Monitoring Alcohol, Tobacco and Other Drug Abuse Treatment Admissions in South Africa

Transcription

1 Monitoring Alcohol, Tobacco and Other Drug Abuse Treatment Admissions in South Africa FEBRUARY 6 Phase 38 JANUARY - JUNE Siphokazi Dada, Cape Town Nadine Harker Burnhams, 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

2 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: Mrs Kholiswa Dube Alcohol, Tobacco & Other Drug Research Unit Medical Research Council P.O Box TYGERBERG South Africa Tel.: +27(0) We are grateful to the National Department of Health (Mental Health & Substance Abuse Directorate) for their funding of this project. ISBN: February 6

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 1 2c. Treatment centres: Northern Region 28 2d. Treatment centres: Port Elizabeth 36 2e. Treatment centres: SANCA East London 6 2f. Treatment centres: KZN 5 2g. Treatment centres: Central Region (Free State, Northern Cape & North West) 6 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 and Central Ms Jodilee Erasmus Pretoria Region data The CODEMISUSED Project: Update on Prof Charles Parry Pretoria Survey of addiction treatment providers (WP5) and innovations in treating codeine dependence Alcohol marketing and adolescent alcohol Prof Neo Morojele Pretoria consumption: results from the International Control (IAC) Study (South Africa) Challenges while conducting the International Alcohol Control Study (IAC) in Tshwane, South Africa Using Respondent-Driven Sampling (RDS) to recruit illegal poly-substance users in Cape Town, South Africa: Implications and Future Directions Ms Elmarie Nel/Dr Nadine Harker Burnhams Dr Nadine Harker Burnhams ii Pretoria Pretoria Treatment centres: KwaZulu-Natal data Ms Furzana Timol Durban Multiple addictions amongst in-patients being treated for substance use disorders in Durban, South Africa Dr Helen Keen Durban The ADF Outpatient Model working with heroin (sugars/whoonga) addiction The importance of a holistic approach to provide HIV prevention services for People Who Inject Drugs in South Africa ethekwini Using respondent-driven Sampling (RDS) to recruit illegal poly-substance users in Cape Town, South Africa: Implications and Future Directions Cops, drugs and interloping academics: An ethnographic justification for harm reduction-based programs in South Africa Mr Sam Pillay Durban Ms Kalvaynya Padayachee Durban Dr Nadine Harker Burnhams Dr Monique Marks / Dr Simon Howell Durban Durban Treatment centres: Port Elizabeth data Ms Diana Kitshoff Port Elizabeth Treatment centres: East London data Mr Roger Weimann Port Elizabeth Drug Pricing Study Results from the Dr Simon Howell Port Elizabeth pilot implementation Using respondent-driven Sampling (RDS) to Dr Nadine Harker Burnhams Port Elizabeth

5 recruit illegal poly-substance users in Cape Town, South Africa: Implications and Future Directions Alcohol control policies in 6 African Prof Charles Parry Port Elizabeth countries: Opportunities for Improvement Visual aid presentation Dr Adriaan Lombard Port Elizabeth Ernest Malgas Treatment Centre for Ms Renee Symons Port Elizabeth Children Treatment centres: Western Cape data Ms Jodilee Erasmus Cape Town The CODEMISUSED Project: Update on Prof Charles Parry Cape Town Survey of addiction treatment providers (WP5) and innovations in treating codeine dependence A relationship between infant deaths and Dr Shanaaz Matthews Cape Town alcohol and substance abuse Does restricting alcohol trading hours Mr Devon Reynolds Cape Town save lives? An investigation of the effect of the Western Cape Liquor Act of 2008 on the roads Motivational Interviewing/Relapse Dr Rodney Dawson Cape Town Prevention in Multi-Drug ResistantTB Using respondent-driven Sampling (RDS) Dr Loraine Townsend Cape Town to recruit illegal poly-substance users in Cape Town, South Africa: Implications and Future Directions Meeting the needs of young women who use drugs and have been exposed to violence Prof Bronwyn Myers 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 Alcohol remained the dominant substance of abuse in the EC and CR; and still causes the biggest burden of harm in terms of both communicable and non-communicable diseases. Between 17% (NR) and 2% (CR) of patients in treatment has alcohol as a primary drug of abuse. This period did see a slight decrease in the proportion of patients seeking treatment for alcohol in the WC and NR. In sharp contrast, KZN and CR 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. For this period, overall treatment admissions (patients both <20s and >20s) with cannabis as a primary drug of abuse increased slightly in the EC and KZN regions, with a slight decrease noted in the NR regions. Methamphetamine (MA) remained the second substance of choice among patients 20 years and younger 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. Mostly heroin is smoked although there has been 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 A and other infectious diseases, more specifically HIV/AIDS. In GT the number of patients reporting nyaope/whoonga (a mixture of cannabis and cheap heroin) as their primary substance of abuse was high (n=180) relative to other sites. In NR seventy patients reported nyaope/whoonga as their primary substance of abuse. A total of 7% in both KZN and NR reported nyaope/whoonga as either their primary or as a secondary drug of abuse. Club drugs and OTC/PRE medicines were still more common as secondary substances. The abuse of OTC/PRE medications 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 6% (EC). During this reporting period, 225 (2%) patients across all sites reported the non-medical use of codeine, with the majority of patients presenting at 1

