SOUTH AFRICAN COMMUNITY EPIDEMIOLOGY NETWORK ON DRUG USE (SACENDU) SACENDU Report Back Meetings October MONITORING ALCOHOL AND DRUG TRENDS January e, Phase 34
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 19070 7505 TYGERBERG South Africa Tel.: +27(0) 21 938 0888 Fax: +27(0) 21 938 0342 E-mail: 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: 978-1-920618-21-6 February 2014
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
PRESENTATIONS AT SACENDU REPORT BACK MEETINGS (Not included in this report but available at www.sahealthinfo.org/admodule/alcdrug.htm.) 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
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
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 www.sahealthinfo.org/admodule/alcdrug.htm. For any queries please contact Yolanda Williams at yolanda.williams@mrc.ac.za or 021-938-0888, We hope you will find this report of value to you in your work. If you have any specific feedback or comments on the report, please contact us at nadine.harker.burnhams@mrc.ac.za /siphokazi.dada@mrc.ac.za or fax us at 021-938-0342. 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 20 000 treatment episodes annually, to facilitate hosting regional meetings attended by approximately 200 persons every six months, and the preparation and mailing of reports that are sent bi-annually to over 300 persons. All updates, briefs, reports and presentations are available online and accessible at www.sahealthinfo.org/admodule/alcdrug.htm. 2
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 2 1 1 1 1 <1 - CTDCC 14 15 16 16 12 14 12 CTDCC M/Plain De Novo 9 10 8 8 7 7 6 Hesketh King 1 2 1 1 1 1 1 George - 6 7-9 3 - Kenilworth <1 <1 - - - - 1 Kensington Treatment 4 4 2 3 2 3 2 centre Ramot 5 6 7 7 4 6 5 SANCA WC 33 22 27 20 27 17 14* Stepping Stones 5 5 5 5 4 4 5 Stikland 5 5 4 5 4 6 4 Sultan Bahu - 1 5 16 17 16 16 Tableview Matrix Tafelsig Clinic Matrix Delft Matrix Khayelitsha Matrix Parkwood Matrix Toevlug 11 8 12 9 8 3 7 8 9 2 13 7 18 7 Toevlug Youth 2 1 1-1 2 1 Western Cape Youth - - - - - 1 3 Centre Total in treatment 3134 2933 2927 2733 3912 3178 3717 *= Includes SANCA George 3
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. 2008 2008 % % % % % % % % % % % YES 72 73 77 75 76 78 76 66 72 69 66 NO 28 27 23 25 24 22 24 34 28 31 34 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. 2008 % % % % % % % % % % Inpatient 48 39 42 44 44 34 41 28 37 39 Outpatient 52 61 58 56 56 66 59 72 63 61 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 45 50 40 39 38 46 47 45 46 Work/employer 9 6 9 7 7 6 6 6 6 Doctor/psychiatrist/nurse 9 8 8 9 10 9 10 8 10 Religious body 2 2 2 2 1 2 2 1 1 Hospital/clinic 3 5 5 6 4 4 3 3 3 Soc services/welfare 19 17 19 21 25 17 20 22 18 Court/correctional 6 5 9 8 6 6 5 5 5 School 4 4 4 4 6 8 5 8 9 Other e.g. radio 3 3 4 4 3 2 2 2 3 Unknown - - - - - - - - - 4
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 74 74 74 76 74 76 76 75 76 Female 26 26 26 24 26 24 24 25 24 ETHNIC GROUP African 12 15 12 11 9 11 11 11 14 Asian 1 <1 1 1 1 <1 <1 1 1 Coloured 70 68 70 71 73 75 76 76 71 White 17 17 16 17 17 14 13 12 14 EMPLOYMENT STATUS Working full-time 22 22 24 24 23 22 19 19 19 Working part-time 5 4 4 4 4 3 3 3 4 Not working 57 58 57 57 56 62 59 59 59 Apprentice/ internship <1 - <1 <1 - - <1 <1 <1 Student/pupil 13 12 12 13 15 11 17 16 15 Disabled: not working 1 2 1 1 1 1 1 1 1 Housewife 1 <1 <1 <1 <1 <1 <1 <1 2 Pensioner/ 1 1 1 1 1 1 1 1 1 retired Other 1 <1 1 <1 <1 <1 <1 1 - MARITAL STATUS Married, living 15 13 15 15 13 16 13 14 15 with spouse Married, not living with spouse 4 3 4 3 4 4 4 5 5 Living together 5 7 6 6 6 5 5 5 5 Divorced 6 7 6 6 7 6 6 7 7 Widowed 1 1 1 1 1 1 1 1 1 Never married 67 66 69 67 69 68 71 68 67 Other 2 3-2 - <1 - - - Unknown - 1 - - - - - - - EDUCATION None 1 1 1 <1 <1 1 <1 <1 <1 Prim. (Grd 1-7) 16 13 15 17 13 12 14 13 13 Second. (Grd 8-12) 75 78 77 75 78 80 80 79 79 Tertiary 8 8 8 8 9 7 6 7 7 *Highest school education completed
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 % 5-9 - - - - - - 3 <1 1 <1 - - 10-14 119 4 116 4 76 3 170 4 123 4 125 3 15-19 487 17 496 17 353 13 696 18 531 17 617 17 20-24 676 23 604 21 694 26 886 23 629 20 751 20 25-29 576 20 616 21 605 22 845 22 674 21 825 22 30-34 334 11 322 11 334 12 466 12 433 14 489 13 35-39 245 8 274 9 205 8 276 7 255 8 308 8 40-44 193 7 192 7 166 6 196 5 166 5 223 6 45-49 144 5 140 5 137 5 151 4 155 5 146 4 50-54 84 3 83 3 79 3 100 3 90 3 104 3 55-59 38 1 45 2 44 2 56 1 53 2 62 2 60-64 21 1 18 1 16 1 25 1 28 1 24 1 65 + 9 <1 11 <1 8 <1 13 <1 12 <1 19 1 *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 38 39 43 49 No 53 54 50 45 line to answer 9 7 7 6 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%. 2008 6 % % % % % % % % % % Alcohol 28 27 29 30 28 28 24 24 22 20 Dagga/Mandrax 3 3 3 4 3 3 2 3 4 3 Dagga 13 14 17 16 18 18 15 20 22 21 Crack 6 3 2 2 2 2 2 2 1 1
