nyaope/Whoonga Table 13: Race by primary substance of abuse (Western Cape) The percentages shown in Table 13, total across the rows. Similar to previous review periods, the proportion of Coloureds in treatment remains higher than any other race groups, with Indians making up 1% of patients in treatment. The proportion of Coloureds in treatment for the majority of substances including cannabis/mandrax (79%), methamphetamine (72%), cannabis (73%) and heroin (67%) is far greater than for any of the other groups. A significant increase in proportion of heroin admissions in Black Africans and a significant increase in Coloured patients reporting cannabis as primary substance of abuse was noted in this period. BLACK AFRICAN COLOURED INDIAN WHITE 9 % % % % % % % % % % % % Alcohol Cannabis/Mandrax* Cannabis < Crack/Cocaine Ecstasy ** Heroin < <1 < Inhalants OTC/PRE

15 BLACK AFRICAN COLOURED INDIAN WHITE % % % % % % % % % % % % Khat Methcathinone ( CAT ) **N <3 not reported Table 14: Multiple substance use (Western Cape) Up to 44% of patients reported using more than one substance of abuse, and this proportion decreased slightly compared to the last period (49%). Primary substance only Primary +2 nd substance Primary+2 nd +3 rd substance Primary +2 nd 3 rd +4 th substance Total no. of patients n % n % n % n % n % n % Table 15: Source of payment (Western Cape) Patients often report a combination of sources of funding for treatment. The category State (52%) was the most common source of payment, followed by family/friends only (18%). Other refers to combination of sources paying for treatment for patients, but it also includes the centres where treatment is offered for free. This category slightly increased during this period. % % % % % % % % % Self Medical Aid State Family/friends State & self Work/employer Unknown Other/combinations CoCT

16 Table 16: Frequency of use by primary drug (Western Cape) The majority of patients reported OTC/PRE (81%) and heroin (91%) as their most daily used substance, while only 68% of cannabis/mandrax, 60% of CAT and 64% of methamphetamine patients reported daily use. Forty-eight percent of patients also reported daily use of crack/cocaine, this proportion significantly decreased during this period. Frequency of use in the past month Not used in the Once per week 2-6 days per Daily past month or less often week % % % % Alcohol Cannabis Cannabis/Mandrax* 4 3 1** Ecstasy ** ** Crack/ Cocaine 8-2* Heroin OTC/PRE ** ** Methcathinone ** ( CAT ) Inhalants ** **: N<5 DATA ON PATIENTS AGED 20 YEARS AND YOUNGER Table 17: Gender and race profile of patients <20 years (Western Cape) The majority of patients younger than 20 years were males (79%). Coloured patients constituted 71% of these patients and a quarter of patients were Black African. 11 % % % % % % % % % GENDER Male Female ETHNIC GROUP Black/African Coloured Indian 1 <1 - <1 1 <1 - <1 <1 White

17 Table 18: Primary substance of abuse of patients <20 years (Western Cape) Most young patients were treated for the abuse of cannabis or methamphetamine. The proportion of adolescent patients treated for alcohol significantly decreased during this period, with a corresponding increase in cannabis admissions. e n % n % n % n % n % n % Alcohol Cannabis Cannabis/Mandrax* Crack /Cocaine <1 2 <1 2 < Heroin Ecstasy <1 1 <1 OTC/PRE 2 < <1 1 < Inhalants <1 - - Methcathinone ( CAT ) <1 1 < Nyaope/Whoonga <1 - - Total Table 19: Primary substance by gender of patients <20 years (Western Cape) Nearly a quarter of adolescent patients who used cannabis/mandrax, cannabis and methamphetamine were female. The majority of other substances were reported by male patients. M F M F M % M F M F M F % % % % % % Alcohol Cannabis Cannabis/Mandrax* 91 9** Crack/Cocaine 75** 25** ** Heroin Ecstasy Inhalants 91 9** OTC/PRE 50** 50** ** 0 Methcathinone ( CAT ) ** ** N<5 12