7 treatment centres in the GT region (N=87). CAT, a synthetic stimulant, continues to show an increase in most provinces particularly in Gauteng. Five hundred and three patients reported CAT as a primary substance of abuse in the Gauteng region. Poly-substance abuse remains high across provinces, with between 19% (NR) and 51% (WC of patients indicating more than one substance of abuse. Overall, and across all regions 15% of patients presented with a dual diagnosis at treatment admission. The majority of patients reported mental health problems at the time of admission (8%), followed by hypertension (28%) and respiratory diseases (21%). Provincial variations are however evident, for instance a higher proportion of patients suffering from mental health problems were found in the WC, accounting for 2% of NCD cases, and a higher proportion of patients suffering from hypertension were found in the NR accounting for 36% of admissions. Presentations made at the SACENDU regional meetings are available. These can be accessed online at For any queries please contact Jodilee Erasmus at jodilee.erasmus@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 siphokazi.dada@mrc.ac.za /nadine.harker.burnhams@mrc.ac.za or call us on It remains for us to especially thank 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, 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 352 patients were treated across all treatment centres for the period January e when compared to 3 in the previous six month review period. Table 1: Proportion of treatment episodes (Western Cape) % % % % % % % Claro Clinic Crescent 1 < CTDCC CTDCC M/Plain De Novo Hesketh King < Kenilworth <1 - Kensington Treatment centre Ramot SANCA WC* Stepping Stones 5 Stikland 6 5 Sultan Bahu Albow Gardens Matrix Tafelsig Clinic Matrix Delft Matrix Khayelitsha Matrix Parkwood Matrix Manenberg Matrix Toevlug Toevlug Youth <1 - - Western Cape Youth Centre Help-me-network Hope House Helderberg CARES Houtbay CARES Lighthouse < Living Grace Total in treatment *= Includes SANCA George 3

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 75% in this period, a % decrease from the last review period. 0 0 % % % % % % % % % % % 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. 0 % % % % % % % % % % Inpatient Outpatient Table : 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 76% of patients, but a slight decrease in female patients was noticed in this period (2%). A greater proportion of patients were Coloured (70%), followed by Black African patients (16%), but no change has been noticed in this period. A greater proportion of the patients were working full-time (19%), followed by those pupils/learners at school (15%). A significant decrease in proportion of patients who were unemployed for more than six months (from 31% to 19%) has been noticed this period. Three quarters of the patients have completed secondary education (Grade 8-12), 8% have primary education and 21% have a tertiary education; a significant increase from the last period. % % % % % % % % % GENDER Male Female ETHNIC GROUP Black African Indian 1 <1 < <1 Coloured White EMPLOYMENT STATUS Working full-time Working parttime Unemployed (unspecified period) Unemployed (< 6 months) Unemployed (> 6 months) Student/Apprenti ce/internship - - <1 <1 <1 < Pupil/learner at school Disabled: not working Housewife <1 <1 <1 <1 2 <1 <1 <1 1 Pensioner/ retired <1 1 EDUCATION LEVEL* None <1 <1 1 <1 <1 <1 <1 <1 2 Primary Secondary Tertiary *Level of education completed 5

