SOUTH AFRICAN COMMUNITY EPIDEMIOLOGY NETWORK ON DRUG USE (SACENDU)

Transcription

1 SOUTH AFRICAN COMMUNITY EPIDEMIOLOGY NETWORK ON DRUG USE (SACENDU) SACENDU Report Back Meetings October MONITORING ALCOHOL AND DRUG TRENDS January e, Phase 34

2 South African Community Epidemiology Network on Drug Use (SACENDU) Monitoring Alcohol and Drug Abuse Treatment Admissions in South Africa February 2014 Phase 34 January to e Siphokazi Dada, Cape Town Nadine Harker Burnhams, Cape Town Yolanda Williams, Cape Town Charles Parry, Cape Town Arvin Bhana, KwaZulu-Natal Aurene Wilford, KwaZulu-Natal Furzana Timol. KwaZulu-Natal Diana Kitshoff, Port Elizabeth Erika Nel, Gauteng Roger Weimann, East London David Fourie, SANCA Three reports have been produced: a) SACENDU Update b) SACENDU Research Brief c) Monitoring Alcohol and Drug Abuse Treatment Admissions in South Africa (this report) For copies of these reports contact: Mrs Yolanda Williams Alcohol & Drug Abuse Research Unit Medical Research Council O Box TYGERBERG South Africa Tel.: +27(0) Fax: +27(0) yolanda.williams@mrc.ac.za We are grateful to the National Department of Health (Mental Health & Substance Abuse Directorate) for their funding of this project. ISBN: February 2014

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 28 2d. Treatment centres: Port Elizabeth 36 2e. Treatment centres: SANCA East London 46 2f. Treatment centres: KZN 54 2g. Treatment centres: Central Region (Free State, Northern Cape & 63 North West) i

4 PRESENTATIONS AT SACENDU REPORT BACK MEETINGS (Not included in this report but available at PRESENTATION PRESENTED BY PRESENTED IN Treatment centres: Gauteng data Ms Erika Nel Pretoria Treatment centres: Mpumalanga data Ms Siphokazi Dada Pretoria The lived experience of Mothers raising Ms Hlamica Maluleke Pretoria adolescents abusing Nyaope. A randomized controlled trial of motivational interviewing to prevent risk for alcohol-exposed pregnancy in the Western Cape. Drugs of abuse trends measured in wastewater. Progress on implementing an alcohol advertising ban. Treatment centres: KwaZulu-Natal data. Integrating Screening and Brief Interventions for Alcohol use in Public Health Facilities. The more they go on the more it impacts on their mother s health : Telling parents stories of adolescent substance abuse. Whoonga: Potential recreational use of HIV antiretroviral medication in South Africa Dr Kirstie Rendall- Mkosi Mr Henrick Viviers Prof Charles Parry Aurene Wilford/Furzana Timol Prof Arvin Bhana Ms Candice Groenewald Prof Jennifer Smit Pretoria Pretoria Pretoria (& Cape Town) Durban Durban Durban Durban Treatment centres: Port Elizabeth data Ms Diana Kitshoff Port Elizabeth Treatment centres: East London data Mr Roger Weimann Port Elizabeth Teachers experience of violence by Mrs Natalie Mansvelt Port Elizabeth students. Use and potential abuse of analgesics: A Prof Ilse Truter & Mr Port Elizabeth quantitative and qualitative investigation Brent Knoesen Effectiveness of a substance abuse & substance-related HIV workplace prevention programme. Dr Nadine Harker Burnhams Port Elizabeth Treatment centres: Western Cape data Ms Siphokazi Dada Cape Town Coping methods: having a family Ms Saadia Cassiem Cape Town member who is a substance dependent Economics of alcohol Prof Corne van Cape Town Walbeek Meth mouth in the Western Cape: Documenting oral health and related risk factors Dr Dirk Smit Cape Town Tikking the boxes Dr Kevin Rebe Cape Town ii