18 Table 20: Primary substance by race of patients <20 years (Western Cape) Black African Coloure d Indian White Black African Coloured Indian White n % n % n % n % n % n % n % n % Alcohol Crack/ Cocaine Cannabis Cannabis/Mandrax* * 0 0 Heroin Inhalants < OTC/PRE * 40* * Methcathinone ( CAT ) *

19 2b: Treatment Centers: Gauteng Ms Erika Nel Table 21: Proportion of treatment episodes (Gauteng) 14 n % n % n % n % n % n % Elim Clinic S/Eastern Gauteng < S/Central Rand S/Eerste Rust S/Nishtara S/Vaal Triangle Magaliesoord Castle Carey House of Mercy Stabilis Horizon Clinic Thusong <1 Houghton House <1 S/West Rand S/JHB Society Wedge Gardens SANCA Soweto < Greater Heidelberg Fabian Ribeiro Viewpoint Recovery Centre Eden Recovery Centre <1 14 <1 10 <1 3 <1 2 <1 Mighty Wings Crossroads <1 - - Total number in treatment Data were collected from 18 specialist treatment centres on a monthly basis during this review period. A total of 3372 patients were treated at Gauteng treatment centres during the period July ember.

20 Table 22: First time admissions (Gauteng) Eighty-three percent of patients were admitted to treatment for the first time during this period, increasing slightly compared to the previous period (85%). % % % % % % % % % % Yes No Table 23: Type of treatment received (Gauteng) During July ember half of the patients were treated at outpatient centres and and the other half at inpatient centres. The proportion of inpatients has increased slightly compared to the previous period. e % % % % % % % % % Inpatient Outpatient Table 24: Referral sources (Gauteng) A slight decrease in referrals from school was noted in this period. Other categories remained fairly stable. % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse (health professional) Religious body Hospital/clinic Social services/welfare Court/correctional services School Other, e.g. radio

21 Table 25: Population profile (Gauteng) Very little change has been noted in the population profile over the last few periods. Over a third of patients were unemployed. The majority of patients (80%) had secondary education, this proportion has remained fairly stable compared to the previous period; and a slight decrease in proportion of students/pupils and an increase in patients who were White was also noticed. Other categories remained fairly stable. % % % % % % % % % GENDER Male Female ETHNIC GROUP Black/African Indian Coloured White EMPLOYMENT STATUS Working full-time Working part-time Unemployed (unspecified period) Unemployed (< 6 months) Unemployed (> 6 months) Students/apprenticeship/internship <1 <1 <1 1 <1 <1 <1 4 4 Pupil/learner at school Medically boarded/disabled 1 <1 <1 <1 <1 <1 <1 <1 <1 Housewife <1 Pensioner/retired MARITAL STATUS* Married, living with spouse Married, not living with spouse Living together/ cohabiting Divorced Widowed Never married EDUCATION None <1 <1 - - <1 <1 <1 <1 1 Primary Secondary Tertiary Mean age *We are no longer collecting data on marital status 16

22 Table 26: Age distribution (Gauteng) The age range of patients in treatment was from 8 to 78 years. The proportion of patients aged years saw a slight decrease from 27% to 24% this review period. Years n % n % n % n % n % n % n % < <1 2 < <1 4 < Table 27: Primary substance of abuse (Gauteng) The most common primary substance of abuse in Gauteng during the July ember period was cannabis (36%), a significant decrease compared to the last period. This was followed by alcohol, which remained stable compared to the previous period. Crack/cocaine, heroin, nyaope/whoonga and CAT admissions remained stable when compared to the previous period. n % n % n % n % n % n % Alcohol Cannabis/ Mandrax* Cannabis Crack/Cocaine Heroin Ecstasy <1 9 <1 5 <1 9 <1 9 < 1 OTC/PRE Methcathinone ( CAT ) 2 Methamphetamin e Khat <1 1 < 1 Inhalants Other <1 1 <1 5 <1 11 <1 4 < 1 17