11 Table 6: Age distribution (Western Cape) The age range of patients in treatment was from 10 to 78 years. Thirty-seven 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 9 < 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, remaining stable. Tested for HIV in the past 12 months % % % % Yes No line to answer Table 8: Primary substance of abuse (Western Cape) Methamphetamine was still the most common primary substance of abuse, accounting for 35% of patient admissions. Methamphetamine has remained stable when compared to the previous period (35%). The proportion of patients admitted for other drugs also remained fairly stable. 0 6 % % % % % % % % % % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin/Opiates Ecstasy - - <1 <1 <1 <1 <1 <1 <1 - OTC/PRE < <1

12 Methamphetamine Methcathinone <1 8 1 <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. Methamphetamine, alcohol and cannabis were the most common drugs used. The proportion of cannabis/mandrax admissions increased slightly, while the proportion of methamphetamine admissions slightly increased compared to the previous period. A slight increase in the proportion of heroin was also noticed during this period. 0 7 % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine OTC/PRE Ecstasy <1-0 Heroin/Opiates Methamphetamine Inhalants <1 1 1 <1 <1 <1 Khat <1 <1 <1 <1 <1 <1 < Other <1 1 <1 < Methcathinone <1 <1 1 Table 10: Mode of usage of primary drug (Western Cape) In looking at the mode of usage of the primary drug, 22% of patients reported swallowing their substances. When alcohol was excluded, 95% reported smoking as their mode of use. Only 2% of patients reported that they injected drugs (all drug variants). The proportion of patients who specifically injected heroin increased slightly in this period. e % % % % % % % % % Swallowed 28(1) 25(1) 25 (2) 23(2) 22(3) 23(2) 22 (2) 25(3) 22(1) Snorted 2(3) (5) 3 () 2(2) 2(2) 2(2) 2(2) 1(2) 2(2) Injected 1(1) 1(2) 1 (2) 1(1) 1(1) 1(2) 1(1) 1(1) 1(2) Smoked 67(95) 70(92) 70(92) 7(95) 7(92) 7(9) 75(0) 73(95) 75(95) Other/ Combination <1(<1) <1(<1) 1(1) <1(<1) 1(2) 1(<1) <1(<1) <1(<1) -(-)

13 Injected Heroin Figures in brackets exclude alcohol Table 11: Mean age by primary substance of abuse (Western Cape) For this period and consistent over the last 5 years the mean age was recorded as 29 years of age. In contrast to the previous two reporting periods the data shows that the mean age for patients whose primary substance of abuse was alcohol and over-the-counter or prescription medicine has increased to the early 0s, in keeping with earlier years (see Table 11). A decrease in mean age for patients admitted for cannabis was noticed during this period (from 25 to 19 years). The mean age for patients with other substances remained fairly stable. 0 8 YEARS Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin/Opiates Ecstasy 50* 20* 28* 28* * - OTC/PRE Methamphetamine Inhalants Methcathinone Nyaope/Whoonga Overall mean age * N < 5 Table 12: Gender, by primary substance of abuse (Western Cape) Cannabis (85%), heroin (82%), crack/cocaine (81%) and the cannabis/mandrax combination (86%) remained mainly male substances of abuse as indicated in Table 12. Proportionately more females were treated for the use of alcohol, OTC/PRE medications and methamphetamine. M F M F M F M F M F M F M F % % % % % % % Alcohol Cannabis/Mandr ax* Cannabis Crack/Cocaine Heroin/Opiates Ecstasy * * OTC/PRE

14 Methamphetami ne Inhalants Khat Methcathinone Nyaope/Whoong a 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 and in keeping with the demographic profile of the province, the proportion of Coloured patients in treatment remains higher than any other race groups, with Indians making up 1% of patients in treatment. Coloured patients in treatment present mostly with cannabis/mandrax (83%), methamphetamine (77%), cannabis (70%) and heroin (89%) problems. A significant decrease in the proportion of heroin admissions among Black African and Coloured patients; and a significant decrease in Coloured patients reporting alcohol as a primary substance of abuse were noted in this period. During this reporting period, a higher proportion of Coloured patients were treated for use of OTC/PRE medications. Jan - BLACK AFRICAN Jan - 5 Jan - COLOURED INDIAN WHITE Jan - 5 Jan - Jan - 5 Jan - % % % % % % % % % % % % Alcohol Cannabis/Mand rax* Cannabis < Crack/Cocaine Ecstasy ** Heroin/Opiates < Methamphetam ine <1 <1 < Inhalants OTC/PRE Khat Methcathinone **N <3 not reported Jan - 5 9

