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) [email protected] 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 [email protected] 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 [email protected] /[email protected] 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

35 Table 53: Primary substance of abuse (Northern Region) % % % % % % % % % Alcohol Dagga Dagga/Mandrax 1 <1 <1 <1 - < Crack Cocaine Methcathinone ( Cat ) < Heroin Ecstasy 1 <1 - <1 - <1 - <1 <1 Inhalants PRE/OTC Tik < <1 Other <1-2 - *Heroin includes Pinch Very few female patients are treated for cannabis, while a relatively high proportion is treated for CAT. Table 54: Gender, by primary substance of abuse (Northern Region) % % % % % M F M F M F M F M F M F Alcohol Dagga Dagga/ Mandrax Crack Cocaine Heroin Ecstasy Inhalants PRE/OTC Methcathinone ( Cat ) Tik Other * Crack and cocaine combined 31

36 Table 55: Race, by primary substance of abuse (Northern Region) AFRICAN COLOURED ASIAN WHITE % % % % Alcohol Dagga < Dagga/ Mandrax Crack/ Cocaine Ecstasy Heroin Inhalants PRE/OTC Tik Khat Other Tobacco (Row% add up to 100) 32 Black patients constitute the majority of heroin patients, and this has significantly increased compared to the previous period. A significant increase was also noted in White patients treated for methcathinone. Table 56: Mean age in years, by primary substance (Northern Region) Methcathinone ( Cat ) 2008 YEARS Alcohol Dagga Dagga/Mandrax ( White Pipe or Mandrax alone) * 31* 18* Crack Cocaine Heroin Ecstasy 32 22* 31* * 28 Inhalants PRE/OTC * Methcathinone ( Cat ) 30 24* - 33* 28* Tik * Other *Crack/cocaine combined # n=4

37 During this reporting period, patients treated for alcohol and over-the-counter or prescription medicine abuse are younger on average than those treated for methamphetamine. Patients treated for inhalants are the youngest. Table 57 indicates that heroin and cocaine are also common secondary drugs of abuse. One third of all patients had heroin as a primary or secondary drug in the 1 st half of. Table 57: Overall proportion of substances used (Northern Region)* n % n % n % n % n % Alcohol Methcathinone ( Cat ) Dagga Mandrax 3 < Methamphetamine ( Tik ) Crack/Cocaine Heroin Inhalants Ecstasy PRE/OTC LSD < Other <1 Tobacco *The percentage of patients reporting the substance as their primary OR secondary drug The most common sources of payment for treatment are the state, family and self. A significant increase in payments by state and self, and slight decrease by family was noted. Table 58: Source of payment (Northern Region) % % % % % % % % State Medical aid Family Friends 1 <1 <1 1 <1 1 1 <1 Employer Self Unknown <1 1 1 Other State/ <1 <1 - - <1 <1 - - Friends State /Other < <1 - - Family/ Self <1 <1 < <1 - Forty-four percent of patients reported that they have been tested for HIV in the last 12 months. 33

38 Table 59: HIV Test (Northern Region) Tested for HIV in the past 12 months % % % % Yes No line to answer Table 60: Area of residence (Northern Region) % % % % % % % % % PROVINCES Mpumalanga Gauteng Kwazulu <1 Natal Free State <1 - <1 <1-1 <1 <1 - Northwest <1 1 <1 1 <1 <1 1 <1 <1 Eastern Cape < <1 <1 - - Northern Cape Western Cape < Limpopo OTHER COUNTRIES Lesotho <1 <1 - - Swaziland - < <1 <1 - - Mozambique <1 <1 - Zambia < <1 <

39 DATA FOR PATIENTS YOUNGER THAN 20 YEARS Cannabis, alcohol and heroin were the most common primary substances of abuse for patients younger than 20 years in this period. A slight increase in alcohol and a significant increase in cannabis were observed compared to the previous period. Table 61: Primary substance of abuse for patients younger than 20 years (Northern Region) % % % % % % % % % Alcohol Cocaine 1 Crack Dagga Dagga/Mandrax Heroin Ecstasy PRE/OTC Methcathinone ( Cat ) Other Inhalants Tik *Crack/Cocaine combined Up to 88% of patients younger than 20 years are Black, and this proportion has significantly increased compared to the previous period. The proportion of White patients younger than 20 years also decreased significantly in this period. Table 62: Profile of patients younger than 20 years (Northern Region) % % % % % % % GENDER Male Female ETHNIC GROUP African Coloured Asian White

40 2d: Treatment centres: Port Elizabeth Ms Diana Kitshoff Data were collected from 4 specialist treatment centres on a monthly basis and a total of 510 patients were treated across these treatment centres for the January e. The majority of patients were treated at Hunter s Craig Psychiatric Hopsital. There has been a significant increase in number of patients in Port Elizabeth during this period since Hunter s Craig rejoined the network. Table 63: Proportion of treatment episodes (Port Elizabeth) % % % % % % % % % SANCA PE Welbedacht Shepherd s Field SANCA Thembilitsha Hunters Craig Total no of persons treated The proportion of new admissions has increased slightly when compared to the previous period. Table 64: First time admissions (Port Elizabeth) 2008 % % % % % % % % % % Yes No The majority of patients are now seen on an inpatient basis, and in this period this proportion has significantly increased compared to the previous period. Table 65: Types of treatment received (Port Elizabeth) % % % % % % % % % Inpatient Outpatient The majority of referrals were from health professionals (78%), a significant increase compared to the previous period. This was followed by referrals from self/family/friend constituting 12% of referrals. 36