5 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 remains the most common primary substance (except for the 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 Central Region. In contrast, KZN saw a marked increase, from 23% in the previous reporting period to 53%, in the number of patients (20 and under) seeking treatment. Changes in treatment admissions for patients younger than 20 years in the KZN region should be monitored over the next few reporting periods. Cannabis is still the most common illicit drug used, especially among youth attending specialist treatment centres. For this period, treatment admissions with cannabis as a primary drug of abuse increased significantly in Gauteng, KZN, CR and NR regions, with a slight decrease noted in the EC and the WC. Despite a decline (from 39% in b to 28%) in the proportion of adolescents admitted for treatment of methamphetamine-related problems in the Western Cape, the province remains heavily affected. Methamphetamine remains the substance of choice among under 20 patients in the WC. Port Elizabeth continues to see a gradual increase of local patients admitted for treatment. The proportion of admissions for cocaine remained fairly low and stable across sites, and is more reported as a secondary drug. Relatively few patients younger than 20 years are admitted for cocainerelated problems. Heroin use remains a growing problem across most sites, except in KZN where it has remained stable. Heroin is mostly smoked although there is a steady increase of patients reporting injecting heroin use. Patients from treatment centres also report injecting other drugs, such as cocaine, methcathinone (CAT), methamphetamine (MA) and over-the-counter/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 prescription or over-the-counter medicines are still more common as secondary substances. Cat (methcathinone), a synthetic stimulant, continues to show an increase in all provinces particularly in Gauteng. Twenty patients younger than 20 years reported methcathinone use in the Western Cape. Poly-substance abuse remains high across provinces, with between 54% and 62% of patients indicating more than one substance of abuse. The proportion of patients seeking treatment for use of Nyaope/Whooga (cheap form of heroin mixed with dagga) has seen increases in Gauteng and remains high but stable in KZN. 1

6 Moving Forward At our most recent round of regional SACENDU meetings we announced some changes to the SACENDU system. Some of these changes relate to increasing SACENDU visibility throughout the country, but also to ensure that SACENDU continues to address emerging research questions related to the changing alcohol and drug scene. Through this process we have revised the SACENDU data collection tool and - a) standardized the demographic questions; b) included questions that relate to the presence of any non-communicable disease at the time of patient treatment admission; c) included questions related to the non-medical use of codeine medications as well information on tobacco use. We believe these changes are key to strengthening the SACENDU system ensuring that we continue to develop the network, monitor both impact and any changes to the AOD scene in South Africa. For any questions regarding the new data collection tool, please contact Ms Siphokazi Dada. We will also be making all the presentations made at the SACENDU regional meetings 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 Chrismara Guttler 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, and Ina Pelser in Mpumalanga). 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. All updates, briefs, reports and presentations are available online and accessible at 2

7 SECTION 2: Treatment Centre data 2a: Treatment Centres: Cape Town Ms Siphokazi Dada Data were collected, on a monthly basis, from 26 specialist treatment centres. Overall 3717 patients were treated across all treatment centres for the period January e when compared to 3178 in the previous six month review period. Table 1: Proportion of treatment episodes (Cape Town) Jul Crescent <1 - CTDCC CTDCC M/Plain De Novo Hesketh King George 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 Western Cape Youth Centre Total in treatment *= Includes SANCA George 3

8 Table 2: First time admissions (Cape Town) In Table 2 Yes indicates a first time admission and No indicates a repeat admission. The proportion of new admissions increased to 66% in this period, a 3% decrease from the last review period % % % % % % % % % % % YES NO Table 3: Type of treatment received (Cape Town) 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 (Cape Town) This review period saw a slight decrease in referrals by social services/welfare. Other sources remain fairly stable. % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse Religious body Hospital/clinic Soc services/welfare Court/correctional School Other e.g. radio Unknown