Cocaine - - Heroin 13 11 12 13 12 13 17 16 15 17 Ecstasy <1 <1 <1 <1 - - <1 <1 <1 <1 OTC/PRE 1 1 1 <1 1 1 1 1 <1 1 Other (solvents etc.) <1 <1 - - - - - - <1 - Speed/crystal methamphetamine 35 41 36 34 35 35 39 34 33 28 Cat (Methcathinone) <1 - - <1 - - - - <1 8 Inhalants 1 1 1 1 1 1 1 1 <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. 2008 % Alcohol 37 37 40 41 40 37 36 34 35 37 Dagga/Mandrax 15 15 18 18 19 15 20 16 20 23 Dagga 33 33 37 34 37 35 37 40 44 45 Crack/cocaine 11 7 5 5 5 5 6 5 4 4 OTC/PRE 4 2 2 2 2 1 2 2 1 2 Ecstasy 2 2 1 1 1 1 2 1 1 1 Heroin 15 12 13 14 13 15 19 18 18 19 Methamphetamine 44 50 46 46 47 47 52 48 50 40 ( Tik ) Inhalants 2 2 2 1 1 2 1 1 <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 1 2 1 <1 1 <1 Ketamine - - - - <1 - - - - - Magic Mushroom - - - - <1 - - - - - CAT - - - - - - - - - 13 Note: The table shows the proportion reporting each drug either as primary or secondary drug. 7
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 9 9 11 8 7 6 7 5 6 Table 11: Mean age by primary substance of abuse (Cape Town) 2008 YEARS Alcohol 40 39 38 38 36 39 40 38 39 41 Dagga/Mandrax 29 28 30 20 27 28 28 27 30 28 Dagga 19 20 20 20 23 19 20 19 20 20 Crack Cocaine 30 32 30 33 34 34 32 33 33 34 Heroin 25 25 25 25 26 26 26 26 27 27 Ecstasy 26 30 30 23 50* 20* 28* 28* 29 33 OTC/PRE 39 40 37 43 40 40 40 41 42 38 Methamphetamine 24 24 24 25 24 26 26 26 28 27 ( Tik ) Inhalants 19 18 13 20 26 19 20 14 17 19 Khat 25 30* 33* - 37* 29* 36* 26 27* 27 GHB - - - - 32* - - - - - CAT - - - - - - - - - 28 Overall mean age 29 28 28 28 28 29 29 28 29 29 * 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
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 70 30 72 28 69 31 73 27 72 28 71 29 71 29 Dagga/Mandrax 91 9 86 14 89 11 94 4 88 12 84 16 90 10 Dagga 85 15 87 13 87 13 90 10 83 17 84 16 85 15 Crack Cocaine 72 28 77 23 67 33 65 35 81 19 82 18 70 30 Heroin 80 20 78 22 78 22 79 21 83 17 79 21 79 21 Ecstasy - - 100-100 - 33 67 50 50 100-88 12 OTC/PRE 34 66 38 62 50 50 29 71 31 69 39 61 45 56 Methamphetamin e ( Tik ) 69 31 73 27 70 30 72 28 70 30 70 30 73 27 Inhalants 88 12 78 22 83 17 94 6 92 8 - - 92 8 Khat - - 50 50 - - 100-56 44 - - 91 9 Other - - - - - - - - - - - - - - LSD - - - - - - - - - - - - - - GHB - - - 100 - - 100 - - - - - - - CAT - - - - - 100 - - - 100 - - 64 36 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 21 16 17 56 56 50 1 1 1 22 27 32 Dagga/Mandrax 8 12 9 87 81 87 - - 1 5 7 3 Dagga 12 17 24 81 77 68 <1 <1 1 7 6 7 Crack/Cocaine 10 7 4 21 29 42-2 2 69 62 53 Ecstasy - - - 100 80 63 - - - - 20 37 Heroin 1 1 4 88 89 85 1 1 1 10 9 10 Methamphetami ne ( Tik ) 8 8 14 85 84 77 <1 1 1 7 7 8 Inhalants 8 80* 42 92 20* 58 - - - - - - 9
AFRICAN COLOURED ASIAN WHITE e e e % % % % % % % % % % % % OTC/PRE - - 4 39 46 40 - - 2 61 54 54 Khat - - - - - 11 11 - - 89 100 89 CAT - - 5-50 88 - - 1 100 50 6 GHB - - - - - - - - - - 100 - 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 % 1644 56 1787 61 1435 53 2236 57 1621 51 1704 46 757 26 694 24 700 26 948 24 827 26 1021 27 398 14 333 11 436 16 539 14 542 17 655 18 134 5 113 4 162 6 189 5 188 6 337 9 2933 100 2927 100 2733 100 3912 100 3178 100 3717 100 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 14 15 15 12 15 7 12 10 8 Medical Aid only 8 8 9 9 7 10 7 7 12 State 17 20 22 26 24 34 31 34 35 Family/friends only 29 30 26 23 23 21 18 19 15 State & self - - 4 3 5 4 2 4 - Work/employer only 3 4 2 2 1 2 1 2 1 Unknown 4 2 3 6 4 4 4 2 2 Other/combinations 25 21 24 19 21 18 22 21 6 10
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 4 4 4 13 13 7 34 32 30 49 57 59 Dagga 5 7 4 9 9 10 36 41 31 50 45 55 Mandrax 13 8 4 5 5 4 30 23 22 53 65 71 Ecstasy 100* 9 - - 7 - - 43 - - 34 - Cocaine/C 8 60* 8 7-20 28 20* 24 57-52 rack Heroin 4 3 1 1 1 1 9 7 8 87 89 90 Methamph etamine 5 4 4 7 7 5 38 33 34 51 58 57 ( Tik ) OTC/PRE 4* 8* 4* - - 2* 11* - 8* 85 92 86 CAT - - 4 - - 6 - - 30 - - 60 Inhalants - - - 26 26 33* 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 75 78 79 78 80 84 78 80 82 Female 25 22 21 22 20 16 22 20 18 ETHNIC GROUP African 19 20 16 14 13 20 15 19 25 Coloured 75 75 74 79 82 75 81 75 70 Asian 1-1 1 <1 - <1 1 <1 White 5 5 7 6 5 5 4 5 5