23 Nyaope/Whoonga Total Table 28: Mode of usage of primary drug (Gauteng) In looking at the mode of use of the primary drug in the table below, 21% of patients reported swallowing their substances, while 62% reported smoking their substances, slight decrease when compared to he previous review period. When alcohol was excluded, 77% reported smoking as their mode of use, a slight decrease compared to previous periods. Only 3% of patients reported injecting their drug of choice. % % % % % % % % Swallowed 40(4) 41 (9) 37(5) 31(5) 30(4) 27(3) 20(2) 21(2) Snorted** 9(14) 12(19) 13(20) 11(15) 11(15) 12(16) 11(14) 13(16) Injected 3(4) 3(4) 3(4) 2(3) 2(3) 3(5) 1(2) 3(4) Smoked 47(75) 44(68) 47(70) 56(77) 57(78) 57(76) 67(82) 62(77) *If alcohol is not taken into account, the figures in brackets apply ** Included with snorted are sniffed and inhaled Table 29: Gender by primary substance of abuse (Gauteng) Male patients continue to dominate admissions for treatment. However, a third of patients who used OTC/PRE were females. M F M F M F M F M F M F M F % % % % % % % % % % % % % % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin OTC/PRE Ecstasy Methcathinone ( CAT ) Inhalants Khat * 0 Nyaope/Whoonga Table 30: Mean age by primary substance (Gauteng) Patients treated for inhalants were the youngest on average, followed by those treated for cannabis and cannabis/mandrax (Table 30). For this period, the average age for alcohol and OTC/PRE medication abuse was 33 and 37 years, respectively. 18

24 YEARS Alcohol Cannabis/Mandrax* Cannabis Cocaine/Crack Heroin Ecstasy 23 21* Methcathinone ( CAT ) Inhalants OTC/PRE Khat Nyaope/Whoonga Table 31: Race by primary substance of abuse (Gauteng) A third of patients treated for methamphetamine, alcohol and CAT abuse were White, while the majority of cannabis, nyaope/whoonga, heroin and cannabis/mandrax patients were of Black African descent (Table 31). A significant increase was noted in the proportion of Black African patients admitted for methamphetamine, OTC/PRE and CAT use when compared to the previous review period. This period saw a significant increase in the proportion of White patients using heroin. BLACK AFRICAN COLOURED INDIAN WHITE % % % % % % % % % % % % Alcohol Cannabis/ Mandrax* Cannabis Crack/ cocaine Ecstasy Heroin Meth-cathinone ( CAT ) Inhalants OTC/PRE Nyaope/Whoonga <

25 Table 32: Second most frequently abused substance (Gauteng) Alcohol, cannabis and CAT, were the most common secondary drugs of abuse. n % n % n % n % n % n % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin Ecstasy OTC/PRE Methcathinone ( CAT ) Inhalants < Other Nyaope/Whoonga TOTAL Table 33: Third most frequently abused substance (Gauteng)** ** ** n % n % n % n % n % n % Alcohol Cannabis/ Mandrax* Cannabis Crack/Cocaine Heroin Ecstasy OTC/PRE Methcathinone ( CAT ) Inhalants Other Tobacco Nyaope/Whoonga TOTAL **Data on 3 rd and 4 th substance of abuse are no longer collected 20

26 Table 34: Fourth most frequently abused substance (Gauteng)** ** ** n % n % n % n % n % n % Alcohol Cannabis/ Mandrax* Cannabis Cocaine/Crack Heroin Ecstasy OTC/PRE Methcathinone ( CAT ) Inhalants ( Tik/Speed ) Other Tobacco Nyaope/Whoonga TOTAL **Data on 3rd and 4th substance of abuse are no longer collected Table 35: Overall use (reported as primary or secondary substance of abuse) (Gauteng) Consistent with previous review periods, overall, cannabis, alcohol and heroin remained the most common substances of abuse in this region. An increase in CAT was also noticed in this period. Admissions for nyaope/whoonga use however remained stable across three review periods. n % n % n % n % n % n % Alcohol Cannabis/Mandrax * Cannabis Crack/Cocaine Heroin Ecstasy <1 21 <1 OTC/PRE Methcathinone ( CAT ) Other Inhalants Nyaope/Whoonga TOTAL