9 Table 5: Population profile (Cape Town) Males continue to predominate consistently around 76% of patients. A slight decrease in the proportion of Coloured (71% from 76%) and a slight increase in African/Black patients (14% from 11%) have been noticed in this period. A greater proportion of the patients are unemployed (59%), followed by those working full-time (19%). 15% were student/learners. As has been found previously, the majority of patients are single (67 %) and 20% of patients are married. Three quarters of the patients have completed secondary education (Grade 8-12), 13% have primary education and 7% have a tertiary education 5 % % % % % % % % % GENDER Male Female ETHNIC GROUP African Asian 1 < <1 <1 1 1 Coloured White EMPLOYMENT STATUS Working full-time Working part-time Not working Apprentice/ internship <1 - <1 <1 - - <1 <1 <1 Student/pupil Disabled: not working Housewife 1 <1 <1 <1 <1 <1 <1 <1 2 Pensioner/ retired Other 1 <1 1 <1 <1 <1 <1 1 - MARITAL STATUS Married, living with spouse Married, not living with spouse Living together Divorced Widowed Never married Other < Unknown EDUCATION None <1 <1 1 <1 <1 <1 Prim. (Grd 1-7) Second. (Grd 8-12) Tertiary *Highest school education completed

10 Table 6: Age distribution (Cape Town) The age range of patients in treatment was from 10 to 82 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 11 <1 8 <1 13 <1 12 < *Age category 65 + Table 7: HIV Test (Cape Town) Forty-nine of patients reported that they have been tested for HIV in the last 12 months, a slight increase compared to the previous period. Tested for HIV in the past 12 months % % % % Yes No line to answer Table 8: Primary substance of abuse (Cape Town) Methamphetamine was still the most common primary substance of abuse, accounting for 28% of patient admissions. Methamphetamine has decreased slightly when compared to the previous period (33%). The proportion of patients admitted for heroin and dagga dependence also remain fairly stable while the proportion admitted for CAT increased significantly to 8% % % % % % % % % % % Alcohol Dagga/Mandrax Dagga Crack

11 Cocaine - - Heroin Ecstasy <1 <1 <1 <1 - - <1 <1 <1 <1 OTC/PRE < <1 1 Other (solvents etc.) <1 < <1 - Speed/crystal methamphetamine Cat (Methcathinone) <1 - - < <1 8 Inhalants <1 <1 Khat <1 <1 <1 <1 <1 Table 9: Overall proportion of substances used (Cape Town) The overall proportion of the primary and secondary drugs of abuse is shown in the table below. Methamphetamine, alcohol and dagga, are the most common drugs used. Proportions for heroin and alcohol remain fairly stable, while the proportions of methamphetamine and dagga increased compared to the previous period. An increase in proportions of dagga/mandrax was also noticed during this period % Alcohol Dagga/Mandrax Dagga Crack/cocaine OTC/PRE Ecstasy Heroin Methamphetamine ( Tik ) Inhalants <1 1 Khat <1 <1 <1 <1 <1 <1 <1 <1 <1 <1 LSD <1 <1 <1 <1 <1 - <1 <1 <1 <1 Other <1 < <1 1 <1 Ketamine < Magic Mushroom < CAT Note: The table shows the proportion reporting each drug either as primary or secondary drug. 7

12 Table 10: Mode of usage of primary drug (Cape Town) In looking at the mode of usage of the primary drug, 22% of patients reported swallowing their substances. When alcohol is excluded 92% report smoking as their mode of use. Only 1% of patients reported that they injected drugs. e % % % % % % % % % Swallowed 28 (2) 31(2) 32(3) 30(3) 28(1) 25(1) 25 (2) 23(2) 22(3) Snorted 3(3) 2(2) 2(3) 2(3) 2(3) 4(5) 3 (4) 2(2) 2(2) Injected 1 (1) 1(2) 2(2) 1(1) 1(1) 1(2) 1 (2) 1(1) 1(1) Smoked 68(92) 66(94) 64(91) 67(93) 67(95) 70 (92) 70 (92) 74(95) 74(92) Other/ Combination Injected Heroin <1(1) <1(1) <1(1) <1(<1) <1(<1) <1(<1) 1(1) <1(<1) 1(2) Figures in brackets above exclude alcohol Table 11: Mean age by primary substance of abuse (Cape Town) 2008 YEARS Alcohol Dagga/Mandrax Dagga Crack Cocaine Heroin Ecstasy * 20* 28* 28* OTC/PRE Methamphetamine ( Tik ) Inhalants Khat 25 30* 33* - 37* 29* 36* 26 27* 27 GHB * CAT Overall mean age * N < 5 For this period the mean age was recorded as 29 years of age. The data continues to show that patients whose primary substance of abuse is alcohol and over-the-counter or prescription medicine are still on average 40 years or older, than those with other primary substances of abuse (see Table 11). The mean age for patients with other substances remains fairly stable. 8