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 89 14 40 7 21 5 77 9 26 4 22 3 Cannabis 233 38 375 60 250 58 550 64 460 70 519 70 Cannabis/ Mandrax 28 5 16 3 11 3 23 2 17 3 26 3 Cocaine Crack 3 1 2 <1 2 1 4 1 2 <1 2 <1 Heroin 44 7 22 4 30 7 24 3 23 4 28 4 Ecstasy - - - - - - - - - - - - OTC/PRE - - - - - - 2 <1 - - 2 <1 Inhalants 11 2 8 1 10 2 33 4 3 1 7 1 Other - - - - - - - - - - 21 3 CAT - - - - - - - - - - 20 3 Speed/ Methamphetamine 202 33 157 25 105 24 153 18 115 18 115 16 Total 610 100 620 100 429 100 866 100 655 100 742 100 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 72 28 50 50 86 14 56 44 58 42 77 23 Cannabis 89 11 86 14 92 8 82 18 84 16 85 15 Cannabis/Ma ndrax 93 7 94 6 100-91 9* 88 12 88 12 Cocaine Crack 100-50 50 50 50 75* 25* 50 50 50 50 Heroin 75 25 73 27 50 50 54 46 78 22 79 21 Ecstasy - - - - - - - - - - Inhalants 82 18 100-90 10 91 9* 100-100 - Methamphetamine ( Tik ) 67 33 71 29 72 28 76 24 70 30 74 26 OTC/PRE - - - - - - 50* 50* - - 50 50 LSD - - - - - - - - - - - - CAT - - - - - - - - - - 63 37 *: N<5 12
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 8 31 17 65 - - 1 4 10 45 11 50 - - 1 5 Crack/ Cocaine - - - - - - 2 100 1 50 1 50 - - - - Cannabis 75 16 360 79 2 < 18 4 129 25 362 70 1 <1 22 4 1 Mandrax 3 18 13 76 - - 1 6 2 8 22 88 - - 1 4 Heroin 1 4 20 87 - - 2 9 2 7 24 86 1 4 1 4 Inhalants 3 100 - - - - - - 5 71 2 29 - - - - Methamphetamin e ( Tik ) 30 26 74 64 1 1 10 8 38 33 73 64 - - 4 4 OTC/PR - - - - - - - - - - 2 100 - - - - E LSD - - - - - - - - - - - - - - - - CAT - - - - - - - - 1 5 19 95 - - - - 13
2b: Treatment Centers: Gauteng Ms Erika Nel Table 21: Proportion of treatment episodes (Gauteng) n % n % n % n % n % n % Elim Clinic 454 15 500 17 464 17 486 15 418 12 400 10 S/Eastern Gauteng 43 2 - - - - 32 1 - - 6 <1 S/Central Rand 332 12 183 6 259 9 437 14 611 17 780 19 S/Eerste Rust - - - - - - - - - - - - S/Nishtara 2 <1 28 1 - - 49 1 58 2 147 4 S/Vaal Triangle 193 7 264 9 245 9 197 6 260 7 353 9 Magaliesoord - - - - - - - - - - - - Castle Carey 281 10 329 11 271 10 297 9 274 8 276 7 House of Mercy 96 3 128 4 96 3 132 4 98 3 103 3 Stabilis 212 7 256 9 179 6 187 6 154 4 122 3 Horizon 364 13 422 14 375 14 350 11 356 10 304 8 Thusong 26 1 79 3 113 4 35 1 75 2 - - Houghton House 84 3 76 3 62 2 116 4 118 3 119 3 S/West Rand - - - - - - - - - - - - S/JHB Society 35 1 43 1 64 2 160 5 37 1 45 1 Wedge Gardens 116 4 121 4 102 4 101 3 154 4 179 4 SANCA Soweto 248 9 207 7 219 8 254 8 499 14 514 13 Greater Heidelberg - - 7 <1- - - 71 2 126 4 159 4 Fabian Ribeiro 398 14 329 11 323 11 272 8 300 9 403 10 Viewpoint Recovery Centre Eden Recovery Centre - - - - 14 1 22 1 - - - - - - - - - - - - 14 <1 14 <1 Mighty Wings - - - - - - - - - - 100 3 Total number in treatment 2884 100 2972 100 2786 100 3198 100 3552 100 4026 100 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
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%). 2008 % % % % % % % % % % Yes 72 74 65 72 76 74 75 75 78 78 No 28 26 35 28 24 26 25 25 22 22 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 57 62 58 67 69 67 63 54 50 Outpatient 43 38 42 33 31 33 37 46 50 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 58 57 65 56 59 56 55 56 52 Work/employer 10 10 9 10 10 10 11 8 7 Doctor/psychiatrist/nurse 6 5 4 5 6 5 6 3 3 (health professional) Religious body 1 1 <1 1 1 1 1 1 1 Hospital/clinic 1 2 1 1 1 1 1 2 1 Social services/welfare 8 10 7 12 9 11 9 11 10 Court/correctional 7 6 6 9 7 7 5 9 14 services School 8 6 6 4 6 6 9 9 10 Other, e.g. radio 1 2 2 2 1 3 2 2 2 Unknown - - - - - - - - - 15
Table 25: Population profile (Gauteng) % GENDER Male 82 82 83 83 82 83 82 85 87 Female 18 18 17 17 18 17 18 15 13 ETHNIC GROUP African 44 49 49 48 48 48 49 56 60 Asian 4 2 3 2 3 3 3 2 3 Coloured 8 6 10 10 8 10 11 13 10 White 44 42 38 40 41 39 37 29 27 EMPLOYMENT STATUS Working full time 35 36 33 36 36 34 35 28 27 Working part 3 3 3 3 4 4 3 4 4 time Not working 37 39 38 41 42 42 38 42 43 Apprenticeship/ internship <1 <1 1 <1 <1 <1 1 <1 <1 Student/pupil 19 18 20 16 15 16 20 22 23 Disabled not working 1 <1 1 1 <1 <1 <1 <1 <1 Housewife 1 2 1 1 1 1 1 1 1 Pensioner/retired 2 1 2 1 1 2 1 1 1 Other 2 1 1 1 1 1 1 2 1 MARITAL STATUS Married, living with spouse 22 21 19 19 19 17 17 15 13 Married, not living with spouse 3 2 3 3 2 2 3 2 1 Living together/ cohabiting 6 7 6 6 5 6 6 7 6 Divorced 8 8 7 8 9 7 7 6 6 Widowed 2 2 2 1 2 2 2 2 1 Never married 58 59 61 62 63 64 64 67 73 Other 1 1 2 1 <1 2 1 2 - EDUCATION None/pre-primary <1 <1 <1 <1 <1 - - <1 <1 Primary 8 6 7 7 37 6 6 8 6 Secondary 78 78 78 77 47 80 81 79 81 Tertiary 14 16 15 16 16 14 13 12 13 Mean age 31 31 31 31 30 30 30 29 28 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
