SOUTH AFRICAN COMMUNITY EPIDEMIOLOGY NETWORK ON DRUG USE (SACENDU)

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

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 19070 7505 TYGERBERG South Africa Tel.: +27(0) 21 938 0313 E-mail: 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.

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

PRESENTATIONS AT SACENDU REPORT BACK MEETINGS (Not included in this report but available on www.sahealthinfo.org/admodule/alcdrug.htm.) 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

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

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

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 www.sahealthinfo.org/admodule/alcdrug.htm. For any queries please contact Yolanda Williams at yolanda.williams@mrc.ac.za or 021-938-0946, 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 021-938-0342 www.sahealthinfo.org/admodule/alcdrug.htm. 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 20 000 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

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 - - - - 1-4 Crescent 1 1 <1 - - - - CTDCC 16 12 14 12 12 12 12 CTDCC M/Plain De Novo 8 7 7 6 6 6 5 Hesketh King 1 1 1 1 <1 1 2 Kenilworth - - - 1 - - <1 Kensington Treatment 3 2 3 2 1 1 1 centre Ramot 7 4 6 5 5 4 2 SANCA WC 20 36 20 14 24 20 18 Stepping Stones 5 4 4 5 4 4 4 Stikland 5 4 6 4 4 5 4 Sultan Bahu 16 17 16 16 8 12 7 Tableview Matrix Tafelsig Clinic Matrix Delft Matrix Khayelitsha Matrix Parkwood Matrix Toevlug 10 8 15 2 13 7 18 7 21 6 24 6 25 8 Toevlug Youth - 1 2 1 1 <1 - Western Cape Youth - - 1 3 3 2 1 Centre Help-me-network - - - - - - 2 Hope House - - - - 2 2 2 Helderberg CARES - - - - - - 2 Houtbay CARES - - - - - - 2 Lighthouse - - - - <1 1 - Living Grace - - - - 2 1 1 Wayout - - - - 1 - - Total in treatment 2733 3912 3178 3717 3478 3510 3444 *= Includes SANCA George

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. 2009 % % % % % % % % % % % YES 75 76 78 76 66 72 69 66 71 75 79 NO 25 24 22 24 34 28 31 34 29 25 21 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 44 44 34 41 28 37 39 33 29 29 Outpatient 56 56 66 59 72 63 61 67 71 71 Table 4: Referral sources (Western Cape) During this review period, the proportions of referrals sources remain fairly stable. % % % % % % % % % Self/family/friends 39 38 46 47 45 46 41 45 44 Work/employer 7 7 6 6 6 6 6 7 7 Doctor/psychiatrist/nurse 9 10 9 10 8 10 8 6 7 Religious body 2 1 2 2 1 1 1 1 1 Hospital/clinic 6 4 4 3 3 3 3 4 4 Social services/welfare 21 25 17 20 22 18 21 20 19 Court/correctional services 8 6 6 5 5 5 5 4 5 School 4 6 8 5 8 9 12 11 11 Other e.g. radio 4 3 2 2 2 3 3 2 2 4

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 76 74 76 76 75 76 75 77 73 Female 24 26 24 24 25 24 25 23 27 ETHNIC GROUP Black African 11 9 11 11 11 14 15 16 16 Indian 1 1 <1 <1 1 1 1 1 1 Coloured 71 73 75 76 76 71 71 72 71 White 17 17 14 13 12 14 13 11 12 EMPLOYMENT STATUS Working full-time 24 23 22 19 19 19 19 19 20 Working part-time 4 4 3 3 3 4 4 4 4 Unemployed 57 56 62 59 59 59 55 10 4 (unspecified period) Unemployed (< 6 months) - - - - - - - 16 16 Unemployed (> 6 months) - - - - - - - 29 31 Student/Apprentice/i nternship <1 - - <1 <1 <1 <1 3 8 Pupil/learner at 13 15 11 17 16 15 20 17 15 school Disabled: not working 1 1 1 1 1 1 1 1 1 Housewife <1 <1 <1 <1 <1 2 <1 <1 <1 Pensioner/ 1 1 1 1 1 1 1 1 <1 retired MARITAL STATUS* Married, living with spouse 15 13 16 13 14 15 13 - - Married, not living with spouse 3 4 4 4 5 5 4 - - Living together 6 6 5 5 5 5 5 - - Divorced 6 7 6 6 7 7 6 - - Widowed 1 1 1 1 1 1 1 - - Never married 67 69 68 71 68 67 70 - - Other 2 - <1 - - - - - - EDUCATION** None <1 <1 1 <1 <1 <1 <1 <1 1 5