15 Table 1: Multiple substance use (Western Cape) Up to 51% of patients reported using more than one substance of abuse, and this proportion increased slightly compared to the last period (%). Primary substance only Primary +2 nd 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 (56%) 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. 10 % % % % % % % % % Self Medical Aid State Family/friends State & self Work/employer Unknown Other/combinations CoCT Table 16: Frequency of use by primary drug (Western Cape) The majority of patients reported that they used their primary drugs of abuse on a daily basis; except for patients who abused cannabis and smoked it between 2-6 days per week. Frequency of use in the past month Not used in the Once per week or 2-6 days per Daily past month less often week % % % % 5 5 Alcohol Cannabis

16 Cannabis/Ma 3 1** ndrax* Ecstasy ** ** - Crack/ - 2* Cocaine Heroin/Opiate s Methampheta mine OTC/PRE ** ** 13** Methcathinon ** 33 10** e Inhalants ** 2-0 **: 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 (83%). Coloured patients constituted 73% of these patients and a quarter of patients were Black African. % % % % % % % % % GENDER Male Female ETHNIC GROUP Black/African Coloured Indian <1 - <1 1 <1 - <1 <1 - White Table 18: Primary substance of abuse of patients <20 years (Western Cape) Most young patients were treated for the abuse of cannabis, and this proportion increased significantly when compared to the previous period. The proportion of adolescent patients treated for alcohol and methamphetamine significantly decreased during this period, with a corresponding increase in cannabis admissions. e n % n % n % n % n % n % Alcohol Cannabis Cannabis/Mandr ax* Crack /Cocaine 2 <1 2 <1 2 <

17 Heroin/Opiates Ecstasy <1 1 <1 - - OTC/PRE <1 1 < <1 Inhalants < <1 Methcathinone <1 1 <1 - - Methamphetami ne Nyaope/Whoong a < <1 Total Table 19: Primary substance by gender of patients <20 years (Western Cape) Half of adolescent patients who used alcohol and heroin 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/Man drax* Crack/Cocain 100* ** e * 0 Heroin/Opiate s Ecstasy Inhalants * 0 0 * Methampheta mine OTC/PRE * 100* * * Methcathinon 100* e * - - ** N<5 Table 20: Primary substance by race of patients <20 years (Western Cape) Black African Coloure d Indian White Black African Coloure d Indian White n % n % n % n % n % n % n % n % Alcohol Crack/Cocain e 1 25 Cannabis

18 Cannabis/Ma * ndrax* Heroin/Opiat es Inhalants Methamphetamine OTC/PRE 2 0* 0* * Methcathino ne B: TREATMENT CENTERS: GAUTENG Ms Erika Nel Table 21: Proportion of treatment episodes (Gauteng) Data were collected from 17 specialist treatment centres on a monthly basis during this review period. A total of 285 patients were treated at Gauteng treatment centres during the period January e. n % n % n % n % n % n % Elim Clinic S/Eastern Gauteng < S/Central Rand S/Nishtara S/Vaal Triangle Castle Carey House of Mercy Stabilis Horizon Clinic Thusong < Houghton House <1 - - S/West Rand S/JHB Society Wedge Gardens SANCA Soweto <

19 Greater Heidelberg Fabian Ribeiro Viewpoint Recovery Centre Eden Recovery Centre <1 1 <1 10 <1 3 <1 2 < Mighty Wings Crossroads < Total number in treatment Table 22: First time admissions (Gauteng) Eighty-one percent of patients were admitted to treatment for the first time during this period, decreasing slightly compared to the previous period (83%). 0 % % % % % % % % % % Yes No Table 23: Type of treatment received (Gauteng) During January e over half of the patients were treated at outpatient centres while % of the patients were treated at inpatient centres. The proportion of inpatients has decreased slightly compared to the previous period. e % % % % % % % % % Inpatient Outpatient