13 Table 12: Gender, by primary substance of abuse (Cape Town) Dagga (85%) and the dagga/mandrax combination (90%) remain mainly male substances of abuse as indicated in Table 12. Proportionately more females are treated for the use of heroin, crack/cocaine, CAT, OTC/Prescription medications and methamphetamine. % M F M F M F M F M F M F M F Alcohol Dagga/Mandrax Dagga Crack Cocaine Heroin Ecstasy OTC/PRE Methamphetamin e ( Tik ) Inhalants Khat Other LSD GHB CAT N <3 not reported Table 13: Race by primary substance of abuse (Cape Town) 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 Asians making up 1% of patients in treatment. The proportion of Coloureds in treatment for the majority of substances including Mandrax (87%), methamphetamine (77%), CAT (88) and heroin (85%) is far greater than for any of the other groups. Whites continue to constitute the majority of patients in treatment for OTC/PRE (54%), cocaine (53%) and Khat (89%). A significant decrease in proportion of cocaine admissions in Whites and an increase in Black/Africans reporting dagga as primary substance of abuse was noted in this period. AFRICAN COLOURED ASIAN WHITE e e e % % % % % % % % % % % % Alcohol Dagga/Mandrax Dagga <1 < Crack/Cocaine Ecstasy Heroin Methamphetami ne ( Tik ) < Inhalants 8 80* *

14 AFRICAN COLOURED ASIAN WHITE e e e % % % % % % % % % % % % OTC/PRE Khat CAT GHB LSD N <3 not reported Table 14: Multiple substance use (Cape Town) Up to 54% of patients reported using more than one substance of abuse, and this proportion increased 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 (Cape Town) Patients often report a combination of sources of funding for treatment. The category State (35%) was the most common source of payment, followed by family/friends only (15%). 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 remains stable during this period. % % % % % % % % % Self only Medical Aid only State Family/friends only State & self Work/employer only Unknown Other/combinations

15 Table 16: Frequency of use by primary drug (Cape Town) The majority of patients reported OTC/PRE (86%) and heroin (90%) as their most daily used substance, while only 60% of CAT and 57% of methamphetamine patients reported daily use. Seventy-one percent of patients also reported daily use of dagga/mandrax, a significant increase compared to the previous period. Frequency of use in the past month Not used in the past Once per week or 2-6 days per Daily month less often week % % % % e e e Alcohol Dagga Mandrax Ecstasy 100* Cocaine/C 8 60* * rack Heroin Methamph etamine ( Tik ) OTC/PRE 4* 8* 4* - - 2* 11* - 8* CAT Inhalants * 39 25* 25* 36 75* 42 *: N<5 DATA ON PATIENTS AGED 20 YEARS AND YOUNGER Table 17: Gender and race profile of patients <20 years (Cape Town) The majority of patients younger than 20 years were males (82%). Coloured patients constituted 70% of these patients and a slight increase in proportions of Black/African patients was noticed in this period. 11 % % % % % % % % % GENDER Male Female ETHNIC GROUP African Coloured Asian <1 - <1 1 <1 White

16 Table 18: Primary substance of abuse of patients <20 years (Cape Town) Most young patients are treated for the abuse of cannabis or methamphetamine. The proportion of adolescent patients treated for other drugs remains the same. e n % n % n % n % n % n % Alcohol Cannabis Cannabis/ Mandrax Cocaine Crack < <1 2 <1 Heroin Ecstasy OTC/PRE < <1 Inhalants Other CAT Speed/ Methamphetamine Total Table 19: Primary substance by gender of patients <20 years (Cape Town) Over a quarter of adolescent patients who use methamphetamine and a third of patients reporting CAT are females, and this proportion has remained fairly constant over the last few periods. - M F M F M % M F M F M F % % % % % % Alcohol Cannabis Cannabis/Ma ndrax * Cocaine Crack * 25* Heroin Ecstasy Inhalants * Methamphetamine ( Tik ) OTC/PRE * 50* LSD CAT *: N<5 12