Primary 17 13 12 14 13 13 14 13 13 Secondary 75 78 80 80 79 79 78 80 78 Tertiary 8 9 7 6 7 7 8 7 9 *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 % 5-9 3 <1 1 <1 - - - - - - 1 <1 10-14 170 4 123 4 125 3 187 5 167 5 185 5 15-19 696 18 531 17 617 17 701 20 635 18 597 18 20-24 886 23 629 20 751 20 574 17 561 16 561 17 25-29 845 22 674 21 825 22 755 22 796 23 725 21 30-34 466 12 433 14 489 13 459 13 504 14 501 15 35-39 276 7 255 8 308 8 264 7 255 7 302 9 40-44 196 5 166 5 223 6 195 6 219 6 201 6 45-49 151 4 155 5 146 4 140 4 159 5 154 5 50-54 100 3 90 3 104 3 85 2 96 3 92 3 55-59 56 1 53 2 62 2 62 2 65 2 53 2 60-64 25 1 28 1 24 1 19 1 18 1 28 1 65 + 13 <1 12 <1 19 1 21 1 11 <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 49 44 69 66 No 45 49 26 30 line to answer 6 7 5 4 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

% % % % % % % % % % Alcohol 30 28 28 24 24 22 20 22 20 22 Cannabis/Mandrax* 4 3 3 2 3 4 3 2 4 5 Cannabis 16 18 18 15 20 22 21 25 22 23 Crack/Cocaine 2 2 2 2 2 1 1 2 1 2 Heroin 13 12 13 17 16 15 17 13 19 13 Ecstasy <1 - - <1 <1 <1 <1 <1 <1 <1 OTC/PRE <1 1 1 1 1 <1 1 1 1 1 Other - - - - - <1 - - <1-34 35 35 39 34 33 28 33 33 35 Methcathinone ( CAT ) <1 - - - - <1 8 1 <1 <1 Inhalants 1 1 1 1 1 <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 41 40 37 36 34 35 37 34 26 30 Cannabis/Mandrax* 18 19 15 20 16 20 23 21 17 17 Cannabis 34 37 35 37 40 44 45 46 33 34 Crack/Cocaine 5 5 5 6 5 4 4 4 2 3 OTC/PRE 2 2 1 2 2 1 2 2 1 1 Ecstasy 1 1 1 2 1 1 1 1 <1 - Heroin 14 13 15 19 18 18 19 14 19 13 46 47 47 52 48 50 40 47 47 46 Inhalants 1 1 2 1 1 <1 1 1 <1 <1 Khat <1 <1 <1 <1 <1 <1 <1 <1 - - LSD <1 <1 - <1 <1 <1 <1 - - - Other 1 1 2 1 <1 1 <1 <1 1 - Methcathinone ( CAT ) - - - - - - 13 2 <1 <1 Note: The table shows the proportion reporting each drug either as primary or secondary drug. 7

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 8 7 6 7 5 6 8 5 5 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 38 36 39 40 38 39 41 39 28 31 Cannabis/Mandrax* 20 27 28 28 27 30 28 29 28 30 Cannabis 20 23 19 20 19 20 20 20 27 25 Crack/Cocaine 33 34 34 32 33 33 34 32 27 28 Heroin 25 26 26 26 26 27 27 27 29 29 Ecstasy 23 50* 20* 28* 28* 29 33 28 32 25* OTC/PRE 43 40 40 40 41 42 38 39 26 29 25 24 26 26 26 28 27 27 30 29 Inhalants 20 26 19 20 14 17 19 25 26 - Khat - 37* 29* 36* 26 27* 27 32 23 - Methcathinone - - - - - - 28 27 31 29 ( CAT ) Nyaope/Whoonga - - - - - - - - 36 - Overall mean age 28 28 29 29 28 29 29 28 28 29 * N < 5 8

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 73 27 72 28 71 29 71 29 73 27 21 79 74 26 Cannabis/Mandrax* 94 4 88 12 84 16 90 10 86 14 72 28 75 25 Cannabis 90 10 83 17 84 16 85 15 82 17 79 21 76 24 Crack/Cocaine 65 35 81 19 82 18 70 30 72 28 88 12 77 23 Heroin 79 21 83 17 79 21 79 21 78 22 73 26 76 24 Ecstasy 33 67 50 50 100-88 12 67 33 100-33* 67* OTC/PRE 29 71 31 69 39 61 45 56 41 59 86 14 82 18 72 28 70 30 70 30 73 27 69 31 76 24 69 31 Inhalants 94 6 92 8 - - 92 8 90 10 83 17 - - Khat 100-56 44 - - 91 9 80 20 60 40 - - Methcathinone ( CAT ) - - - 100 - - 64 36 67 33 58 42 70 30 Nyaope/Whoonga - - - - - - - - - - - 100 - - 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 20 16 14 50 67 71 1 1 0 29 17 16 Cannabis/Mandrax* 8 7 9 84 81 79-1 1 8 11 11 Cannabis 21 23 18 70 66 73 <1 1 1 9 11 8 Crack/Cocaine 2 27 17 27 63 81 6 2 0 65 7 2 Ecstasy - - 0 100 33 100** - - 0-67 0 Heroin 4 8 19 88 85 67 1 1 5 7 6 14 12 16 17 81 72 70 < <1 <1 7 12 13 Inhalants 14 25-71 58 - - - - 15 17 - OTC/PRE 46 18 18 27 73 68 - - 0 67 9 14