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 10-19 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 - - - - - - - - 4 <1 2 <1 10-14 69 3 58 2 53 2 63 2 71 2 94 3 74 2 15-19 572 22 562 20 557 19 513 19 631 20 764 22 926 24 20-24 427 16 542 19 572 20 547 20 636 20 168 22 870 23 25-29 405 15 452 16 498 17 504 18 476 15 573 16 639 17 30-34 298 11 304 11 302 10 296 11 365 12 377 11 427 11 35-39 245 9 242 9 262 9 218 8 268 9 229 7 271 7 40-44 196 8 233 8 209 7 199 7 208 7 224 6 209 5 45-49 159 6 168 6 170 6 163 6 188 6 170 5 172 5 50-54 115 4 132 5 138 5 111 4 122 4 134 4 116 3 55-59 86 3 80 3 82 3 65 3 80 3 83 2 64 2 60-64 32 1 35 1 41 1 22 1 47 2 26 1 35 1 65 20 1 23 1 26 1 29 1 24 1 26 1 21 1 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 1191 41 1124 38 1000 36 1096 34 989 28 1084 27 Dagga/ Mandrax* 46 2 40 1 46 2 21 1 26 1 36 1 Dagga 820 28 739 25 769 28 910 29 920 26 1599 40 Crack 181 6 Cocaine powder 217 7 173 6 191 6 154 4 131 3 Heroin 359 12 475 16 353 13 475 15 340 10 477 12 Ecstasy 7 <1 4 <1 17 1 7 1 1 <1 9 <1 OTC/PRE 86 3 120 4 98 4 76 2 64 2 51 1 Methcathinone ( Cat ) 108 3 141 5 229 8 270 8 263 7 321 8 Methamphetamine ( Tik ) 29 1 51 2 40 1 76 2 89 2 104 3 Khat - - 26 1 22 1 40 1 26 1 33 1 LSD - - 1 - - - - - - - - - Inhalants 39 1 33 1 39 1 36 1 38 1 35 1 Other - - 1 - - - - - 8 <1 1 <1 GHB - - - - - - - - - - - - Nyaope - - - - - - - - 132 4 145 4 Total 2884 100 2972 100 2786 100 3198 100 3552 100 4026 100 * White pipe or Mandrax alone 17
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 79 21 78 22 79 21 79 21 81 19 81 19 83 17 Dagga/Mandrax 88 12 100-100 - 96 4 100-92 8 94 6 Dagga 93 7 92 8 94 6 94 6 89 11 91 9 94 6 Crack/ Cocaine 78 22 86 14 80 20 78 22 82 18 80 20 77 23 Heroin 87 13 88 12 88 12 88 12 87 13 91 9 91 9 OTC/PRE 48 52 46 54 37 63 44 56 28 72 42 58 39 61 Ecstasy 57 43 43 57 75 25 88 12 86 14 100-89 11 Methcathinone ( Cat ) 75 25 67 33 76 24 79 21 74 26 71 29 75 25 Inhalants 85 15 90 10 76 24 84 16 83 17 92 8 83 17 Methamphetamine ( Tik ) 87 13 75 25 63 37 61 39 75 25 80 20 86 14 GHB - - - - - - - - - - - - - - Khat 80 20 61 39 81 19 50 50 80 20 64 36 91 9 LSD 100 - - - 100 - - - - - - - - - Nyaope - - - - - - - - - - 85 15 93 7 Other 100 - - - - - - - - - 87 13 100-18
Table 30: Mean age by primary substance (Gauteng) YEARS Alcohol 36 39 38 39 40 39 40 40 39 Dagga/Mandrax 24 23 21 24 25 24 24 25 26 Dagga 26 21 21 21 21 22 21 21 22 Cocaine/Crack 30 28 29 31 30 30 30 31 32 Heroin 26 26 25 24 24 24 24 25 25 Ecstasy 26 23 28 23 21* 27 21-21 Methcathinone ( Cat ) 25 28 26 25 27 27 27 27 27 Methamphetamine Tik ) 24 25 25 27 26 26 25 26 27 Inhalants 30 18 18 18 18 19 19 19 18 OTC/PRE 37 41 39 42 39 38 42 40 40 LSD - - 25* - - - - - - Khat 23 30 30 26 27 26 27 31 28 Nyaope - - - - - - - 24 24 Other - - - - - - - 24 41 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 44 44 50 5 7 6 2 1 2 49 48 41 Dagga/ Mandrax 71 54 56 19 38 31-4 8 10 4 7 Dagga 66 68 77 17 17 11 4 2 2 12 12 10 Crack/ cocaine 34 37 35 12 15 9 5 9 5 49 39 50 Ecstasy 43-67 - - - 14 100-43 - 33 Heroin 69 67 77 5 8 3 2 2 3 24 23 17 Methcathinone ( Cat ) Methamphetamine ( Tik ) 8 5 7 20 26 6 4 6 21 68 63 66 16 9 5 49 59 45 3 2 4 35 30 46 Inhalants 83 87 74 8 5 17 - - - 9 8 9 Khat - 4 6 10 4 9 3 102 6 87 81 79 LSD - - - - - - - - - - - - OTC/PRE 9 9 6 4-6 3 5 6 84 87 82 Tobacco - 89 - - 6 - - 1 - - 4 - Nyaope - 94 96-5 2-1 - - - 2 Other - 87 - - 12 - - - - - - 100 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
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 195 14 179 12 163 12 206 14 253 13 247 11 Dagga/ Mandrax* 53 4 52 4 36 3 35 2 65 3 62 3 Dagga 321 22 460 31 366 28 386 26 719 36 553 24 Crack Cocaine Powder 192 13 203 14 166 13 206 14 172 9 175 8 Heroin 286 20 209 14 191 15 187 13 214 11 191 8 Ecstasy 16 1 15 1 18 1 23 2 14 1 18 1 OTC/PRE 49 3 62 4 82 6 59 4 34 2 36 1 LSD 5 <1 3 <1 4 <1 2 <1 1 <1 - - Meth-cathinone ( Cat ) 75 5 74 5 71 5 101 7 131 7 147 6 Methamphetamine ( Tik) 22 2 27 2 39 3 51 4 54 3 79 3 Inhalents 30 2 19 1 23 2 18 1 16 1 20 1 Khat 6 <1 7 1 4 <1 15 1 11 1 8 <1 GHB - - - - - - 2 <1 2 <1 2 <1 Magic Mushroom - - - - - - - - - - - - Other 183 13 171 11 160 12 173 12 12 1 171 7 Tobacco - - - - - - - - 276 14 605 26 TOTAL 1433 100 1481 100 1323 100 1464 100 1974 100 2336 100 * 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 110 21 98 17 124 22 103 19 184 22 175 18 Dagga/ Mandrax* 14 3 18 3 20 4 22 4 37 4 45 5 Dagga 85 16 106 19 84 15 103 19 103 12 120 13 Crack Cocaine Powder 112 21 101 18 81 15 86 16 95 11 97 10 Heroin 30 6 50 9 42 8 37 7 151 18 160 17 Ecstasy 26 5 23 4 25 4 24 4 14 2 24 5 OTC/PRE 15 3 22 4 34 6 9 1 18 2 13 1 LSD 12 2 4 1 9 2 4 1 7 1 3 <1 Methcathinone ( Cat ) 25 5 33 6 41 7 40 7 49 6 60 6 Methamphetamine ( Tik ) 18 3 15 3 22 4 34 6 35 4 36 4 Inhalants 11 2 7 1 10 2 4 1 15 2 11 1 20