41 Table 66: Referral sources (Port Elizabeth) The table below depicts the population profile of patients attending treatment centres in Port Elizabeth in the first half of. Single males are the most common type of patients seen in treatment and a significant increase in female patients was also noted in this reporting period. A significant decrease in patients who were unemployed and a significant increase in patients who were employed were also noted in this reporting period. The majority of patients are from Coloured descent (38%), followed closely by White patients (35%). The proportion of patients who selfidentified as being married also increased significantly from 18% to 42% during this reporting period and the proportion of those who are student/learners also decreased in this reporting period (12%). 37 % % % % % % % % % Self/family/friends Work/employer Doctor/psychiatrist/nurse (health professional) Religious body <1 <1 <1 1 <1 1 <1 - - Hospital/clinic Social services/welfare Court/correctional services/police/lawyer School Other e.g. radio, Children s home, adverts < While 14% of the patients were younger than 20 years in this reporting period, 15% of patients were in the age category of years of age, decreasing significantly compared to the previous period. Table 67: Age distribution (Port Elizabeth) Years n % n % n % n % n % n % Under

42 Table 68: Population Profile (Port Elizabeth) % % % % % % % % % GENDER Male Female ETHNIC GROUP African Asian Coloured White MARITAL STATUS Married (living with spouse) Living Together Divorced Widowed Single Separated/not living with spouse Other 1 <1 < EMPLOYMENT STATUS Working full-time Working Part-time Unemployed Intern/Apprentice 1 2 < Learner/Student Disabled/Boarded Housewife Pension/Retired Other <1 < Twenty percent of patients reported that they have been tested for HIV in the last 12 months. Table 69: HIV Test (Port Elizabeth) Tested for HIV in the past 12 months % % % % % Yes No line to answer Alcohol remains the most common primary substance of abuse (36%), now followed by methamphetamine and OTC/PRE (21% and 22%, respectively). The proportion of patients admitted for Mandrax has remained stable from the previous reporting period, and cocaine showed a slight decrease. 38

43 Table 70: Primary substance of abuse (Port Elizabeth) % % % % % % % % % % Alcohol Dagga Dagga/Mandrax Cocaine Crack Ecstasy <1 - - < OTC/PRE Heroin Inhalants 1 <1 <1 <1 <1-1 <1 1 - Methamphetamine ( Tik ) Khat - <1 1 <1 - - <1 - - <1 LSD < CAT *Crack/cocaine combined 1 Over the counter or prescription medicines Most patients attending treatment centres use their primary substance of abuse on a daily basis (88%), a significant increase compared to the previous period. Table 71: Frequency of use of primary substance of abuse (Port Elizabeth) % % % % % % % % Daily days per week Once a week or less Not used in past month < <1 The majority of users (primary substance of abuse) reported having started abusing drugs between the ages of years (37%). Table 72: Age at which primary substance of abuse first used or experimented with (Port Elizabeth) Years n % n % n % n % n % n % n % <

44 < Age unkno wn During this review period, female patients were admitted for cocaine, methamphetamine and OTC/Prescription medication abuse. Table 73: Gender by primary substance of abuse (Port Elizabeth) 40 M F M F M F M F M F M F Alcohol Dagga/Mandrax Dagga Crack Cocaine Ecstasy OTC PRE Heroin Inhalants Methamphetamine ( Tik ) Other Khat CAT LSD *OTC/PRE combined Crack/cocaine combined The majority of patients treated for methamphetamine and dagga/mandrax are Coloured (59% and 80%). More White patients are treated for methcathinone (75%) and crack/cocaine (67%). Table 74: Race by primary substance of abuse (Port Elizabeth) AFRICAN COLOURED ASIAN WHITE % % % % Alcohol Dagga/ Mandrax Dagga Crack Cocaine Ecstasy OTC PRE Heroin

45 Methamphetamine ( Tik ) Khat CAT Inhalants LSD *OTC/PRE combined + Crack/cocaine combined The mean age of all patients was 30 years. Patients treated for alcohol and over-the-counter or prescribed medication were on average older than those treated for other drugs. The youngest mean age was for inhalants. Table 75: Average/Mean age by Primary Substance (Port Elizabeth) Alcohol Dagga/ Mandrax Dagga Ecstasy Cocaine Crack OTC PRE Heroin * 34* 23 Inhalants 14* 22* - 18* 32* 14* - Methamphetamine Tik LSD * - Cat - 25* - 28* 25* 25* - Khat 21* * *n < 5 + Cocaine/Crack combined Smoking and swallowing are the most common methods of drug use. Table 76: Mode of use for primary drug (Port Elizabeth) n % n % n % n % n % n % n % Swallowed Smoked Snorted Sniffed Injected Other/ Combination < *Snorted/sniffed combined 41