17 Table 20: Primary substance by race of patients <20 years (Cape Town) African % Asian White African Coloured Asian White n % n % n % n % n % n % n % n % Alcohol Crack/ Cocaine Cannabis < < Mandrax Heroin Inhalants Methamphetamin e ( Tik ) OTC/PR E LSD CAT

18 2b: Treatment Centers: Gauteng Ms Erika Nel Table 21: Proportion of treatment episodes (Gauteng) n % n % n % n % n % n % Elim Clinic S/Eastern Gauteng <1 S/Central Rand S/Eerste Rust S/Nishtara 2 < S/Vaal Triangle Magaliesoord Castle Carey House of Mercy Stabilis Horizon Thusong Houghton House S/West Rand S/JHB Society Wedge Gardens SANCA Soweto Greater Heidelberg < Fabian Ribeiro Viewpoint Recovery Centre Eden Recovery Centre <1 14 <1 Mighty Wings Total number in treatment Data were collected from 18 specialist treatment centres on a monthly basis during this review period. A total of 4026 patients were treated at Gauteng treatment centres during the period January e. 14

19 Table 22: First time admissions (Gauteng) Seventy-eight percent of patients were admitted to treatment for the first time during this period, remaining stable as in the previous period (78%) % % % % % % % % % % Yes No Table 23: Type of treatment received (Gauteng) Half of patients admitted during January e were treated at inpatient centres and another 50% were treated at outpatient centres. The proportion of inpatients has decreased significantly compared to the previous period. % % % % % % % % % Inpatient Outpatient Table 24: Referral sources (Gauteng) e A slight decrease in referrals from self/family/friends was noted in this period, and a slight increase was noticed in referrals from courts/correctional services. Other categories remained fairly stable. % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse (health professional) Religious body 1 1 < Hospital/clinic Social services/welfare Court/correctional services School Other, e.g. radio Unknown

20 Table 25: Population profile (Gauteng) % GENDER Male Female ETHNIC GROUP African Asian Coloured White EMPLOYMENT STATUS Working full time Working part time Not working Apprenticeship/ internship <1 <1 1 <1 <1 <1 1 <1 <1 Student/pupil Disabled not working 1 <1 1 1 <1 <1 <1 <1 <1 Housewife Pensioner/retired Other MARITAL STATUS Married, living with spouse Married, not living with spouse Living together/ cohabiting Divorced Widowed Never married Other < EDUCATION None/pre-primary <1 <1 <1 <1 <1 - - <1 <1 Primary Secondary Tertiary Mean age Very little change has been noted in the population profile over the last few periods. Over a third are unemployed and over 70% have never been married. The majority of patients (81%) have some secondary education, this proportion has remained fairly stable compared to the previous period; and a slight increase in proportion of patients who are Black African was also noticed. Other categories remained fairly stable. 16

21 Table 26: Age distribution (Gauteng) The age range of patients in treatment was from 9 (youngest we have ever had) to 78 years. The proportion of patients aged years continues to be high (26%), but has remained stable compared to the previous period. Years n % n % n % n % n % n % n % <10 1 < <1 2 < Table 27: Primary substance of abuse (Gauteng) The most common primary substance of abuse in Gauteng during the January e period was dagga (40%), a significant increase compared to the last two periods. This is followed by alcohol, which remained fairly stable compared to the previous period. Crack/cocaine, heroin and CAT admissions have remained stable when compared to the previous period. n % n % n % n % n % n % Alcohol Dagga/ Mandrax* Dagga Crack Cocaine powder Heroin Ecstasy 7 <1 4 < <1 9 <1 OTC/PRE Methcathinone ( Cat ) Methamphetamine ( Tik ) Khat LSD Inhalants Other <1 1 <1 GHB Nyaope Total * White pipe or Mandrax alone 17