27 Table 36: Suburb of residence (Gauteng) METRO SUBSTRUCTURE n % n % n % n % n % n % Greater Pretoria MS Greater Johannesburg MS Kyalami MS N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A East Rand MS N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A West Rand MS N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Vaal MS N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Townships in Gauteng N/A N/A N/A N/A N/A N/A N/A N/A Other parts of N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A province OTHER PROVINCES Mpumalanga Limpopo North West Northern Cape <1 8 <1 11 <1 13 <1 5 <1 Eastern Cape 13 <1 6 <1 14 < <1 Free State Kwa-Zulu Natal < < Western Cape <1 1 <1 3 <1 12 <1 7 <1 OTHER COUNTRIES 13 <1 12 <1 9 <1 12 <1 10 <1 6 <1 Total number on whom information was available Table 37: Sources of payment (Gauteng) A slight decrease in payments by medical aid was noticed in this period. Proportions by other sources of payment remained fairly stable compared to the previous period. % % % % % % % % % % State Medical Aid Family Friends < Employer Self Other/Comb < <1 Unknown

28 Table 38: HIV tested in the past 12 months (Gauteng) Forty-eight percent of those who completed the question Have you been tested for HIV in the past 12 months indicated that they had been tested, an increase compared to the two previous periods. Tested for HIV in the past 12 months n % n % n % Yes No lined to answer TOTAL DATA ON PATIENTS AGED 20 YEARS AND YOUNGER Table 39: Gender, Race and Education of Patients aged 20 years and younger (Gauteng) Up to 69% of patients younger than 20 years were of Black African descent. This review period also showed a slight decrease in the proportion of < 20 with secondary education (80%) <1 <1 <1 <1 % % % % % % % % % GENDER Male Female ETHNIC GROUP Indian Black/African Coloured White EDUCATION None/Preprimary Primary Secondary Tertiary <

29 Table 40: Primary substance of abuse for patients aged 20 years and younger (Gauteng) The most common primary drug of abuse amongst young patients was cannabis, although this proportion has significantly decreased compared to the last period. This was followed by CAT and alcohol. This period has seen an increase in the proportion of <20s admitted for problematic alcohol and CAT use. n % n % n % n % n % n % n % Alcohol Cannabis Cannabis/ Mandrax* Crack/ Cocaine Heroin Ecstasy 1 < <1 1 <1 1 <1 2 <1 OTC/PRE < < <1 4 <1 Inhalants Methcathinone ( CAT ) Nyaope/Whoonga TOTAL Table 41: Gender by primary substance of abuse for patients aged 20 years and younger (Gauteng) M F M F M F M F M F M F M F % % % % % % % % % % % % % % Alcohol Cannabis Cannabis/ Mandrax* Crack/Cocaine Heroin Ecstasy Inhalants OTC/PRE Methcathinone ( CAT ) Nyaope/Whoonga