BLACK AFRICAN COLOURED INDIAN WHITE % % % % % % % % % % % % Khat - 20-20 80 - - - - 80 - - Methcathinone ( CAT ) **N <3 not reported 50 8 0 81 58 70 - - 0 16 33 30 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 % 2236 57 1621 51 1704 46 1809 52 1790 51 1933 56 948 24 827 26 1021 27 903 26 1719 49 1511 44 539 14 542 17 655 18 518 15 - - - - 189 5 188 6 337 9 248 7 - - - - 3912 100 3178 100 3717 100 3478 100 3509 100 3444 100 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 12 15 7 12 10 8 11 9 8 Medical Aid 9 7 10 7 7 12 7 7 9 State 26 24 34 31 34 35 29 29 52 Family/friends 23 23 21 18 19 15 19 20 18 State & self 3 5 4 2 4 - - 17 - Work/employer 2 1 2 1 2 1 1 2 2 Unknown 6 4 4 4 2 2 1 2 3 Other/combinations 19 21 18 22 21 6 10 3 1 CoCT - - - - - - 17 11 5 10

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 4 5 3 8 8 9 35 32 34 53 55 54 Cannabis 8 6 3 10 12 13 41 34 37 42 49 47 Cannabis/Mandrax* 4 3 1** 2 3 5 29 21 26 65 73 68 Ecstasy - - 0-33 0 - - 66** - 67 33** Crack/ Cocaine 8-2* 9 12 17 32 20 33 50 68 48 Heroin 3 2 2 1 1 5 7 6 3 89 91 91 2 3 2 4 6 6 36 30 29 57 61 64 OTC/PRE 2 5 0 1** 5 10 18 18 10** 79 72 81 Methcathinone - 8 0-33 10** - 25 30-33 60 ( CAT ) Inhalants 10 - - 10** 8-38 50-43 42 - **: 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 78 80 84 78 80 82 80 84 79 Female 22 20 16 22 20 18 20 16 21 ETHNIC GROUP Black/African 14 13 20 15 19 25 23 26 26 Coloured 79 82 75 81 75 70 72 70 71 Indian 1 <1 - <1 1 <1 - <1 <1 White 6 5 5 4 5 5 5 4 4

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 77 9 26 4 22 3 55 6 188 23 82 11 Cannabis 550 64 460 70 519 70 592 67 257 32 363 46 Cannabis/Mandrax* 23 2 17 3 26 3 20 2 20 3 35 5 Crack /Cocaine 4 1 2 <1 2 <1 2 <1 9 1 12 2 Heroin 24 3 23 4 28 4 52 6 83 10 93 12 Ecstasy - - - - - - - - 1 <1 1 <1 OTC/PRE 2 <1 - - 2 <1 1 <1 10 1 5 1 Inhalants 33 4 3 1 7 1 5 1 3 <1 - - Methcathinone ( CAT ) - - - - 20 3 5 1 1 <1 1 <1 153 18 115 18 115 16 156 17 223 28 191 24 Nyaope/Whoonga - - - - - - - - 1 <1 - - Total 866 100 655 100 742 100 888 100 802 100 783 100 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 56 44 58 42 77 23 72 28 84 16 84 16 Cannabis 82 18 84 16 85 15 84 16 82 18 78 22 Cannabis/Mandrax* 91 9** 88 12 88 12 80 20 80 20 77 23 Crack/Cocaine 75** 25** 50 50 50 50-100 89 11 92 8** Heroin 54 46 78 22 79 21 77 23 84 16 85 15 Ecstasy - - - - - - 100-0 100 Inhalants 91 9** 100-100 - 100-100 - - - 76 24 70 30 74 26 72 27 85 15 78 22 OTC/PRE 50** 50** - - 50 50 100-90 10 100** 0 Methcathinone ( CAT ) - - - - 63 37 20 80 100 - - 100** ** N<5 12

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 37 20 144 76 - - 7 4 17 21 59 72 0 0 6 7 Crack/ Cocaine 3 33 6 67 - - - - 5 42 7 58 0 0 0 0 Cannabis 71 28 176 68 2 1 8 3 83 23 272 75 0 0 7 2 Cannabis/Mandrax* 2 10 18 90 - - - - 6 17 28 80 1 3* 0 0 Heroin 15 18 66 80 - - 2 2 27 29 59 64 0 0 6 7 Inhalants 1 33 2 67 - - - - - - - - 0 0 - - 76 34 137 61 1 <1 9 4 61 32 122 64 0 0 7 4 OTC/PRE 2 20 7 70 - - 1 10 2 40* 40* 0 0 1 20* Methcathinone ( CAT ) - - 1 100 - - - - 0 0 1 100* 0 0 0 0 13