n % n % n % n % n % n % Khat 2 <1 3 1 1 <1 4 1 2 <1 7 1 GHB - - - - 1 <1 1 <1 1 <1 - - Magic Mushroom 1 <1 - - - - - - - - 1 <1 Other 69 13 81 14 63 11 76 14 8 1 44 5 Tobacco - - - - - - - - 121 14 139 15 Nyaope - - - - - - - - - - 14 2 TOTAL 530 100 561 100 557 100 547 100 840 100 949 100 * White pipe or Mandrax alone Table 34: Fourth most frequently abused substance (Gauteng) n % n % n % n % n % n % Alcohol 50 29 26 14 42 23 30 18 57 24 43 17 Dagga/ Mandrax* 1 1 7 4 5 3 4 2 7 3 12 5 Dagga 21 12 24 13 19 10 19 11 29 12 28 11 Cocaine/Crack 24 14 31 17 24 13 26 16 27 11 34 14 Heroin 13 8 9 5 9 5 12 7 18 8 12 5 Ecstasy 15 9 12 7 12 6 20 12 16 7 22 9 OTC/PRE 8 5 17 9 24 13 1 1 5 2 9 4 LSD 11 4 3 2 12 6 9 5 4 2 8 3 Meth-cathinone ( Cat ) 10 6 14 7 14 8 15 9 19 8 16 7 Inhalants 2 1 5 3 1 1 2 1 8 3 6 2 Khat - - 14 7 3 2 4 3 3 1 1 <1 Magic Mushrooms - - 1 1 - - - - - - 2 1 Metham-phetamine ( Tik ) 5 3 7 4 8 4 13 8 19 8 17 7 Other 13 8 14 7 12 6 12 7 - - 11 4 Tobacco - - - - - - - - 25 11 25 10 TOTAL 173 100 184 100 185 100 167 100 237 100 247 100 * White pipe or Mandrax alone 21
Table 35: Secondary substance of abuse (2 nd, 3 rd and 4 th most frequently used) (Gauteng) n % n % n n % % n % n % Alcohol 355 17 303 14 329 16 339 16 494 17 465 13 Dagga/ Mandrax 68 3 77 4 61 3 61 3 109 4 119 3 Dagga 427 20 590 27 469 23 508 24 851 28 701 19 Crack/Cocaine Powder 328 16 335 15 271 13 318 15 294 10 306 8 Heroin 329 16 268 12 242 12 236 11 360 12 363 10 Ecstasy 57 3 50 2 55 3 67 3 44 1 40 1 OTC/PRE 72 3 101 5 140 7 69 3 56 2 58 2 LSD 28 1 10 1 25 1 15 1 12 <1 8 <1 Meth-cathinone ( Cat ) 110 5 121 6 126 6 156 7 199 7 193 5 Metham-phetamine ( Tik ) 45 2 49 2 69 3 98 5 108 4 219 6 Nyaope - - - - - - - - 23 1 181 5 Other 265 13 266 12 235 12 261 12 28 1 225 6 Tobacco - - - - - - - - 422 14 769 21 TOTAL 2084 100 2170 100 2022 100 2128 100 3000 100 3647 100 Table 36: Overall use (reported as primary or secondary substance of abuse) (Gauteng) n % n % n % n % n % n % Alcohol 1546 31 1427 27 1329 48 1435 45 1483 42 1549 38 Dagga/Mandrax 114 2 117 2 107 4 82 3 135 5 155 4 Dagga 1247 25 1329 26 1238 44 1418 44 1771 50 2300 57 Crack/Cocaine 509 10 549 11 444 16 509 16 448 13 437 11 Heroin 688 14 743 14 595 21 711 22 700 20 840 21 Ecstasy 62 1 54 1 72 3 74 2 45 1 49 1 OTC/PRE 158 3 221 4 238 9 145 5 185 5 109 3 LSD 28 1 11 <1 25 1 15 1 12 <1 11 <1 Methcathinone ( Cat ) 218 4 262 5 355 13 426 13 462 13 514 13 Methamphetamine ( Tik ) 74 1 100 2 109 4 174 5 185 5 323 8 Other 265 5 266 5 235 8 261 8 28 1 225 6 Inhalants 82 2 64 1 73 3 60 2 77 2 72 2 Khat 26 1 50 1 30 1 63 2 42 1 41 1 GHB - - - - - - - - - - - - Magic Mushroom 1 <1 2 <1 - - - - - - - - Nyaope - - - - - - - - 155 4 326 8 Tobacco - - - - - - - - 923 26 769 19 TOTAL 5018 100 5192 100 4850 100 5373 100 6651 100 7720 100 22
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 557 19 590 20 500 18 484 15 529 15 525 13 Greater Johannesburg MS 972 34 831 28 732 26 1471 46 1173 33 1682 42 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 829 21 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 101 4 126 4 116 4 124 4 126 4 122 3 Limpopo 64 2 82 3 89 3 82 3 71 2 60 2 North West 90 3 109 4 85 3 128 4 102 3 92 2 Northern Cape 24 1 16 1 11 <1 18 1 12 <1 8 <1 Eastern Cape 17 1 17 1 16 1 13 <1 6 <1 14 <1 Free State 30 1 41 1 28 1 38 1 50 1 31 1 Kwa-Zulu Natal 21 1 16 1 26 1 21 1 23 1 17 <1 Western Cape 5 <1 7 <1 4 <1 19 1 8 <1 1 <1 OTHER COUNTRIES 10 <1 6 <1 17 1 13 <1 12 <1 9 <1 Total number on whom information was available 2884 100 2972 100 2786 100 3198 100 3552 100 4026 100 Table 38: Sources of payment (Gauteng) 2008 % % % % % % % % % % State 25 19 24 26 24 25 24 24 22 30 Medical Aid 29 29 29 29 28 30 33 32 30 19 Family 19 20 21 21 21 20 22 23 23 25 Friends 1 1 1 1 1 1 1 1 <1 1 Employer 5 6 5 4 4 5 5 4 4 3 Self 15 14 12 12 11 11 9 10 10 12 Other/Comb 2 9 7 <1 4 4 3 5 9 7 Unknown 1 2 2 3 7 4 3 1 1 2 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
Table 39: HIV Tests (Gauteng) Tested for HIV in the past 12 months n % n % n % Yes 30 964 31 949 29 31 No 67 1860 61 2022 62 64 lined to answer 3 243 8 287 9 5 Missing - - - - - - TOTAL 100 3198 100 3258 100 100 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) 24 - - 1 1 - - - 1 <1 % % % % % % % % % GENDER Male 87 89 89 87 89 92 84 86 90 Female 13 11 11 13 11 8 16 14 10 ETHNIC GROUP Asian 2 1 2 2 3 2 3 2 1 African 66 76 70 66 70 71 64 73 77 Coloured 14 10 18 18 15 15 19 17 13 White 18 13 10 14 12 12 14 8 9 EDUCATION None/Preprimary Primary 14 14 13 13 28 13 13 17 11 Secondary 84 84 84 84 71 84 87 81 87 Tertiary 2 2 2 1 1 3 <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 85 13 62 10 59 10 49 8 45 6 44 5 78 8 Dagga 406 63 383 62 381 63 359 62 486 69 473 54 747 75