22 Table 28: Mode of usage of primary drug (Gauteng) In looking at the mode of usage of the primary drug in the table below, 30% of patients reported swallowing their substances, while 57% reported smoking their substances. This is in keeping with results from the previous review period. When alcohol is excluded 78% reported smoking as their mode of use, also remaining stable compared to previous period. Only 2% of patients reported that they injected drugs. % % % % % % % % Swallowed 50(7) 49(9) 46(8) 40(4) 41 (9) 37(5) 31(5) 30(4) Snorted** 6(11) 5(9) 8(14) 9(14) 12(19) 13(20) 11(15) 11(15) Injected 3(5) 3(6) 2(4) 3(4) 3(4) 3(4) 2(3) 2(3) Smoked 41(77) 42(75) 44(74) 47(75) 44(68) 47(70) 56(77) 57(78) *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, except for OTC/PRE medicines where the majority of patients are female (61%). Nearly a quarter of patients who use crack/cocaine and CAT are females. % M F M F M F M F M F M F M F Alcohol Dagga/Mandrax Dagga Crack/ Cocaine Heroin OTC/PRE Ecstasy Methcathinone ( Cat ) Inhalants Methamphetamine ( Tik ) GHB Khat LSD Nyaope Other

23 Table 30: Mean age by primary substance (Gauteng) YEARS Alcohol Dagga/Mandrax Dagga Cocaine/Crack Heroin Ecstasy * Methcathinone ( Cat ) Methamphetamine Tik ) Inhalants OTC/PRE LSD * Khat Nyaope Other Patients treated for inhalants are the youngest on average, followed by those treated for cannabis and mandrax (Table 30). For this period, the average age for both alcohol and OTC/PRE medication abuse is 40 years. Table 31: Race by primary substance of abuse (Gauteng) % % % % AFRICAN COLOURED ASIAN WHITE 19 Alcohol Dagga/ Mandrax Dagga Crack/ cocaine Ecstasy Heroin Methcathinone ( Cat ) Methamphetamine ( Tik ) Inhalants Khat LSD OTC/PRE Tobacco Nyaope Other Most patients treated for cocaine, Khat and Cat abuse are still White, while the majority of dagga, heroin and dagga/mandrax patients are of Black descent (Table 31). A significant increase was noted

24 in the proportion of Black African heroin patients (77%) when compared to the two previous review periods (69% and 67%). Additionally, a significant increase in methamphetamine use (46%) among White patients was noted in the 1 st half of. Table 32: Second most frequently abused substance (Gauteng) n % n % n % n % n % n % Alcohol Dagga/ Mandrax* Dagga Crack Cocaine Powder Heroin Ecstasy OTC/PRE LSD 5 <1 3 <1 4 <1 2 <1 1 <1 - - Meth-cathinone ( Cat ) Methamphetamine ( Tik) Inhalents Khat 6 < < <1 GHB <1 2 <1 2 <1 Magic Mushroom Other Tobacco TOTAL * White pipe or Mandrax alone Cannabis (dagga), heroin, tobacco and cocaine are the most common secondary drugs of abuse. Table 33: Third most frequently abused substance (Gauteng) n % n % n % n % n % n % Alcohol Dagga/ Mandrax* Dagga Crack Cocaine Powder Heroin Ecstasy OTC/PRE LSD <1 Methcathinone ( Cat ) Methamphetamine ( Tik ) Inhalants

25 n % n % n % n % n % n % Khat 2 < < <1 7 1 GHB <1 1 <1 1 <1 - - Magic Mushroom 1 < <1 Other Tobacco Nyaope TOTAL * White pipe or Mandrax alone Table 34: Fourth most frequently abused substance (Gauteng) n % n % n % n % n % n % Alcohol Dagga/ Mandrax* Dagga Cocaine/Crack Heroin Ecstasy OTC/PRE LSD Meth-cathinone ( Cat ) Inhalants Khat <1 Magic Mushrooms Metham-phetamine ( Tik ) Other Tobacco TOTAL * White pipe or Mandrax alone 21