2b: Treatment Centers: Gauteng Ms Erika Nel Table 21: Proportion of treatment episodes (Gauteng) 14 n % n % n % n % n % n % Elim Clinic 486 15 418 12 400 10 384 12 273 8 394 12 S/Eastern Gauteng 32 1 - - 6 <1 - - 145 4 127 4 S/Central Rand 437 14 611 17 780 19 450 14 860 25 774 23 S/Eerste Rust - - - - - - - - - - - - S/Nishtara 49 1 58 2 147 4 116 4 95 3 120 4 S/Vaal Triangle 197 6 260 7 353 9 546 17 238 7 316 9 Magaliesoord - - - - - - - - - - - - Castle Carey 297 9 274 8 276 7 247 8 331 9 341 10 House of Mercy 132 4 98 3 103 3 91 3 - - 70 2 Stabilis 187 6 154 4 122 3 73 2 74 2 82 2 Horizon Clinic 350 11 356 10 304 8 329 10 342 10 264 8 Thusong 35 1 75 2 - - - - 20 1 2 <1 Houghton House 116 4 118 3 119 3 58 2 - - 3 <1 S/West Rand - - - - - - - - - - - - S/JHB Society 160 5 37 1 45 1 - - 92 2 25 1 Wedge Gardens 101 3 154 4 179 4 163 5 170 5 155 5 SANCA Soweto 254 8 499 14 514 13 2 <1 217 6 27 1 Greater Heidelberg 71 2 126 4 159 4 62 2 160 5 154 5 Fabian Ribeiro 272 8 300 9 403 10 525 17 421 12 442 13 Viewpoint Recovery Centre Eden Recovery Centre 22 1 - - - - - - - - - - - - 14 <1 14 <1 10 <1 3 <1 2 <1 Mighty Wings - - - - 100 3 72 2 22 1 74 2 Crossroads - - - - - - - - 16 <1 - - Total number in treatment 3198 100 3552 100 4026 100 3128 100 3479 100 3372 100 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.

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 72 76 74 75 75 78 78 77 85 83 No 28 24 26 25 25 22 22 23 15 17 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 67 69 67 63 54 50 59 47 50 Outpatient 33 31 33 37 46 50 41 53 50 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 56 59 56 55 56 52 52 50 51 Work/employer 10 10 10 11 8 7 7 5 6 Doctor/psychiatrist/nurse 5 6 5 6 3 3 3 3 4 (health professional) Religious body 1 1 1 1 1 1 1 1 1 Hospital/clinic 1 1 1 1 2 1 2 3 2 Social services/welfare 12 9 11 9 11 10 15 12 13 Court/correctional services 9 7 7 5 9 14 12 13 12 School 4 6 6 9 9 10 6 11 9 Other, e.g. radio 2 1 3 2 2 2 1 2 2 15

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 83 82 83 82 85 87 86 87 87 Female 17 18 17 18 15 13 14 13 13 ETHNIC GROUP Black/African 48 48 48 49 56 60 55 61 59 Indian 2 3 3 3 2 3 3 2 2 Coloured 10 8 10 11 13 10 11 16 14 White 40 41 39 37 29 27 31 21 25 EMPLOYMENT STATUS Working full-time 36 36 34 35 28 27 27 23 25 Working part-time 3 4 4 3 4 4 4 4 4 Unemployed (unspecified period) 41 42 42 38 42 43 48 8 5 Unemployed (< 6 months) - - - - - - - 11 11 Unemployed (> 6 months) - - - - - - - 26 30 Students/apprenticeship/internship <1 <1 <1 1 <1 <1 <1 4 4 Pupil/learner at school 16 15 16 20 22 23 18 21 19 Medically boarded/disabled 1 <1 <1 <1 <1 <1 <1 <1 <1 Housewife 1 1 1 1 1 1 1 1 <1 Pensioner/retired 1 1 2 1 1 1 1 1 1 MARITAL STATUS* Married, living with spouse 19 19 17 17 15 13 13 - - Married, not living with spouse 3 2 2 3 2 1 2 - - Living together/ 6 5 6 6 7 6 6 - - cohabiting Divorced 8 9 7 7 6 6 6 - - Widowed 1 2 2 2 2 1 1 - - Never married 62 63 64 64 67 73 72 - - EDUCATION None <1 <1 - - <1 <1 <1 <1 1 Primary 7 37 6 6 8 6 5 7 8 Secondary 77 47 80 81 79 81 82 83 80 Tertiary 16 16 14 13 12 13 12 10 12 Mean age 31 30 30 30 29 28 28 27 28 *We are no longer collecting data on marital status 16