46 Table 77: Secondary substance of abuse (Port Elizabeth) n % n % n % n % n % n % Alcohol Dagga/Mandrax Dagga Cocaine Crack Ecstasy LSD OTC PRE Heroin Inhalants Khat Polysubstance Methamphetamine ( Tik ) GHB Tobacco Other *Cocaine/Crack combined + OTC/PRE Combined Medical aid was the most common sources of payment and the proportion has increased significantly compared to the previous period. This is followed by family and self. Table 78: Source of payment (Port Elizabeth) 2008 % % % % % % % % % % Self Medical Aid Family Friends < Employer Unknown < Other < State <1 Employer/Self < <

47 Table 79: Treatment population suburb of residence (Port Elizabeth) n % n % n % n % n % n % METRO SUBSTRUCTURE Bethelsdorp, Gelvandale, Korsten, Malabar Roadhouse, New Brighton, Motherwell Uitenhage, Despatch North End, Mount Road, Central Walmer, Kabega Park, Summerstrand < Port Elizabeth (other parts) OTHER PARTS OF THE PROVINCE George, King Williams Town, Humansdorp, Maclear and East London Unknown 3 < Other Provinces Table 80: Tertiary substance of abuse (Port Elizabeth) n % n % n % n % n % n % Alcohol White Pipe Dagga Cocaine Crack Heroin Ecstasy Ecstasy/ Dagga OTC/PRE Methamphetamine ( Tik ) Moonflower LSD Khat Other Inhalants *Crack/cocaine combined 43

48 SUBSTANCE ABUSE FOR PERSONS YOUNGER THAN 20 YEARS Table 81: Primary substance of abuse of patients younger than 20 years (Port Elizabeth) n % n % n % n % n % n % n % Alcohol Dagga/ Mandrax Dagga Cocaine Crack Ecstasy Heroin OTC/PRE Inhalants Methamphetamine ( Tik ) Other TOTAL Cocaine and Crack combined Methamphetamine was the most commonly used substance by patients in treatment who are younger than 20 years of age and this proportion increased significantly compared to previous reporting periods. A significant decrease in < 20 patients reporting dagga was also noted in this period (24%). The majority of young people in treatment are male (68%), however a significant increase in proportion of female patients was noticed in this period. Table 82: Gender of patients abusing substances younger than 20 years (Port Elizabeth) n % n % n % n % n % n % n % Male Female The majority of patients under 20 years of age who seek treatment belong to the Coloured (49%) population, and this proportion has decreased slightly during this period. A slight increase in White and Black patients was however noticed. 44

49 Table 83: Race of patients younger than 20 years (Port Elizabeth) n % n % n % n % n % n % n % African Asian Coloured White TOTAL

50 2e: SANCA East London treatment demand Table 84: Demographics (East London) Mr Roger Weimann n % n % n % n % n % GENDER Males Females TOTAL ETHNIC GROUP African Coloured Asian White EMPLOYMENT STATUS Working full time Working part time Not working Apprentice/intern Student/learner Disabled/medically boarded Pensioner Other Housewife MARITAL STATUS Married, living with spouse Married not living with spouse Living together Divorced Widowed Never married Other None EDUCATION Grade Grade Tertiary During January e, 77 patients were treated at SANCA Central Eastern Cape. This period saw a significant increase in patients who are Black and in student/learners. There was a significant increase in patients who are unemployed and other categories remained stable. 46

51 Table 85: Referral source (East London) Jan n % n % n % n % n % n % Self Family or friends Employers Health Profession Religious groups Hospital/clinic Social Services Courts/correctional services School Other Self or family/friends are the most common sources of referral followed by employer referrals. The average age of all patients was 29 years. Thirty percent of patients were younger than 20 years in the 1 st half of. A slight increase in patients across all other age groups was also noted. Table 86: Age group (East London) Age Group n % n % n % n % n % n % Table 87: Inpatient versus outpatient (East London) n % n % n % n % n % n % Inpatient Outpatient TOTAL The majority of patients were treated on an outpatient basis (80%) 47

52 Table 88: First time admissions (East London) - n % n % n % n % n % n % n % No Yes All patients were admitted for the first time. Table 89: Number of previous treatments (East London) - n n n n n n n n Nil One Two Three Four >Four Thirty-seven percent of patients reported that they have been tested for HIV in the last 12 months; it is encouraging to see that more people are testing for HIV. Table 90: HIV Test (East London) - Tested for HIV in the past 12 months % % % % % Yes No line to answer Alcohol remains the most common primary drug, followed by cannabis (dagga) and the dagga/mandrax combination. Table 91 Primary substance of abuse (East London) - n % n % n % n % n % n % n % Alcohol Cocaine Crack Dagga Ecstasy Heroin PRE/OTC