26 Table 35: Secondary substance of abuse (2 nd, 3 rd and 4 th most frequently used) (Gauteng) n % n % n n % % n % n % Alcohol Dagga/ Mandrax Dagga Crack/Cocaine Powder Heroin Ecstasy OTC/PRE LSD <1 8 <1 Meth-cathinone ( Cat ) Metham-phetamine ( Tik ) Nyaope Other Tobacco TOTAL Table 36: Overall use (reported as primary or secondary substance of abuse) (Gauteng) n % n % n % n % n % n % Alcohol Dagga/Mandrax Dagga Crack/Cocaine Heroin Ecstasy OTC/PRE LSD < <1 11 <1 Methcathinone ( Cat ) Methamphetamine ( Tik ) Other Inhalants Khat GHB Magic Mushroom 1 <1 2 < Nyaope Tobacco TOTAL

27 Consistent with previous review periods, overall, alcohol and dagga remains the most common substances of abuse in this region. Table 37: Suburb of residence (Gauteng) n % n % n % n % n % n % METRO SUBSTRUCTURE 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 N/A N/A Other parts of province N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A OTHER PROVINCES Mpumalanga Limpopo North West Northern Cape < <1 8 <1 Eastern Cape <1 6 <1 14 <1 Free State Kwa-Zulu Natal <1 Western Cape 5 <1 7 <1 4 < <1 1 <1 OTHER COUNTRIES 10 <1 6 < <1 12 <1 9 <1 Total number on whom information was available Table 38: Sources of payment (Gauteng) 2008 % % % % % % % % % % State Medical Aid Family Friends <1 1 Employer Self Other/Comb < Unknown A significant decrease in payments by Medical aid and a slight increase of payments by the state were noticed in this period. Proportions by other sources of payment remained fairly stable compared to the previous period. 23

28 Table 39: HIV Tests (Gauteng) Tested for HIV in the past 12 months n % n % n % Yes No lined to answer Missing TOTAL Thirty-one percent of those who completed the question Have you been tested for HIV in the past 12 months indicated that they had been tested, similar to the previous period. DATA ON PATIENTS AGED 20 YEARS AND YOUNGER Up to 77% of patients younger than 20 years are of Black African descent, and this proportion has slightly increased when compared to the previous period, while only 54% of patients older than 20 years are Black. This review period also shows a slight decrease in the proportion of < 20 females seeking treatment (10%). Table 40: Gender, Race and Education of Patients aged 20 years and younger (Gauteng) <1 % % % % % % % % % GENDER Male Female ETHNIC GROUP Asian African Coloured White EDUCATION None/Preprimary Primary Secondary Tertiary <1 1 1 The most common primary drug of abuse amongst young patients is cannabis, followed by alcohol and heroin. Table 41: Primary substance of abuse for patients aged 20 years and younger (Gauteng) n % n % n % n % n % n % N % Alcohol Dagga

29 n % n % n % n % n % n % N % Dagga/ Mandrax Crack/ Cocaine Heroin Ecstasy 2 < <1 1 < <1 OTC/PRE < < <1 Inhalants Other Khat <1 2 < <1 3 <1 Nyaope TOTAL Table 42: 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 Dagga Dagga/ Mandrax Crack Cocaine Heroin Ecstasy Inhalants OTC/PRE Methcathinone ( Cat ) Methamphetamine ( Tik ) Methcathinone ( Cat ) Methampheta mine(tik) Other KHAT Nyaope *Crack/Cocaine combined Ninety-one percent of teenage heroin patients are Black, compared to 74% of patients aged 20 or older. This proportion increased slightly compared to the previous review period (84%). A significant decrease was also noticed in the proportion of White crack/cocaine patients, from 50% to 14% in this period. 25