20 Table 2: Referral sources (Gauteng) A slight increase in referrals from self/family/friends and a slight decrease in referrals from social services/welfare and court/correctional services were 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 Table 25: Population profile (Gauteng) Very little change has been noted in the population profile over the last few review periods. Over a third of patients were unemployed. The majority of patients (75%) had secondary education; this proportion has decreased compared to the previous period. A slight increase in the proportion of patients who had a tertiary education and an increase in patients who were Black African 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 3 Unemployed (unspecified period) Unemployed (< 6 months) Unemployed (> 6 months) Students/apprenticeship/interns hip 5 <1 <1 1 <1 <1 <1 15

21 Pupil/learner at school Medically boarded/disabled <1 <1 <1 <1 <1 <1 <1 <1 <1 Housewife <1 1 Pensioner/retired EDUCATION LEVEL None <1 - - <1 <1 <1 <1 1 1 Primary Secondary Tertiary Table 26: Age distribution (Gauteng) The age range of patients in treatment was from 10 to 83 years. For this review period the proportion of patients aged years remained fairly stable at 25%. Years n % n % n % n % n % n % n % < <1 2 < <1 < Mean age

22 Table 27: Primary substance of abuse (Gauteng) The most common primary substance of abuse in Gauteng during the January e period was cannabis (38%), remaining stable 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/Opiates Ecstasy 1 <1 9 <1 5 <1 9 <1 9 <1 3 <1 OTC/PRE Methcathinone Methamphetamine Khat <1 1 <1 11 <1 Inhalants 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, 23% of patients reported swallowing their substances, while 58% reported smoking their substances, slight decrease when compared to the previous review period. When alcohol was excluded, 73% 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 1 (9) 37(5) 31(5) 30() 27(3) 20(2) 21(2) 23(3) Snorted** 12(19) 13(20) 11(15) 11(15) 12(16) 11(1) 13(16) 16(20) Injected 3() 3() 2(3) 2(3) 3(5) 1(2) 3() 3() Smoked (68) 7(70) 56(77) 57(78) 57(76) 67(82) 62(77) 58(73) *If alcohol is not taken into account, the figures in brackets apply ** Included with snorted are sniffed and inhaled 17

23 Table 29: Gender by primary substance of abuse (Gauteng) Male patients continue to dominate admissions for treatment. However, half of patients who used OTC/PRE medications were females; and increase in proportion of female patients using alcohol, methamphetamine and inhalants was also noticed in this period. M F M F M F M F M F M F M F % % % % % % % % % % % % % % Alcohol Cannabis/Mandrax* Cannabis Crack/Cocaine Heroin/Opiates OTC/PRE Ecstasy Methcathinone Inhalants Methamphetamine Khat * 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 nyaope/whoonga (Table 30). For this period, the average age for alcohol and OTC/PRE medication abuse was 0 and 2 years, respectively. YEARS Alcohol Cannabis/Mandrax* Cannabis Cocaine/Crack Heroin/Opiates Ecstasy 21* Methcathinone Methamphetamine Inhalants OTC/PRE Khat Nyaope/Whoonga

24 Table 31: Race by primary substance of abuse (Gauteng) The majority of patients treated for methamphetamine, OTC/PRE and CAT abuse were White patients, while the majority of alcohol, cannabis, nyaope/whoonga, heroin and cannabis/mandrax patients were of Black African descent (Table 31). A significant increase was noted in the proportion of White patients admitted for methamphetamine, and the proportion of Coloured patients admitted for CAT use when compared to the previous review period. This period saw a significant increase in the proportion of White patients using crack/cocaine. Jan - BLACK AFRICAN Jan - 5 COLOURED INDIAN WHITE % % % % % % % % % % % % Alcohol Cannabis/ Mandrax* Cannabis Crack/Cocaine Ecstasy Heroin Meth-cathinone Methamphetami ne Inhalants OTC/PRE Nyaope/Whoong < a 5 19