n % n % n % n % n % n % N % Dagga/ Mandrax 33 5 15 2 12 2 12 2 4 1 5 1 12 1 Crack/ Cocaine 9 1 12 2 14 2 14 4 9 1 6 1 7 1 Heroin 65 10 86 14 88 14 67 11 75 11 51 6 59 6 Ecstasy 2 <1 3 1 1 <1 1 <1 4 1 - - 3 <1 OTC/PRE 5 1 2 <1 7 1 3 1 2 <1 4 1 2 <1 Inhalants 29 5 32 5 26 4 27 5 24 3 27 3 24 2 3 1 17 2 12 2 37 6 27 4 20 2 32 3 6 1 8 1 8 1 5 1 22 3 11 1 12 1 Other - - - - - - - - - - 4 1 - - Khat - - 3 1 2 <1 2 <1 4 1 2 <1 3 <1 Nyaope - - - - - - - - - - 17 2 23 2 TOTAL 642 100 621 100 610 100 576 100 702 100 862 100 1002 100 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 80 20 76 24 85 15 94 6 64 36 82 18 83 17 Dagga 92 8 90 10 94 6 94 6 87 13 89 11 93 7 Dagga/ Mandrax 85 15 100-100 - 92 8 100-100 - 100 - Crack Cocaine 67 33 75 25 64 36 79 9 78 22 50 50 57 43 Heroin 94 6 92 8 89 11 94 6 85 15 92 8 88 12 Ecstasy 50 50 33 67 100 - - 100 100 - - - 100 - Inhalants 83 17 87 13 69 31 78 22 79 21 96 4 83 17 OTC/PRE 80 20 50 50 71 29 100-50 50 25 75 50 50 Methcathinone ( Cat ) Methamphetamine ( Tik ) Methcathinone ( Cat ) 67 33 59 41 50 50 86 14 85 15 60 40 69 31 Methampheta mine(tik) 60 40 67 33 38 62 60 40 55 45 46 54 92 8 Other - - - - - - - - - - 100 - - - KHAT - - 67 33 - - - 100 100-100 - 100 - Nyaope - - - - - - - - - - 76 23 95 5 *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
Table 43: Race by primary substance of abuse for patients aged 20 years and younger (Gauteng) % % % % AFRICAN COLOURED ASIAN WHITE Alcohol 77 66 81 12 21 7 - - 3 11 13 9 Dagga 66 69 79 21 22 14 4 1 1 9 8 6 Dagga/ 100 100 58 - - 33 - - - - - 8 Mandrax Crack 11 33 71 11 17 14 - - - 78 50 14 Cocaine Heroin 82 84 91 3 10 2 - - 2 15 6 5 Ecstasy 75-100 - - - - - - 25 - - Inhalants 79 100 79 13-17 - - - 8-4 OTC/PRE 50 50 50 - - 50-25 - 50 25 - LSD - - - - - - - - - - - - Meth-cathinone ( Cat ) Methamphetamine ( Tik ) 15 5 13 26 40 36 3 10 56 45 46 18 9 18 55 55 36 5 9-22 27 46 Khat - - - - 50 33 25 50-75 - 67 Nyaope - 100 96 - - - - - - - 4 *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 60 10 60 10 74 13 55 8 124 14 131 13 Dagga 117 19 138 23 94 16 82 12 229 27 122 12 Dagga/ Mandrax 21 3 20 3 12 2 17 2 24 3 18 2 Crack 44 7 36 6 31 5 Cocaine 25 4 20 2 19 2 Heroin 109 18 194 15 58 10 48 7 81 9 70 7 Ecstasy 7 1 6 1 4 1 5 1 2 <1 7 1 LSD 5 1 - - 2 <1 - - 1 <1 - - Inhalants 28 6 12 2 26 5 16 2 27 3 14 1 OTC/PRE 1 <1 11 2 6 1 15 2 4 <1 2 <1 Methcathinone ( Cat ) 23 4 17 3 18 3 31 4 31 4 39 4 Methamphetamine 11 2 10 2 13 2 26 4 16 2 19 2 ( Tik ) Nyaope - - - - - - - - - - 7 1 Other 116 19 105 17 94 16 102 15 13 2 58 6 Tobacco - - - - - - - - 167 19 272 27 TOTAL 621 100 610 100 576 100 702 100 862 100 1002 100 *Crack/Cocaine combined
Table 45: Mode of usage of primary substance of abuse for patients aged 20 years and younger (Gauteng) 2008 % % % % % % % % % % Swallowed 15 28 16 16 14 11 12 8 7 11 Snorted 7 9 5 6 8 7 13 9 7 6 Injected 2 2 1 1 1 1 <1 11 <1 <1 Smoked 74 61 78 77 74 81 75 82 86 82 Other 1 - - <1 <1 - - - <1 - Smoke/Snort <1 - - - - - - - <1 - Smoke/Inject <1 - - - - - - - - - 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 45 35 42 48 45 42 39 36 39 35 Work/Employer 1 1 <1 <1 <1 <1 1 <1 1 <1 Health professional 3 4 3 3 2 4 2 4 2 1 Religious body <1 0 <1 1 <1 <1 1 1 <1 1 Hospital/Clinic 1 1 1 2 <1 1 1 <1 1 1 Social 10 8 15 8 14 10 13 9 8 8 Services/Welfare Court/Correctional services 13 16 12 12 19 15 14 8 13 17 School 25 33 24 24 17 25 25 40 34 37 Other 2 2 3 2 3 2 4 2 1 1 Unknown - - - - - - - - - - 27
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) 101 82 89 74 39 95 52 16 - MARC (In-patient) 34 21 40 2 39 MARC (Out-patient) 24 45 5 6 21 15 90 69 79 Sanca Witbank (Out-patient) 468 327 425 352 461 460 249 454 598 Sanca Nelspruit (Out-patient) 129 90 98 149 123 125 130 168 200 (LADHC) SANCA Far North (Polokwane) 35 87 105 87 10 81 57 53 64 (Outpatient) Healing Wings - - - - - 116 77 58 - Total number in treatment 809 652 762 669 693 892 655 818 941 First-time admissions remained stable compared to the previous period (82%) Table 48: First Time Admissions (Northern Region) 2008 % Yes 89 86 83 81 80 83 77 74 80 82 No 11 14 17 19 20 17 23 26 20 18 Consistent with previous reporting periods, the majority of patients are treated on an outpatient basis (95%). 28
Table 49: Type of treatment received (Northern Region) 2008 % Inpatient 17 23 20 18 12 13 26 30 15 5 Outpatient 83 77 80 82 88 87 74 70 85 95 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 47 49 49 48 50 46 47 36 39 Work/employer 16 16 16 11 14 13 10 9 10 Doctor/psychiatrist/nurse (health professional) 18 13 12 13 15 13 10 16 15 Religious body <1 - <1 1-1 1 1 - Hospital/clinic 1 2 1 7 1 1 1 1 1 Social services/welfare 6 7 8 7 4 11 10 7 7 Court/correctional services 6 5 6 5 3 6 4 5 4 School 5 7 5 7 9 4 13 10 12 Other, e.g. radio 1 1 3 1 4 5 4 4 1 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 % 10-14 1 1 1 2 1 3 3 4 7 15-19 16 16 18 17 20 15 25 22 22 20-24 20 23 21 20 23 23 21 21 21 25-29 18 16 18 19 19 20 15 18 18 30-34 10 12 11 12 12 15 12 12 11 35-39 9 9 9 9 8 8 7 7 7 40-44 8 9 5 7 6 5 6 6 4 45-49 5 8 6 6 3 5 5 3 4 50-54 5 3 5 4 5 3 3 4 3 55-59 3 3 3 3 2 2 2 3 2 60-64 1 1 1 1 1 1 1 - <1 65-69 70-75 - - <1 <1 1 <1 <1 1 <1 29