30 Table 43: Race by primary substance of abuse for patients aged 20 years and younger (Gauteng) % % % % AFRICAN COLOURED ASIAN WHITE Alcohol Dagga Dagga/ Mandrax Crack Cocaine Heroin Ecstasy Inhalants OTC/PRE LSD Meth-cathinone ( Cat ) Methamphetamine ( Tik ) Khat Nyaope *Crack/Cocaine combined Cannabis, tobacco and heroin remain the most common secondary drugs. Table 44: Secondary and Tertiary substance of abuse for patients aged 20 years and younger (Gauteng) Jan 26 Jan n % n % n % n % n % n % Alcohol Dagga Dagga/ Mandrax Crack Cocaine Heroin Ecstasy <1 7 1 LSD < <1 - - Inhalants OTC/PRE 1 < <1 2 <1 Methcathinone ( Cat ) Methamphetamine ( Tik ) Nyaope Other Tobacco TOTAL *Crack/Cocaine combined

31 Table 45: Mode of usage of primary substance of abuse for patients aged 20 years and younger (Gauteng) 2008 % % % % % % % % % % Swallowed Snorted Injected <1 11 <1 <1 Smoked Other <1 < <1 - Smoke/Snort < <1 - Smoke/Inject < A higher proportion of patients (37%) are referred to treatment centres by school and this has increased slightly compared to the previous period. This is followed by self/family/friends (35%) and court/correctional services (17%). Other categories remain stable. Table 46: Referral Sources for patients aged 20 years and younger (Gauteng) 2008 % % % % % % % % % % Self/Family/Friends Work/Employer 1 1 <1 <1 <1 <1 1 <1 1 <1 Health professional Religious body <1 0 <1 1 <1 <1 1 1 <1 1 Hospital/Clinic <1 1 1 <1 1 1 Social Services/Welfare Court/Correctional services School Other Unknown

32 2c: Treatment Centres: Northern Region Ms Siphokazi Dada Data were collected from 6 specialist treatment centres on a monthly basis. Overall, 941 patients were treated across all treatment centres for the period January e as compared to 818 in the previous six month period. Table 47: Number of treatment episodes (Northern Region) Number Swartfontein (Inpatient) MARC (In-patient) MARC (Out-patient) Sanca Witbank (Out-patient) Sanca Nelspruit (Out-patient) (LADHC) SANCA Far North (Polokwane) (Outpatient) Healing Wings Total number in treatment First-time admissions remained stable compared to the previous period (82%) Table 48: First Time Admissions (Northern Region) 2008 % Yes No Consistent with previous reporting periods, the majority of patients are treated on an outpatient basis (95%). 28

33 Table 49: Type of treatment received (Northern Region) 2008 % Inpatient Outpatient Family/friends or self continue to be the most common sources of referral (39%), followed by health professionals (15%) and school (12%). Other categories remained stable. Table 50: Referral sources (Northern Region) % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse (health professional) Religious body <1 - < Hospital/clinic Social services/welfare Court/correctional services School Other, e.g. radio The mean age of all patients in this reporting period was 27 years. Twenty-nine percent of patients were younger than 20 years. Table 51: Age distribution (Northern Region) Age Category Jan % < <1 <1 1 <1 <1 1 <1 29

34 A slight increase in the proportion of patients who are Not working (39%) and who are students was noted during this period. The proportion of married slightly decreased, while the never married slightly increased. Majority of patients have completed secondary school (75%) other categories remained fairly stable compared to the previous period. Table 52: Population profile (Northern Region) Jan % GENDER Male Female ETHNIC GROUP African Coloured Asian White EMPLOYMENT STATUS Working full time Working part time Not working Apprenticeship/internship <1 1 <1 <1 <1-1 - Student/pupil Disabled not working <1 <1 - <1 <1 <1 - <1 Housewife <1 <1 1 <1 - <1 <1 <1 Pensioner/retired <1 Other MARITAL STATUS Married, living with spouse Married, not living with spouse Living together Divorced Widowed Never married Other EDUCATION None pre-primary Primary Secondary Tertiary Dagga continues to be the most common primary substance of abuse in this region, and has slightly increased during this period when compared to the 2 nd half of. Alcohol has also seen a slight decrease during this period (22%). The proportion of patients reporting heroin as a primary drug slightly increased in the 1 st half of. 30