Table 26: Age distribution (Gauteng) The age range of patients in treatment was from 8 to 78 years. The proportion of patients aged 10-19 years saw a slight decrease from 27% to 24% this review period. Years n % n % n % n % n % n % n % <10 - - - - 4 <1 2 <1 - - 1 <1 4 <1 10-14 63 2 71 2 94 3 74 2 31 1 123 4 119 4 15-19 513 19 631 20 764 22 926 24 552 19 786 23 660 20 20-24 547 20 636 20 168 22 870 23 690 24 840 24 791 24 25-29 504 18 476 15 573 16 639 17 547 19 659 19 692 21 30-34 296 11 365 12 377 11 427 11 388 14 402 12 408 12 35-39 218 8 268 9 229 7 271 7 218 7 206 6 209 6 40-44 199 7 208 7 224 6 209 5 164 6 150 4 167 5 45-49 163 6 188 6 170 5 172 5 110 4 97 3 123 4 50-54 111 4 122 4 134 4 116 3 72 3 78 2 76 2 55-59 65 3 80 3 83 2 64 2 43 2 51 2 47 1 60-64 22 1 47 2 26 1 35 1 25 1 25 1 21 6 65 29 1 24 1 26 1 21 1 23 1 32 1 24 1 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 1096 34 989 28 1084 27 768 24 653 19 670 2 0 Cannabis/ 21 1 26 1 36 1 50 2 72 2 55 2 Mandrax* Cannabis 910 29 920 26 1599 40 1147 36 1449 42 1198 3 6 Crack/Cocaine 191 6 154 4 131 3 120 4 92 3 136 4 Heroin 475 15 340 10 477 12 402 13 399 11 455 1 4 Ecstasy 7 1 1 <1 9 <1 5 <1 9 <1 9 < 1 OTC/PRE 76 2 64 2 51 1 41 1 37 1 39 1 Methcathinone 1 270 8 263 7 321 8 316 10 290 8 387 ( CAT ) 2 Methamphetamin e 76 2 89 2 104 3 83 3 137 4 112 3 Khat 40 1 26 1 33 1 16 1 9 <1 1 < 1 Inhalants 36 1 38 1 35 1 21 1 42 1 41 1 Other - - 8 <1 1 <1 5 <1 11 <1 4 < 1 17

Nyaope/Whoonga - - 132 4 145 4 154 5 279 8 264 8 Total 2786 100 3198 100 3552 100 3128 100 3479 100 3371 1 0 0 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 79 21 81 19 81 19 83 17 72 22 82 18 83 17 Cannabis/Mandrax* 96 4 100-92 8 94 6 82 18 94 6 89 11 Cannabis 94 6 89 11 91 9 94 6 94 6 92 8 90 10 Crack/Cocaine 78 22 82 18 80 20 77 23 87 13 83 17 86 14 Heroin 88 12 87 13 91 9 91 9 93 7 88 12 90 10 OTC/PRE 44 56 28 72 42 58 39 61 34 65 43 57 64 36 Ecstasy 88 12 86 14 100-89 11 80 20 67 33 78 22 Methcathinone ( CAT ) 79 21 74 26 71 29 75 25 80 20 81 19 85 15 Inhalants 84 16 83 17 92 8 83 17 71 29 79 21 81 19 61 39 75 25 80 20 86 14 79 21 80 20 85 15 Khat 50 50 80 20 64 36 91 9 94 6 89 11 100* 0 Nyaope/Whoonga - - - - 85 15 93 7 83 17 87 13 90 10 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

YEARS Alcohol 39 40 39 40 40 39 39 36 33 Cannabis/Mandrax* 24 25 24 24 25 26 26 27 29 Cannabis 21 21 22 21 21 22 23 22 25 Cocaine/Crack 31 30 30 30 31 32 31 30 29 Heroin 24 24 24 24 25 25 25 27 27 Ecstasy 23 21* 27 21-21 26 28 26 Methcathinone 25 27 27 27 27 27 28 30 27 ( CAT ) 27 26 26 25 26 27 28 28 27 Inhalants 18 18 19 19 19 18 19 17 19 OTC/PRE 42 39 38 42 40 40 39 39 37 Khat 26 27 26 27 31 28 27 32 32 Nyaope/Whoonga - - - - 24 24 24 27 25 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 42 51 51 7 8 13 1 2 2 50 39 34 Cannabis/ Mandrax* 63 67 56 31 25 20 4 1 2 2 7 22 Cannabis 71 71 62 13 19 17 1 2 2 15 8 19 Crack/ cocaine 40 59 54 12 9 15 7 1 1 41 31 30 Ecstasy 40 33 67-44 0 - - 0 60 22 33 Heroin 77 81 59 3 3 12 1 2 2 19 14 26 Meth-cathinone ( CAT ) 7 12 50 20 26 12 9 7 2 64 55 36 8 8 44 2 67 17 5 5 2 44 20 37 Inhalants 90 86 71-14 20 - - 5 - - 5 OTC/PRE 10 11 46 5 3 8 5 11 3 80 75 44 Nyaope/Whoonga 95 85 91 1 2 2 3 1 <1 1 12 7 19