53 Mandrax Inhalants Methamphetamine Other CAT TOTAL Smoking was reported as the common mode of drug use (57%), followed by swallowing (39%). Table 92: Mode of usage (primary drug) (East London) n % n % n % n % n % n % Swallow Smoke Snort/Sniff Inject Other TOTAL Most dagga patients are male (95%), while a third of methamphetamine patients (33%) and half of heroin patients are female, although numbers are small. Table 93: Primary substance of abuse by Gender (East London) Male Female Male Female Male Female n % n % n % n % n % n % Alcohol Cocaine Crack Dagga Heroin PRE/OTC Ecstasy Inhalants White Pipe Other Methampheta mine(tik) Tobacco Most patients treated for dagga, dagga/mandrax and alcohol related problems were Black, whereas most methamphetamine patients were Coloured. 49

54 Table 94: Primary substance of abuse by race (East London) African Coloured Asian White % % % % Alcohol Cocaine/ Crack Dagga Heroin PRE/OTC Ecstasy Table 95: Secondary substance of abuse (East London) Alcohol, dagga/mandrax and dagga remain the secondary substances of abuse, with a slight decrease in methamphetamine abuse and an increase in cocaine as a secondary substance of abuse when compared to the second half of. n % n % n % n % n % n % Alcohol Cocaine Crack Cat Dagga Ecstasy White Pipe PRE/OTC LSD White Pipe Methamphetamine Inhalents Methamphetamine ( Tik ) Heroin Inhalants Other Tobacco

55 Table 96: Tertiary substance of abuse (East London) n % n % n % n % n % n % Alcohol Cocaine Crack Dagga Ecstasy Glue White Pipe PRE/OTC Heroin LSD CAT Inhalents Tik/Speed Other Tobacco Patients treated for alcohol or over-the-counter medications are on average older than patients treated for dagga. Table 97: Average age by primary drug (East London) Jul - Years Years Years Years Years Years Years Years Average age of all patients Alcohol Dagga Mandrax Cocaine/crack Ecstasy * 23* 33* - - Heroin 27* 19* OTC * 39* 34* 35* 39* - Inhalants 12* - 13* Other Methamphetamine (tik) 20* 28* 20* * n < 5 51

56 Table 98: Source of payment (East London) n % n % n % n % n % n % State Self Medical aid Employer Family Friends Unknown Other combinations Family (52%), medical aid (12%) and state (14%) was the most common sources of payment. Other categories remained stable during this period. SUBSTANCE ABUSE FOR PERSONS YOUNGER THAN 20 YEARS Table 99: Primary substance of patients younger than 20 years (East London) Dagga remains the primary substance of abuse for persons under the age of 20 years. Jan - n % n % n % n % n % Alcohol Cocaine Crack Dagga Ecstasy Methamphetamine White pipe PRE/OTC Heroin/Opiates Inhalants Other Tobacco TOTAL

57 Table 100: Gender and race profile of patients younger than 20 years (East London) The demographic profile of <20 patients seeking treatment in this region is male and of Black African descent. Jan - % % % % % % GENDER Male Female ETHNIC GROUP African Coloured Asian White

58 2f: Specialist Treatment Centres: KZN Table 101: Proportion of Treatment Episodes (KZN) Ms Furzana Timol & Ms Aurene Wilford Jan - * Data collection for these periods began at different times During January e a total of 934 patients were admitted to the four participating treatment centres, one in Durban, one in Pietermaritzburg, one in Ramsgate as well as the SANCA centre in Zululand. While the overall percentage of first time admissions remains high, closer inspection of these rates show variations in the number of repeat patients between the various treatment centres. The outpatient centres have a higher proportion of patients who have been treated previously (19%), whereas about 15% of those admitted to inpatient centres had received previous treatment. Table 102: First Admissions (KZN) % % % % % % % % % SANCA Penthouse SANCA Lulama (Durban) Newlands Park Centre SANCA Pietermaritzburg Chatsworth Anti- Drug Forum SANCA Newcastle SANCA Zululand South Coast Jullo centre Persons treated over all centres Jan - % % % % % % % % % % Yes No Most patients were treated on an outpatient basis during this period. 54

59 Table 103: Type of treatment received (KZN) Jan Jan - Jul - % % % % % % % Inpatient Outpatient The SANCA treatment centres based in Zululand, Durban and Pietermaritzburg have the largest numbers of African patients, whilst the South Coast centre sees mostly White patients. Table 104: Proportion of Race Groups in Treatment Centres (KZN) % % % % African Coloured Indian White SANCA Penthouse * * * - - SANCA Lulama (Durban) SANCA Pietermaritzburg Chatsworth Anti- Drug Forum South Coast 10* 3** 8* 5* 6* 4* 3** SANCA Newcastle 50* 41-50* * * - SANCA Zululand * Overall Race *:n<=5; **:n=1 The table below shows a slight decrease in the proportion of patients who were not working and an increase in patients who are students. A slight decrease in patients who completed tertiary education was also noted. In the latest round of data collection, it should be noted that the majority of patients in the sample are African (67%) as compared to the first half of where a majority of patients were Indians. In this period Indian patients comprised 11%, slightly decreasing compared to the previous period. Table 105: Population Profile of Patients (KZN) 55 Jul - % % % % % % % % % GENDER Male Female ETHNIC GROUP African Coloured Indian White