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 86 90 87 88 84 81 86 87 Female 14 10 13 12 16 19 14 13 ETHNIC GROUP African 67 65 65 70 61 64 64 77 Coloured 3 1 2 1 2 3 4 2 Asian 1 4 1 2 1 1 1 1 White 29 30 32 27 36 31 31 20 EMPLOYMENT STATUS Working full time 42 42 41 38 34 30 36 30 Working part time 1 1 1 3 4 3 4 3 Not working 38 37 36 38 44 41 35 39 Apprenticeship/internship <1 1 <1 <1 <1-1 - Student/pupil 17 16 19 20 16 25 25 27 Disabled not working <1 <1 - <1 <1 <1 - <1 Housewife <1 <1 1 <1 - <1 <1 <1 Pensioner/retired 1 1 1 1 1 1 1 <1 Other 1 2 1-1 1-1 MARITAL STATUS Married, living with spouse 22 21 22 16 14 15 17 13 Married, not living with spouse 4 2 3 2 4 3 2 1 Living together 8 5 7 6 5 5 5 5 Divorced 4 5 6 4 6 5 4 3 Widowed 1 1 2 1 1 1 1 4 Never married 61 65 60 72 71 71 70 74 Other - 1 - - - - 2 - EDUCATION None pre-primary 1 6 2 1 1 1 1 1 Primary 9 7 9 8 11 10 14 17 Secondary 73 71 75 82 80 80 75 75 Tertiary 17 16 14 9 8 9 10 7 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
Table 53: Primary substance of abuse (Northern Region) % % % % % % % % % Alcohol 38 38 36 31 30 27 32 24 22 Dagga 45 44 37 41 36 36 38 31 38 Dagga/Mandrax 1 <1 <1 <1 - <1 1 1 1 Crack Cocaine Methcathinone ( Cat ) 4 4 3 4 2 4 3 4 3 <1-1 1 1 4 4 5 1 Heroin 8 11 20 20 28 22 16 22 29 Ecstasy 1 <1 - <1 - <1 - <1 <1 Inhalants 2 1 2 1 1 3 2 2 3 PRE/OTC 1 1 1 1 1 2 2 1 2 Tik <1 - - - 1 2 1 1 <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 85 15 80 20 80 20 83 17 75 25 79 21 Dagga 92 8 96 4 94 6 79 21 96 4 96 4 Dagga/ Mandrax 100 - - - 100-100 - 80 20 90 10 Crack Cocaine 78 22 60 40 68 32 74 26 78 22 86 14 Heroin 88 12 92 8 89 11 88 12 93 7 90 10 Ecstasy - 100 - - 100 - - - 100 - - 100 Inhalants 75 25 70 30 77 23 94 6 78 22 48 52 PRE/OTC 33 67 50 50 31 69 64 36 13 87 52 48 Methcathinone ( Cat ) 50 50 86 14 55 45 68 32 74 26 67 33 Tik - - 50 50 63 37 100-100 - 50 50 Other - - - - - 100 - - 75 25 - - * Crack and cocaine combined 31
Table 55: Race, by primary substance of abuse (Northern Region) AFRICAN COLOURED ASIAN WHITE % % % % Alcohol 50 53 59 3 5 5 1-1 45 42 35 Dagga 78 77 88 4 4 2 2 1 <1 13 18 10 Dagga/ 100 80 90 - - - - - - - 20 10 Mandrax Crack/ Cocaine 61 16 41-23 - - 7-39 54 59 Ecstasy - - - - - - 100 - - - - Heroin 78 76 86 2 3 1 - - 2 20 21 11 Inhalants 31 100 89 - - 7 - - - 69-4 PRE/OTC 45 12 39 - - 8 - - 4 55 87 48 46 5 8-8 - - 8-54 79 92 Tik - - 25 33 - - - - - 67 100 75 Khat - - - - - - - - - - - - Other - 94 - - - - - - - - 6 - Tobacco - - - - - - - - - - 100 - (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 39 38 38 39 38 36 37 37 35 31 Dagga 28 28 26 26 28 29 28 21 27 26 Dagga/Mandrax ( White Pipe or Mandrax alone) 36 22 25* 31* 18* - - 16 25 20 Crack Cocaine 28 30 28 28 30 30 30 29 28 28 Heroin 24 24 25 24 25 24 25 26 24 25 Ecstasy 32 22* 31* - - - - - 32* 28 Inhalants 14 23 21 18 14 17 17 29 14 16 PRE/OTC 41 38 37 30 34 40* 37 40 30 31 Methcathinone ( Cat ) 30 24* - 33* 28* 27 27 25 26 30 Tik - - - - - 25* 25 27 30 39 Other - 32 28 - - - - - 23 - *Crack/cocaine combined # n=4
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 279 40 313 35 289 44 294 36 294 31 Methcathinone ( Cat ) 14 2 56 6 56 8 60 7 24 3 Dagga 464 67 577 65 392 60 484 59 645 68 Mandrax 3 <1 13 2 17 3 12 1 17 2 Methamphetamine ( Tik ) 5 1 31 4 25 4 18 2 11 1 Crack/Cocaine 58 8 121 14 89 14 80 10 61 6 Heroin 238 34 267 30 164 25 211 26 278 29 Inhalants 13 2 8 1 25 4 25 3 35 4 Ecstasy 6 1 15 2 14 2 20 2 9 1 PRE/OTC 5 1 30 3 19 3 20 2 28 3 LSD - - 6 1 3 <1 5 1 - - Other 62 9 44 5 54 8 16 2 3 <1 Tobacco - - - - - - 129 16 157 17 *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 28 23 24 25 29 31 22 34 Medical aid 3 2 1 3 3 2 3 1 Family 18 21 18 21 33 27 33 24 Friends 1 <1 <1 1 <1 1 1 <1 Employer 11 10 9 11 5 5 6 3 Self 36 38 37 35 26 27 32 35 Unknown 1 3 5 2 1 <1 1 1 Other 2 2 5 3 2 2 2 3 State/ <1 <1 - - <1 <1 - - Friends State /Other <1 - - - 1 <1 - - Family/ Self <1 <1 <1 - - 1 <1 - Forty-four percent of patients reported that they have been tested for HIV in the last 12 months. 33
Table 59: HIV Test (Northern Region) Tested for HIV in the past 12 months % % % % Yes 34 28 36 44 No 50 55 51 52 line to answer 16 17 13 4 Table 60: Area of residence (Northern Region) % % % % % % % % % PROVINCES Mpumalanga 90 80 81 84 93 76 77 84 91 Gauteng 2 2 3 1 2 9 7 6 1 Kwazulu- 2 3 - - 2 1 2 2 <1 Natal Free State <1 - <1 <1-1 <1 <1 - Northwest <1 1 <1 1 <1 <1 1 <1 <1 Eastern Cape <1 - - - - <1 <1 - - Northern - - - - - - - - - Cape Western Cape <1 - - - - 2 2 1 - Limpopo 5 14 16 15 3 11 10 7 7 OTHER COUNTRIES Lesotho - - - - - <1 <1 - - Swaziland - <1 - - - <1 <1 - - Mozambique - - - - - 1 <1 <1 - Zambia <1 - - - - <1 <1 - - 34