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 206 14 253 13 247 11 181 10 245 18 278 22 Cannabis/Mandrax* 35 2 65 3 62 3 53 3 75 5 29 2 Cannabis 386 26 719 36 553 24 527 28 422 30 394 31 Crack/Cocaine 206 14 172 9 175 8 119 7 89 6 128 10 Heroin 187 13 214 11 191 8 120 6 83 6 72 6 Ecstasy 23 2 14 1 18 1 12 1 11 1 12 1 OTC/PRE 59 4 34 2 36 1 32 2 14 1 21 2 Methcathinone ( CAT ) 101 7 131 7 147 6 155 8 140 10 148 12 51 4 54 3 79 3 67 4 74 5 86 7 Inhalants 18 1 16 1 20 1 8 <1 18 1 20 2 Other 173 12 12 1 171 7 130 7 181 13 70 6 Nyaope/Whoonga - - - - - - 20 1 38 3 8 1 TOTAL 1464 100 1974 100 2336 100 1859 100 1394 100 1266 100 Table 33: Third most frequently abused substance (Gauteng)** ** ** n % n % n % n % n % n % Alcohol 103 19 184 22 175 18 110 16 - - - - Cannabis/ Mandrax* 22 4 37 4 45 5 36 5 - - - - Cannabis 103 19 103 12 120 13 89 13 - - - - Crack/Cocaine 86 16 95 11 97 10 83 12 - - - - Heroin 37 7 151 18 160 17 53 8 - - - - Ecstasy 24 4 14 2 24 5 17 2 - - - - OTC/PRE 9 1 18 2 13 1 15 2 - - - - Methcathinone ( CAT ) 40 7 49 6 60 6 45 6 - - - - 34 6 35 4 36 4 46 7 - - - - Inhalants 4 1 15 2 11 1 7 1 - - - - Other 76 14 8 1 44 5 132 19 - - - - Tobacco - - 121 14 139 15 58 8 - - - - Nyaope/Whoonga - - - - 14 2 4 1 - - - - TOTAL 557 100 547 100 840 100 949 100 701 100 - - **Data on 3 rd and 4 th substance of abuse are no longer collected 20

Table 34: Fourth most frequently abused substance (Gauteng)** ** ** n % n % n % n % n % n % Alcohol 30 18 57 24 43 17 30 19 - - - - Cannabis/ Mandrax* 4 2 7 3 12 5 6 4 - - - - Cannabis 19 11 29 12 28 11 19 12 - - - - Cocaine/Crack 26 16 27 11 34 14 19 12 - - - - Heroin 12 7 18 8 12 5 7 4 - - - - Ecstasy 20 12 16 7 22 9 14 9 - - - - OTC/PRE 1 1 5 2 9 4 9 6 - - - - Methcathinone ( CAT ) 15 9 19 8 16 7 12 8 - - - - Inhalants 2 1 8 3 6 2 1 1 - - - - ( Tik/Speed ) 13 8 19 8 17 7 10 6 - - - - Other 12 7 - - 11 4 11 7 - - - - Tobacco - - 25 11 25 10 7 5 - - - - Nyaope/Whoonga - - - - - - 1 1 - - - - TOTAL 167 100 237 100 247 100 154 100 - - - - **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 1435 45 1483 42 1549 38 1089 35 898 18 948 22 Cannabis/Mandrax * 82 3 135 5 155 4 145 5 147 3 84 2 Cannabis 1418 44 1771 50 2300 57 1782 57 1871 38 1592 34 Crack/Cocaine 509 16 448 13 437 11 421 13 181 4 264 6 Heroin 711 22 700 20 840 21 582 17 482 10 527 11 Ecstasy 74 2 45 1 49 1 48 1 20 <1 21 <1 OTC/PRE 145 5 185 5 109 3 97 3 51 1 60 1 Methcathinone ( CAT ) 426 13 462 13 514 13 528 17 430 9 535 12 174 5 185 5 323 8 206 7 211 4 198 4 Other 261 8 28 1 225 6 273 9 205 4 73 2 Inhalants 60 2 77 2 72 2 37 1 60 1 61 1 Nyaope/Whoonga - - 155 4 326 8 179 6 317 7 272 6 TOTAL 5373 100 6651 100 7720 100 5912 100 4875 100 4635 100 21

Table 36: Suburb of residence (Gauteng) METRO SUBSTRUCTURE n % n % n % n % n % n % Greater Pretoria MS 484 15 529 15 525 13 456 17 406 12 349 10 Greater Johannesburg MS 1471 46 1173 33 1682 42 1413 45 2354 68 2244 65 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 829 21 682 22 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 124 4 126 4 122 3 108 4 81 2 107 3 Limpopo 82 3 71 2 60 2 81 3 66 2 89 3 North West 128 4 102 3 92 2 92 3 72 2 81 2 Northern Cape 18 1 12 <1 8 <1 11 <1 13 <1 5 <1 Eastern Cape 13 <1 6 <1 14 <1 14 1 19 1 15 <1 Free State 38 1 50 1 31 1 29 1 34 1 35 1 Kwa-Zulu Natal 21 1 23 1 17 <1 14 1 11 <1 18 1 Western Cape 19 1 8 <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 3198 100 3552 100 4026 100 3128 100 3479 100 3372 100 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 26 24 25 24 24 22 30 31 42 41 Medical Aid 29 28 30 33 32 30 19 21 17 21 Family 21 21 20 22 23 23 25 22 17 17 Friends 1 1 1 1 1 <1 1 1 1 1 Employer 4 4 5 5 4 4 3 3 2 2 Self 12 11 11 9 10 10 12 11 10 9 Other/Comb <1 4 4 3 5 9 7 9 2 <1 Unknown 3 7 4 3 1 1 2 2 10 8 22