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

26 Table 3: Fourth most frequently abused substance (Gauteng)** n % n % n % n % n % n % Alcohol Cannabis/Mandrax* Cannabis Cocaine/Crack Heroin/Opiates Ecstasy OTC/PRE Methcathinone Inhalants Methamphetamine Other Tobacco Nyaope/Whoonga TOTAL **Data on 3rd and th 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 and methamphetamine 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/Opiates Ecstasy <1 21 < OTC/PRE Methcathinone Methamphetamine Other Inhalants Nyaope/Whoonga

27 Table 36: Suburb of residence (Gauteng) METRO SUBSTRUCTURE n % n % n % n % n % n % Greater Pretoria MS Greater Johannesburg MS OTHER PROVINCES Mpumalanga Limpopo North West Northern Cape 12 <1 8 <1 11 <1 13 <1 5 <1 6 <1 Eastern Cape 6 <1 1 < <1 6 <1 Free State KwaZulu-Natal < < <1 Western Cape 8 <1 1 <1 3 <1 12 <1 7 <1 5 <1 OTHER COUNTRIES 12 <1 9 <1 12 <1 10 <1 6 <1 5 <1 Total number on whom information was available Table 37: Sources of payment (Gauteng) A significant increase in payments by family and a decrease in payments by the state were noticed in this period. Proportions by other sources of payment remained fairly stable compared to the previous period. 0 % % % % % % % % % % State Medical Aid Family Friends < Employer Self Other/Comb <1 1 Unknown

28 Table 38: HIV tested in the past 12 months (Gauteng) Forty-three percent of those who completed the question Have you been tested for HIV in the past 12 months indicated that they had been tested, a slight decrease compared to the 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 76% of patients younger than 20 years were of Black African descent. This review period also showed a slight increase in the proportion of < 20 with secondary education (86%) <1 <1 <1 <1 1 % % % % % % % % % GENDER Male Female ETHNIC GROUP Indian Black/African Coloured White EDUCATION LEVEL None/Preprimary Primary Secondary Tertiary 1 3 <

29 Table 0: Primary substance of abuse for patients aged 20 years and younger (Gauteng) The most common primary drug of abuse among young patients was cannabis, and this proportion has significantly increased compared to the last period. This was followed by CAT and heroin. This period has also seen an increase decrease in the proportion of <20s admitted for problematic alcohol use. n % n % n % n % n % n % n % Table 1: Gender by primary substance of abuse for patients aged 20 years and younger (Gauteng) Alcohol Cannabis Cannabis/ Mandrax* Crack/ Cocaine Heroin/Opiates OTC/PRE 2 <1 1 2 < <1 <1 1 <1 Inhalants Meth-cathinone Methamphetamine Nyaope/Whoong a TOTAL M F M F M F M F M F M F M F % % % % % % % % % % % % % % Alcohol Cannabis Cannabis/Mandrax* Crack/Cocaine Heroin/Opiates Ecstasy Inhalants OTC/PRE Methcathinone

30 Methamphetamine( Tik ) Nyaope/Whoonga Table 2: Race by primary substance of abuse for patients aged 20 years and younger (Gauteng) Seventy-eight percent of teenage heroin patients were Black African, compared to 16% of patients aged 20 or older. This proportion increased slightly compared to the previous review period (61%). A significant increase in the proportion of White patients who abused methamphetamine (from 17% to 8%) and CAT (from 17% to 52%) was also noticed, in this period. BLACK/AFRICAN COLOURED INDIAN WHITE % % % % % % % % % % % % Alcohol Cannabis Cannabis/Mandrax* Crack/Cocaine Heroin/Opiates Ecstasy Inhalants OTC/PRE Methcathinone Methamphetamine Nyaope/Whoonga Table 3: Secondary substance of abuse for patients aged 20 years and younger (Gauteng) Cannabis, alcohol, heroin and CAT remained the most common secondary drugs. n % n % n % n % n % n % Alcohol Cannabis Cannabis/Mandrax* < Crack/Cocaine < Heroin/Opiates Ecstasy 2 < <1 - - Inhalants OTC/PRE <1 2 < < Methcathinone < Methamphetamine < Nyaope/Whoonga < <