60 EMPLOYMENT STATUS Employed (full-time) Employed (part-time) Not Working Apprenticeship/ Internship <1 < <1 <1 <1 <1 Student/pupil Disabled <1 1 1 Housewife <1 - <1 1 < <1 Pensioner <1 1 1 <1 <1 1 Other MARITAL STATUS Married, living with spouse Married, not living with spouse Living in a nonmarried intimate relationship Divorced Widowed Never married (& not living in nonmarried intimate relationship) Other <1 < EDUCATION Pre-Primary Primary Secondary Tertiary None 1 <1 <1 1 1 <1 <1 1 1 A well-established trend is that most referrals are made through a combination of self; family or friends (42%), and this proportion remained stable compared to the previous reporting period. Referrals from employers (13%) and health professionals (3%) slightly decreased in this period. This period saw an increase school Table 106: Referral Sources (KZN) 56 Jan - Jul - % Self/Family/Friends Social Service/ Welfare Employer/Work Court/Correctional Services

61 Health Professionals Hospital/Clinic School Religious Group <1 < <1 Other Notably, 50% of the population in treatment is 24 years or younger, this has increased slightly compared to the last period (45%). Over 60% of the population in treatment is between 10 and 29 years of age. Table 107: Age Distribution of the Treatment Population (KZN) AGE Years 2008 Jan - Jul - % % % % % % % % % % Table 108: Race by age under and over 20 years age (KZN) 20 years or younger Over 20 Years n % n % n % n % n % n % African Coloured Indian White While 42% of African patients are younger than 20 years, 48of Coloured patients are younger than 20 years. There has been a slight increase (21%) in Indian under 20s seeking treatment. Thirty percent of patients reported that they have been tested for HIV in the last 12 months. 57

62 Table 109: HIV Test (KZN) Jan - Jul - Tested for HIV in the past 12 months % % % % % Yes No line to answer Alcohol remains the most commonly abused substance among people in treatment, and the proportions remained stable during this period. Cannabis and crack/cocaine are the next two primary substances to be abused, and there is a slight increase in dagga compared to last period. Table 110: Primary Substance of Abuse 1 st most frequently used (KZN) 58 Jan - Jul - % Alcohol Cannabis Mandrax ( white pipe ) Crack/Cocaine PRE/OTC 1 1 <1 2 1 < Ecstasy <1 <1 <1 <1 - <1 1-1 Heroin ( sugars ) Inhalants 1 <1 1 < Cannabis/ Cocaine LSD <1 <1 - CAT <1 < Methamphetamine (Tik) <1-1 <1 1 <1 Khat The majority of over 20 s use alcohol, heroin, cannabis and cocaine/crack during this period. Table 111: Primary Substance of Abuse by Age Cohort (KZN) 20 Years or Younger Over 20 Years % % % % % % % % % % Alcohol Cannabis CAT * ** 75* Dagga/ 33* 53 14* 36** 50* 67** 47** 86** 64 50* Mandrax Crack 13 6** 22** 9** Cocaine Heroin **

63 Sugars Ecstasy 1* ** 99* 100** 100* - 83** * PRE/OTC 13* 13* 14* - 20* 66** 66** 86** 100** 80* Solvents 100* 100** - 60** 71* * 40** 29* * Tik/Speed - 67** ** - 100** 100* Tobacco *n=1; **n=<10 Substances such as inhalants are more likely to be used by younger individuals. The mean age of cannabis patients was 28 years during this period. Table 112: Mean Age by Primary Substance of Abuse (KZN) Primary substance of abuse 2008 YEARS Jan - Jul - % % % % % % % % % % Alcohol Cannabis Mandrax Crack 31 Cocaine Ecstasy 26* * 24* - 32* 35* - 28 OTC/PRE * * 43 38* 31 Heroin ( sugars ) Inhalants/ Solvents ** 14* 15** 15* 34* 18* 25 CAT ** 14** 14* Methamphetime (Tik) * 17* - 21** * 36 Ketamine *n=1; **n=<10 Table 113 shows that the mean age of persons in treatment remains fairly stable. Table 113: Age of first use of Alcohol/other Drugs and age of patients in treatment (KZN) Mean age of persons in treatment 2008 Years Jan - Jul

64 Table 114: Primary Substance of Abuse by Race (KZN) AFRICAN COLOURED ASIAN WHITE % % % % Alcohol Cannabis Mandrax Crack/ Cocaine Ecstasy Heroin ( Sugars ) OTC/PRE CAT Inhalants Methamp hetamine (Tik) *n=1 **n=< Up to 67% of alcohol patients, 71% of cannabis patients and 71% of heroin patients are African, while 81% of methcathinone patients are White. Table 115: Gender by Primary Substance of Abuse (KZN) Primary substance Jan - of abuse % % % % % % M F M F M F M F M F M F Alcohol Cannabis Dagga/ Mandrax Crack Cocaine Ecstasy OTC/PRE Heroin ( sugars ) Inhalents/ Solvents Heroin CAT Methamp hetamine (Tik) *n=1; **n=<10 Males continue to dominate in the use of all substances, although a third of methcathinone abuse patients during this period were females (38%). OTC/PRE is mostly abused by females, but in this period more male patients reported OTC/PRE although the numbers are small.