30 Table 42: Race by primary substance of abuse for patients aged 20 years and younger (Gauteng) Sixty-nine percent of teenage heroin patients were Black African, compared to 57% of patients aged 20 or older. This proportion decreased slightly compared to the previous review period (78%). A significant increase was also noticed in the proportion of Black African patients who abused nyaope/whoonga, from 81% to 92% in this period. BLACK/AFRICAN COLOURED INDIAN WHITE % % % % % % % % % % % % Alcohol Cannabis < Cannabis/ Mandrax* Crack/Cocaine Heroin Ecstasy Inhalants OTC/PRE Methcathinone ( CAT ) Nyaope/Whoonga Table 43: Secondary substance of abuse for patients aged 20 years and younger (Gauteng) Cannabis, alcohol and CAT remaiedn the most common secondary drugs. Jan n % n % n % n % n % n % Alcohol Cannabis Cannabis/Mandrax* <1 5 1 Crack/Cocaine <1 9 1 Heroin Ecstasy < <1 Inhalants OTC/PRE <1 2 < <1 - - Methcathinone < ( CAT ) < Nyaope/Whoonga < <1 Other TOTAL

31 Table 44: Mode of usage of primary substance of abuse for patients aged 20 years and younger (Gauteng) % % % % % % % % % % Swallowed Snorted Injected <1 11 <1 <1 1 <1 2 Smoked Combination <1 <1 <1 Table 45: Referral Sources for patients aged 20 years and younger (Gauteng) A higher proportion of patients (38%) were referred to treatment centres by school and this has remained fairly stable compared to the previous period. This was followed by self/family/friends (33%) and social services/welfare (11%). Other categories remained stable. % % % % % % % % % % Self/Family/Friends Work/Employer <1 <1 <1 1 <1 1 <1 <1 1 <1 Health professional Religious body 1 <1 <1 1 1 <1 1 <1 <1 <1 Hospital/Clinic 2 <1 1 1 < Social Services/Welfare Court/Correctional services School Other Unknown

32 2c: Treatment Centres: Northern Region Ms Siphokazi Dada Table 46: Number of treatment episodes (Northern Region) Data were collected from 5 specialist treatment centres on a monthly basis. Overall, 1135 patients were treated across all treatment centres for the period July ember as compared to 1004 in the previous six month period. Number Swartfontein (Inpatient) MARC (In-patient) 2 39 MARC (Out-patient) Sanca Witbank (Out-patient) Sanca Nelspruit (Out-patient) (LADHC) SANCA Far North (Polokwane) (Outpatient) Healing Wings Healing Wings Youth Total number in treatment Table 47: First Time Admissions (Northern Region) First-time admissions continue to remain stable (95%) % Yes No

33 Table 48: Type of treatment received (Northern Region) Consistent with previous reporting periods, the majority of patients were treated on an outpatient basis (86%), remaining fairly stable compared to the previous period.. % Inpatient Outpatient Table 49: Referral sources (Northern Region) Family/friends or self continue to be the most common sources of referral (49%), followed by school (16%) and work/employer (13%). A slight decrease in referrals by health professionals and social/welfare services was noticed, while other categories remained stable. % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse (health professional) Religious body <1 Hospital/clinic <1 Social services/welfare Court/correctional services School Other, e.g. radio Table 50: Age distribution (Northern Region) The mean age of all patients in this reporting period was 27 years. Twenty-six percent of patients were younger than 20 years. Age Category Jan 28 %

34 <1 1 1 <1 65 <1 1 <1 <1 1 <1 1 <1 <1 Table 51: Population profile (Northern Region) A slight increase in the proportion of patients who were unemployed was noted during this period, and majority have been unemployed for more than six months (26%). Majority of patients have completed secondary school (83%) and other categories remained fairly stable compared to the previous period. Jan Black African Coloured Indian White EMPLOYMENT STATUS Working full time Working part time Unemployed (unspecified period) Unemployed (<6 months) Unemployed (<6 months) Student/Apprentice/internship <1 < Pupil/learner at school Disabled/medically boarded <1 <1 <1 - <1 <1 <1 - Housewife <1 - <1 <1 <1 - <1 <1 Pensioner/retired <1 1 1 <1 MARITAL STATUS* Married, living with spouse Married, not living with spouse Living together Divorced Widowed Never married Other EDUCATION None <1 1 <1 Primary Secondary Tertiary *We are no longer collecting data on marital status 29 % GENDER Male Female