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 1137 38 1417 42 1593 48 No 1781 60 1886 56 1608 48 lined to answer 61 2 57 2 128 4 TOTAL 3128 100 3479 100 3371 100 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 <1 <1 % % % % % % % % % GENDER Male 87 89 92 84 86 90 89 87 88 Female 13 11 8 16 14 10 11 13 12 ETHNIC GROUP Indian 2 3 2 3 2 1 1 1 1 Black/African 66 70 71 64 73 77 69 68 69 Coloured 18 15 15 19 17 13 16 22 19 White 14 12 12 14 8 9 14 8 11 EDUCATION None/Preprimary Primary 13 28 13 13 17 11 10 14 18 Secondary 84 71 84 87 81 87 88 85 80 Tertiary 1 1 3 <1 1 1 2 1 1 23

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 49 8 45 6 44 5 78 8 36 6 40 4 150 19 Cannabis 359 62 486 69 473 54 747 75 401 69 701 77 378 48 Cannabis/ Mandrax* 12 2 4 1 5 1 12 1 12 2 10 1 8 1 Crack/ Cocaine 14 4 9 1 6 1 7 1 5 1 6 1 19 2 Heroin 67 11 75 11 51 6 59 6 46 8 41 5 59 8 Ecstasy 1 <1 4 1 - - 3 <1 1 <1 1 <1 2 <1 OTC/PRE 3 1 2 <1 4 1 2 <1 - - 2 <1 4 <1 Inhalants 27 5 24 3 27 3 24 2 12 2 31 3 31 4 Methcathinone ( CAT ) 37 6 27 4 20 2 32 3 28 5 27 3 79 10 5 1 22 3 11 1 12 1 8 1 19 2 29 4 Nyaope/Whoonga - - - - 17 2 23 2 28 5 32 4 24 3 TOTAL 576 100 702 100 862 100 1002 100 583 100 910 100 783 100 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 94 6 64 36 82 18 83 17 67 33 75 25 87 13 Cannabis 94 6 87 13 89 11 93 7 95 5 89 11 91 9 Cannabis/ Mandrax* 92 8 100-100 - 100-92 8 90 10 75 25 Crack/Cocaine 79 9 78 22 50 50 57 43 100-83 17 89 11 Heroin 94 6 85 15 92 8 88 12 93 7 91 9 86 14 Ecstasy - 100 100 - - - 100-100 - 100 0 50 50 Inhalants 78 22 79 21 96 4 83 17 58 42 71 29 77 23 OTC/PRE 100-50 50 25 75 50 50 - - 50 50 100 0 Methcathinone ( CAT ) 86 14 85 15 60 40 69 31 64 36 70 30 86 14 60 40 55 45 46 54 92 8 50 50 68 32 86 14 Nyaope/Whoonga - - - - 76 23 95 5 89 11 88 22 83 17 24

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 201 201 201 201 201 201 201 201 3 4 4 3 4 4 3 4 % % % % % % % % % % % % Alcohol 52 68 74 26 5 17-3 0 22 25 9 Cannabis 72 70 67 17 23 22 <1 1 2 11 6 10 Cannabis/ 75 90 63 25 10 25-0 0-0 13 Mandrax* Crack/Cocaine 60 100 74-0 16-0 0 40 0 13 Heroin 87 78 61-7 15-2 0 13 12 24 Ecstasy 100 0 50-100 0-0 0-0 50 Inhalants 92 87 74 8 13 19-0 7-0 0 OTC/PRE - 0 75-0 25-50 0-50 0 Methcathinone 11 4 68 29 59 15 11 0 0 50 37 17 ( CAT ) - 11 55 75 79 24-5 3 25 5 17 Nyaope/Whoonga 93 81 92 7 9 0-0 0-9 8 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 55 8 124 14 131 13 58 10 31 3 51 7 Cannabis 82 12 229 27 122 12 88 15 19 2 89 11 Cannabis/Mandrax* 17 2 24 3 18 2 14 2 1 <1 5 1 Crack/Cocaine 25 4 20 2 19 2 17 3 2 <1 9 1 Heroin 48 7 81 9 70 7 26 4 - - 19 2 Ecstasy 5 1 2 <1 7 1 4 1 - - 1 <1 Inhalants 16 2 27 3 14 1 11 2 - - 11 1 OTC/PRE 15 2 4 <1 2 <1 - - 3 <1 - - Methcathinone 31 4 31 4 39 4 33 6 4 <1 28 4 ( CAT ) 26 4 16 2 19 2 16 3 3 <1 12 2 Nyaope/Whoonga - - - - 7 1 1 <1 8 1 1 <1 Other 102 15 13 2 58 6 47 8 28 3 19 2 TOTAL 702 100 862 100 1002 100 583 100 910 100 783 100 25 201 4