65 Table 116: Secondary Substance of Abuse (2 nd most frequently used) (KZN) Jan - % Alcohol Cannabis Mandrax Crack/Cocaine Heroin Sugars Ecstasy PRE/OTC LSD < Methamphetamine - < Inhalants <1 1 1 <1 1 <1 1 1 <1 Other (including cigarettes) The second most frequently used drugs as reported by the treatment population are cannabis, alcohol and cocaine/crack. The table below shows that family were the most the most common source of payment (43%), followed by self (16%) and medical aid (15%), which has decreased slightly during this period. The proportion of payments by employer also decreased slightly in this period. Table 117: Sources of Payment Treatment Expenses (KZN) Jan - n % n % n % n % n % n % Family Self Medical Aid State Employer Other/ Unknown Friends 2 < <1 Unable to < <1 pay Employer/Se < <1 1 <1 - - lf Total

66 DATA FOR PATIENTS YOUNGER THAN 20 YEARS The most common primary substance of abuse for patients who are younger than 20 years during this period was alcohol (53%), followed cannabis (31%). A slight increase in crack/cocaine and heroin was also noticed and other categories remained fairly stable in the 1 st half of. Table 118: Primary substance of abuse of patients <20 years (KZN) Jan - n % n % n % n % n % Alcohol Cannabis Mandrax Cocaine Crack Ecstasy OTC/PRE Heroin (including Sugars) Inhalants/Solvents CAT Methamphetamine (tik) TOTAL

67 2g: Central Region Ms Siphokazi Dada Data representing 472 patients were collected from five treatment centres during the period January e compared to 495 for the previous six-month period. In the Free State, Aurora collected data from 290 patients, SANCA Goldfields from 55 patients and SANCA Sasolburg from 23 patients. In the Northern Cape, no data was received during this period. In the North West, SANPARK Klerksdorp collected data from 104 patients. Table 119 shows the proportion of patients from each treatment centre. Table 119: Proportion of treatment episodes Free State Northern Cape North West % % % Aurora SANCA Goldfields SANCA Sasolburg SANCA Kimberley SANCA Upington SANPARK Klerksdorp Total in treatment In Table 120 Yes indicates a first time admission and No indicates a repeat admission. The proportion of first time admissions to treatment centres increased slightly in the North West, but remained stable in the Free State. First time admissions make up the majority of admissions across all provinces. Table 120: First time admissions Free State Northern Cape North West % % % Yes No

68 Table 121 indicates that in the North West (99%) and in the Free State most patients (67%) were treated on an inpatient basis. Table 121: Type of treatment received Free State Northern Cape North West % % % Inpatient Outpatient The most common source of referral to specialist treatment centres in the Free State was the employer (25%), followed closely by family/friends (24%) and social services/welfare (19%). A slight increase in referrals by school was noticed in this period. In the North West employer and family/friends (28%) were the most common sources of referral, followed by social services (18%) and self (17%). A significant decrease in referrals by court/correctional services was noticed in this period. Table 122: Referral sources Free State Northern Cape North West % % % Self Family/friends Work/employer Doctor/psychiatrist/ nurse (Health professional) Religious body Hospital/clinic <1 1 < Social services/welfare Court/correctional School Other e.g. radio <1 - - <

69 Table 123: Population profile Free State Northern Cape North West % % % GENDER Male Female ETHNIC GROUP Asian <1 - < Black Coloured White EMPLOYMENT STATUS Working fulltime Working parttime Not working Apprentice/ internship <1 - < Student/learner s Disabled: not working <1 - < Housewife Pensioner/ retired Other MARITAL STATUS Married, living with spouse Married, not living with spouse Living together Divorced Not married *Highest school education completed Male patients predominate in both provinces (87% and 88%). During this period, Black patients were in the majority in both provinces. In the Free State and North West, most patients were working fulltime, followed by patients who were not working. In the Northern Cape most patients were unemployed. Across all three provinces the majority of patients have never been married, followed by those married and living with spouse. Most patients have a secondary level of education or more. 65

70 The average age of persons seen by treatment centres was 31 years in the Free State and 33 years in the North West. The proportion of patients younger than 20 years of age increased in the Free State, but decreased in the North West. Table 124: Age distribution Free State Northern Cape North West % % % <1 <1 1 < Thirty-eight percent of patients in the Free State and 51% in the North West reported that they had been tested for HIV in the past 12 months. Table 125: HIV test Free State Northern Cape North West Free State Northern North West Cape % % Yes No line In both provinces alcohol was the most commonly abused primary substance among people in treatment. Cannabis was the second most common primary substance of abuse in both provinces. A slight decrease in treatment admissions for crack/cocaine in Free State and for dagga/mandrax in North West is noted during this period. Table 126: Primary substance of abuse Free State Northern Cape North West % % % Alcohol Cannabis Cannabis/Mx