31 Other TOTAL Table : Mode of usage of primary substance of abuse for patients aged 20 years and younger (Gauteng) 0 % % % % % % % % % % Swallowed Snorted Injected 1 1 <1 11 <1 <1 1 <1 2 1 Smoked Combination <1 <1 <1 - Table 5: Referral Sources for patients aged 20 years and younger (Gauteng) A higher proportion of <20 patients (39%) were referred to treatment centres by self/family/friends and this has slightly increased compared to the previous period. This was followed by school (37%) and court/correctional services (10%). Other categories remained stable. 0 % % % % % % % % % % Self/Family/Friends Work/Employer <1 <1 1 <1 1 <1 <1 1 <1 - Health professional Religious body <1 <1 1 1 <1 1 <1 <1 <1 - Hospital/Clinic <1 1 1 < Social Services/Welfare Court/Correctional services School Other

32 2C: TREATMENT CENTRES: NORTHERN REGION Ms Siphokazi Dada Table 6: Number of treatment episodes (Northern Region) Data were collected from 5 specialist treatment centres on a monthly basis. Overall, 1076 patients were treated across all treatment centres for the period January e as compared to 1135 in the previous six month period. Number Swartfontein (Inpatient) MARC (In-patient) 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

33 Table 7: First Time Admissions (Northern Region) First-time admissions continue to remain stable (97%) 0 % Yes No Table 8: 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. 0 % Inpatient Outpatient Table 9: Referral sources (Northern Region) Family/friends or self continue to be the most common sources of referral (55%), followed by school (13%) and social/welfare services (13%). A slight decrease in referrals by work/employer was noticed, while other categories remained stable. % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse (health professional) Religious body <1 - Hospital/clinic <1 1 Social services/welfare Court/correctional services School Other, e.g. radio

34 Table 50: Age distribution (Northern Region) The mean age of all patients in this reporting period was 26 years. Twenty-five percent of patients were younger than 20 years. Age Category Jan 29 % <1 1 1 <1 < <1 <1 1 <1 1 <1 <1 <1 Table 51: Population profile (Northern Region) A slight increase in patients who identify as Black African was reported. 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 (38%). Majority of patients reported completing secondary school education (78%). All other categories remained fairly stable compared to the previous period. % GENDER Male Female RACE Black African Coloured Indian <1 White EMPLOYMENT STATUS Working full time Working part time Unemployed (unspecified period) Unemployed (<6 months) Unemployed (>6 months) Student/Apprentice/internship < Pupil/learner at school Disabled/medically boarded <1 <1 - <1 <1 <1 - <1

35 Housewife - <1 <1 <1 - <1 <1 1 Pensioner/retired <1 1 1 <1 <1 EDUCATION LEVEL None <1 1 <1 1 Primary Secondary Tertiary Table 52: Primary substance of abuse (Northern Region) Cannabis continued to be the most common primary substance of abuse in this region, and has slightly decreased to 37% during this period when compared to the 2 nd half of (2%). Heroin slightly increased (30%), while other categories remained fairly stable compared to the previous period. 30 % % % % % % % % % Alcohol Cannabis Cannabis/Mandrax* - < <1 1 <1 1 Crack/Cocaine Methcathinone Heroin/Opiates Ecstasy - <1 - <1 <1 - <1 <1 - Inhalants OTC/ PRE <1 Methamphetamine <1 1 <1 1 1 Nyaope/Whoonga Table 53: Gender, by primary substance of abuse (Northern Region) Very few female patients were treated for cannabis, while a relatively high proportion was treated for alcohol. % % % % % % M F M F M F M F M F M F Alcohol Cannabis Cannabis/ Mandrax* Crack/ Cocaine Heroin/Opia tes

36 Ecstasy Inhalants OTC/ PRE Methcathin one Methamphe tamine Nyaope/ Whoonga Table 5: Race, by primary substance of abuse (Northern Region) Black African patients constitute the majority of heroin patients, and this has slightly increased compared to the previous period. A significant decrease in White patients treated for crack/cocaine and OTC/PRE was also noticed. Jan - BLACK COLOURED INDIAN WHITE AFRICAN % % % % Jan Alcohol Cannabis < Cannabis/ Mandrax* Crack/ Cocaine Heroin/Opiates < < Inhalants OTC/PRE Meth-cathinone Methamphetami ne Nyaope/Whoong a (Row% add up to 100) 5 31