Table 44: Mode of usage of primary substance of abuse for patients aged 20 years and younger (Gauteng) % % % % % % % % % % Swallowed 16 14 11 12 8 7 11 7 5 21 Snorted 6 8 7 13 9 7 6 7 7 13 Injected 1 1 1 <1 11 <1 <1 1 <1 2 Smoked 77 74 81 75 82 86 82 84 88 65 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 48 45 42 39 36 39 35 43 32 33 Work/Employer <1 <1 <1 1 <1 1 <1 <1 1 <1 Health professional 3 2 4 2 4 2 1 2 2 3 Religious body 1 <1 <1 1 1 <1 1 <1 <1 <1 Hospital/Clinic 2 <1 1 1 <1 1 1 2 1 2 Social 8 14 10 13 9 8 8 12 11 11 Services/Welfare Court/Correctional services 12 19 15 14 8 13 17 16 10 11 School 24 17 25 25 40 34 37 24 40 38 Other 2 3 2 4 2 1 1 1 2 1 Unknown - - - - - - - - - - 26

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) 74 39 95 52 16-116 97 144 MARC (In-patient) 2 39 MARC (Out-patient) 6 21 15 90 69 79 46 44 47 Sanca Witbank (Out-patient) 352 461 460 249 454 598 467 534 571 Sanca Nelspruit (Out-patient) 149 123 125 130 168 200 188 157 199 (LADHC) SANCA Far North (Polokwane) 87 10 81 57 53 64 89 147 173 (Outpatient) Healing Wings - - 116 77 58-34 14 - Healing Wings - - - 19 11 - - - - Youth Total number in treatment 669 693 892 655 818 941 959 1004 1134 Table 47: First Time Admissions (Northern Region) First-time admissions continue to remain stable (95%) % Yes 81 80 83 77 74 80 82 78 92 95 No 19 20 17 23 26 20 18 22 8 5 27

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 18 12 13 26 30 15 5 23 13 14 Outpatient 82 88 87 74 70 85 95 77 87 86 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 48 50 46 47 36 39 46 49 49 Work/employer 11 14 13 10 9 10 8 10 13 Doctor/psychiatrist/nurse (health professional) 13 15 13 10 16 15 8 6 4 Religious body 1-1 1 1-1 1 <1 Hospital/clinic 7 1 1 1 1 1 3 2 <1 Social services/welfare 7 4 11 10 7 7 16 9 13 Court/correctional services 5 3 6 4 5 4 5 5 4 School 7 9 4 13 10 12 9 16 16 Other, e.g. radio 1 4 5 4 4 1 3 2 1 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 % 10-14 2 1 3 3 4 7 2 2 4 15-19 17 20 15 25 22 22 23 26 22 20-24 20 23 23 21 21 21 22 21 24 25-29 19 19 20 15 18 18 20 20 21 30-34 12 12 15 12 12 11 13 12 12 35-39 9 8 8 7 7 7 7 7 6 40-44 7 6 5 6 6 4 4 4 5

45-49 6 3 5 5 3 4 3 2 3 50-54 4 5 3 3 4 3 2 3 2 55-59 3 2 2 2 3 2 2 2 1 60-64 1 1 1 1 - <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 70 61 64 64 77 69 76 77 Coloured 1 2 3 4 2 3 2 3 Indian 2 1 1 1 1 1 2 1 White 27 36 31 31 20 26 20 18 EMPLOYMENT STATUS Working full time 38 34 30 36 30 26 23 23 Working part time 3 4 3 4 3 3 6 5 Unemployed (unspecified 38 44 41 35 39 46 19 13 period) Unemployed (<6 months) - - - - - - 6 4 Unemployed (<6 months) - - - - - - 17 26 Student/Apprentice/internship <1 <1-1 - - 5 3 Pupil/learner at school 20 16 25 25 27 23 22 25 Disabled/medically boarded <1 <1 <1 - <1 <1 <1 - Housewife <1 - <1 <1 <1 - <1 <1 Pensioner/retired 1 1 1 1 <1 1 1 <1 MARITAL STATUS* Married, living with spouse 16 14 15 17 13 11 - - Married, not living with spouse 2 4 3 2 1 2 - - Living together 6 5 5 5 5 4 - - Divorced 4 6 5 4 3 4 - - Widowed 1 1 1 1 4 1 - - Never married 72 71 71 70 74 78 - - Other - - - 2 - - - - EDUCATION None 1 1 1 1 1 <1 1 <1 Primary 8 11 10 14 17 10 7 10 Secondary 82 80 80 75 75 81 85 83 Tertiary 9 8 9 10 7 9 7 7 *We are no longer collecting data on marital status 29 % GENDER Male 88 84 81 86 87 89 89 90 Female 12 16 19 14 13 11 11 10