71 Crack/Cocaine Heroin Methampheta mine Ecstasy Inhalants Methcathinone OTC/PRE < Khat The overall proportion of the primary and secondary drugs of abuse is shown in Table 127. Alcohol and cannabis are the most common substances used. In the Free State and in the North West crack/cocaine is also a relatively common drug. A significant increase in treatment admissions for methcathinone in Free State is noted during this period. Table 127: Overall proportion of substances used Free State Northern Cape North West % % % Alcohol Cannabis Cannabis/Mx Crack/Cocaine Ecstasy <1 4 2 Heroin < Inhalants Khat LSD Methamphetam ine Methcathinone OTC/PRE < Tobacco Note: The table shows the proportion reporting each drug either as primary or secondary drug. Fifty-three percent in the Free State and 58% in the North West swallowed their drugs, making this the most popular means of consumption. However, when alcohol is excluded 73% in the Free State and 49% in the North West report smoking as their mode of use. Therefore, smoking was reported to be the most common mode of use for substances other than alcohol. Out of sixteen patients who reported heroin as their primary substance of abuse, in the North West one smoked, one swallowed it, two snorted it and three reported injecting the drug; in Free State, four smoked it, one injected it and four injected it. 67

72 Table 128: Mode of usage of primary drug *n=<5; **n=1 Free State Northern Cape North West % % % Swallowed 55(7) 58(6) 53(6) 60(2) 54(3) -(-) 65(7) 64(10) 58(12) Snorted 8(17) 10(21) 9(19) 12(28) 8(13) -(-) 6(16) 13(33) 14(31) Injected 1(1) 1(2) 2(3) -(-) -(-) -(-) -(-) 1(3) 4(8) Smoked 36(75) 31(71) 36(73) 29(69) 38(87) -(-) 29(77) 21(53) 24(49) Figures in brackets above exclude alcohol Injected 17** 50* 67* ** 43* Heroin Table 129: Mean age by primary substance *n=<10; **n=1 Years Free State Northern Cape North West Alcohol Cannabis Cannabis/ * 21* 22* Mandrax Crack/Cocaine ** - 31* - 24 Ecstasy ** Heroin * 26 Inhalants * - 29* - - Khat Methamphetami * 19** 31 ne Methcathinone * * OTC/PRE ** * 39** - Overall mean age Across sites the average age of persons seen by treatment centres was 31 years in the Free State and 33 years in the North West. However, age differences were noted for different substances. Across all sites, persons with alcohol or over-the-counter/ prescription drugs as their primary substance of abuse are on average older than persons having other primary substances of abuse. In contrast, in the Free State, patients whose primary substance of abuse is inhalants are substantially younger. In the North West, persons whose primary substance of abuse is alcohol are older, while those with cannabis as a primary substance of abuse are younger. 68

73 Table 130: Gender, by primary substance of abuse for the Free State Free State % % % M F M F M F Alcohol Cannabis * 97 3* Cannabis/Mandrax 100* - 100* ** Crack/Cocaine 90 10* 82 18* 94 6** Ecstasy Heroin 50* 50* 83* 17** 78 22** Inhalants 93 7* 88* 12** 100* - Khat Methamphetamine 78 22* 89* 11** 86* 14** Methcathinone 17** 83* 17** 83* OTC/PRE 27* 73 67* 33* 44* 55* *n=<10; **n=1 Table 131 Gender, by primary substance of abuse for the Northern Cape Northern Cape % % % M F M F M F Alcohol Cannabis 93 7* 80* 20** - - Cannabis/Mandrax Crack/Cocaine ** Ecstasy Heroin Inhalants 91 9* 100* Khat Methamphetamine Methcathinone 50** 50** OTC/PRE 100** *n=<10; **n=1 As in the previous reporting period, across all sites, male patients outnumbered female patients. Overall 87% of patients were male, but gender differences were noted for various primary substances of abuse (see Tables ). Table 132: Gender, by primary substance of abuse for the North West North West % % % M F M F M F Alcohol * Cannabis 96 4** 93 7* 95 5** Cannabis/Mandrax 67* 33** 100* - 100* - 69

74 Crack/Cocaine 100* ** Ecstasy ** - Heroin 100* - 80* 20** 86* 14** Inhalants 50** 50** Khat Methamphetamine 100* - 100** - 50* 50* Methcathinone 100* - 67* 33* 86* 14** OTC/PRE - 100* - 100** - - *n=<10; **n=1 Table 133: Race by primary substance of abuse for the Free State BLACK COLOURED ASIAN WHITE % % % % % % % % % % % % Alcohol < Cannabis Cannabis/ Mandrax 53* - 38* 37* 100* 50* * Crack/ Cocaine 30* 15* 29* 10* 33 18* - 4* * Ecstasy Heroin 33* - 22* 17* * 100* 78* Inhalants 30* 38* 17** 67 25* 83* ** 38* - Khat Methamph etamine - 11** - 67* 44* 14** * 33* 44* 43* Methcathi none - 6** 13* 17** 6** 8* 33* * OTC/PRE * 17** 22* * 78* Tobacco - 50* * *n=<10; **n=1 Table 134: Race by primary substance of abuse for the Northern Cape BLACK COLOURED ASIAN WHITE % % % % % % % % % % % % Alcohol Cannabis 32 60* * * - - Cannabis/ Mandrax Crack/ Cocaine 40* * -*

75 BLACK COLOURED ASIAN WHITE % % % % % % % % % % % % Ecstasy Heroin Inhalants 30 67* ** Khat Methampheta mine OTC/PRE *n=<5; **n=1 14* ** Table 135: Race by primary substance of abuse for the North West - 100* * BLACK COLOURED ASIAN WHITE 5** - % % % % % % % % % % % % Alcohol * 2** Cannabis * - 5** * 21* 21 Cannabis/ 67* 100* 100* * - - Mandrax * * Crack/ 67* - 33* * * - 22* Cocaine * Ecstasy ** Heroin 100* 40* 29* * 71 Inhalants 100* Khat Methcathino ne Methamphet amine OTC/PRE *n=<5; **n=1-17** 29* - 17** * * 25** * * * 64* 71-75* 100* * - In all three provinces, as in the previous six-month period, the majority of patients report only one substance of abuse. 71

76 Table 136: Multiple substance use Free State Northern Cape North West n % n % n % n % n % n % 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 Table 137: Source of payment Free State Northern Cape North West % % % Self Medical Aid State Family < Friends Work/ employer < Unknown < Other/ combinations During this period, in both provinces the most common source of payment for treatment in the Free State and North West is medical aid, followed by State. 72

77 Tables show the frequency of use of primary drug for each province. Across all provinces, the majority of substances were used on a daily basis. Table 138: Frequency of use by primary drug for the Free State Table 139: Frequency of use by primary drug for the Northern Cape *n=<5; **n=1 Frequency of use in the past month Not used in the past Once per week or 2-6 days per week Daily month less often % % % % Alcohol - 1* 1* 6 4* Cannabis 4 4* 5 5 3* 4* Cannabis/M ax ** 20** 25* 87 80* 75 Crack/Coca ine - 4** 6** 20* 4** 24* * Ecstasy Heroin 17** * 100* 100 Inhalants 3** 13** - 3** - 17** 50 25* 33* 43 62* 50** Methamphe tamine ** - 14** 11** 33** Methcathin 17** - one 8* 17** 13* - 33** * OTC/PRE - 17** ** * 100 Tobacco ** *n=<5; **n=1 Frequency of use in the past month Not used in the past Once per week or 2-6 days per week Daily month less often % % % % Alcohol 1* 5** - 7 5** Cannabis * ** * - Cannabis/ Mx - Crack/ * 100** Cocaine - Ecstasy Heroin Inhalants ** - Methamp hetamine - OTC/PRE ** - - Tobacco

78 Table 140: Frequency of use by primary drug for the North West * (n<5), ** (n=1) Frequency of use in the past month Not used in the past Once per week or less 2-6 days per week Daily month often % % % % DATA FOR PATIENTS YOUNGER THAN 20 YEARS In both provinces, the majority of patients under 20 years are male. In the Free State (54%) and in the North West (80%), most patients under 20 years are from the Black population. Table 141: Gender and race profile of patients <20 years Free State Northern Cape North West % % % GENDER Male Female ** 30* - ETHNIC GROUP African * Coloured * - Asian * 4** White * 20* 20** In the Free State and the North West, most young people were treated for the abuse of cannabis, followed by alcohol, although the numbers are small. Alcohol 1** - - 4* 2** 2** Cannabis * 33* 16* 92 67* 84 Cannabis/ ** - 100* Mx * 67* 100* Crack/ ** * Cocaine - 44* Ecstasy * * Heroin ** * * 100* 86 Inhalants ** ** - - Khat Methcathi none OTC/PRE ** ** 100* * ** - 16** 33** 33* 43* 33** 67* 43* - 74

79 Table 142: Primary substance of abuse of patients <20 years Free State Northern Cape North West n % n % n % n % n % n % Alcohol * ** 1 20** Cannabis * Cannabis/ Mandrax 1 1** * ** - - Cocaine/ crack ** Heroin ** - - Methamphe tamine ** - - Inhalants OTC/PRE Methcathino ne ** 1 20** Total Tables show that across all provinces, males make up the majority of patients for most primary substances of abuse. Table 143: Primary substance by gender of patients <20 years (%) for the Free State Free State % % % M F M F M F Alcohol 83 17* Cannabis * 99 1* Cannabis/Mandrax 100** - 100* - 67* 33* Crack/Cocaine - 100** Heroin 100** Ecstacy Methamphetamine 100** Inhalants 96 4* OTC/PRE 100** Tobacco

80 Table 144: Primary substance by gender of patients <20 years (%) for the Northern Cape Northern Cape % % % M F M F M F Alcohol * Cannabis 94 6* Cannabis/Mandrax 100* Crack/Cocaine Heroin Methamphetamine 100* Inhalants 100* - 100* OTC/PRE Tobacco * (n<5), ** (n=1) Table 145: Primary substance by gender of patients <20 years (%) for the North West North West % % % M F M F M F Alcohol 80* 20** 100** - 100** - Cannabis ** 80* 100* - Cannabis/Mandrax ** Crack/Cocaine ** - Heroin 100** - 100** Methamphetamine ** Inhalants Methcathinone ** 100** - * (n<5), ** (n=1) 76

81 77