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 18 18 8 15 18 14 4 16 20 Cocaine 1 Crack 2-2 1 1 2 1 1 Dagga 63 62 65 62 46 47 71 43 52 Dagga/Mandrax - 1-2 - 1 2 1 2 Heroin 8 13 20 13 30 17 16 12 13 Ecstasy 2 - - - - - - - - PRE/OTC 1 1 1 - - 2-1 3 Methcathinone - - - - - 2 3 2 - ( Cat ) Other - - - - - - 6 - Inhalants 7 4 7 7 5 12 2 8 9 Tik - - - - - 4 1 - - *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 92 90 90 82 76 82 84 Female 8 10 10 18 24 18 16 ETHNIC GROUP African 80 67 73 70 84 78 88 Coloured 3 3 3 6 4 3 3 Asian 1 2 1 1 2 1 - White 16 28 23 25 10 18 9 35
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 45 33 55 37 30 27 23 49 12 Welbedacht 8 8 6 6 8 7 7 20 13 Shepherd s Field 9 16 8 11 9 8 6 30 11 SANCA Thembilitsha - - - - - - 5 - - Hunters Craig 39 43 31 47 53 58 59 1 64 Total no of persons treated 690 502 741 515 536 566 654 169 510 The proportion of new admissions has increased slightly when compared to the previous period. Table 64: First time admissions (Port Elizabeth) 2008 % % % % % % % % % % Yes 75 65 55 63 68 62 69 71 75 70 No 25 35 45 37 32 38 31 29 25 30 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 56 66 45 64 70 73 77 52 88 Outpatient 44 34 55 36 30 27 23 49 12 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
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 30 29 38 20 22 19 19 57 12 Work/employer 6 3 7 9 7 5 5 7 3 Doctor/psychiatrist/nurse 48 52 40 56 63 67 67 24 78 (health professional) Religious body <1 <1 <1 1 <1 1 <1 - - Hospital/clinic 2 1 3 3 1 1 1-1 Social services/welfare 3 4 5 5 4 3 4 2 3 Court/correctional services/police/lawyer 6 8 3 3 1 1 1 3 1 School 4 2 3 1 2 3 2 6 1 Other e.g. radio, Children s home, adverts 1 1 1 2 1 <1 1 - - While 14% of the patients were younger than 20 years in this reporting period, 15% of patients were in the age category of 20-24 years of age, decreasing significantly compared to the previous period. Table 67: Age distribution (Port Elizabeth) Years n % n % n % n % n % n % Under 10 - - - - - - - - - - - - 10-14 3 1 5 1 8 1 4 1 1 1 3 1 15-19 86 17 54 10 91 16 124 19 35 21 68 13 20-24 70 14 69 13 71 12 82 12 37 22 79 15 25-29 68 13 79 15 91 16 81 12 22 13 67 13 30-34 62 12 51 10 73 13 59 9 25 15 57 11 35-39 54 10 79 15 76 14 77 12 16 9 51 10 40-44 65 13 64 12 62 11 80 12 9 5 56 11 45-49 49 10 50 9 32 6 55 8 10 6 44 9 50-54 28 5 48 9 27 5 38 6 5 3 35 7 55-59 12 2 20 4 18 3 30 5 5 3 25 5 60-64 10 2 11 2 6 1 11 2 2 1 12 2 65-69 7 1 6 1 11 2 13 2 2 1 13 2 70-80 - - - - - - - - - - - -
Table 68: Population Profile (Port Elizabeth) % % % % % % % % % GENDER Male 74 71 73 72 70 72 67 82 63 Female 26 29 27 28 30 28 33 18 37 ETHNIC GROUP African 16 17 19 18 15 23 22 22 21 Asian 1 4 2 3 2 4 3 1 5 Coloured 48 38 47 41 46 38 38 47 38 White 35 41 32 38 36 35 37 30 35 MARITAL STATUS Married (living 35 34 28 31 45 47 44 18 42 with spouse) Living Together 5 5 6 6 3 2 2 4 4 Divorced 12 16 12 12 11 8 8 4 8 Widowed 2 2 2 2 2 2 4 2 4 Single 43 41 49 47 38 40 41 68 40 Separated/not 2 1 3 1 1 1 1 5 2 living with spouse Other 1 <1 <1 1 - - - - - EMPLOYMENT STATUS Working full-time 49 47 49 57 62 63 58 40 64 Working Part-time 3 1 3 3 2 2 3 3 1 Unemployed 26 29 28 22 19 16 16 36 17 Intern/Apprentice 1 2 <1 1 2 3 1-1 Learner/Student 14 10 12 12 9 11 15 19 12 Disabled/Boarded 2 3 1 1 2 1 1-2 Housewife 1 4 4 2 2 3 3-1 Pension/Retired 3 2 2 2 2 2 3 2 3 Other 1 2 1 - <1 <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 24 21 13 25 20 No 75 78 85 70 74 line to answer 1 1 2 5 6 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
Table 70: Primary substance of abuse (Port Elizabeth) 2008 39 % % % % % % % % % % Alcohol 42 54 50 43 44 48 41 41 37 36 Dagga 13 12 13 17 15 12 12 13 22 9 Dagga/Mandrax 11 7 4 8 5 3 3 3 4 4 Cocaine Crack 13 8 8 7 6 6 4 6 8 5 Ecstasy - - - <1 - - <1 - - - OTC/PRE 1 7 11 12 14 13 14 14 14 3 22 Heroin 7 3 4 4 4 2 2 1 2 2 Inhalants 1 <1 <1 <1 <1-1 <1 1 - Methamphetamine 7 5 9 7 12 15 22 21 22 21 ( Tik ) Khat - <1 1 <1 - - <1 - - <1 LSD <1 - - - - - - - 1 - CAT - - - - - - 1 1 1 1 *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 85 80 81 81 87 92 70 88 2-6 days per week 12 13 14 14 10 5 25 9 Once a week or less Not used in past month 3 5 4 4 2 2 4 3 <1 2 1 1 1 1 1 <1 The majority of users (primary substance of abuse) reported having started abusing drugs between the ages of 20-29 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 % 5-10 8 2 2 <1 7 1 7 1 - - - - - - 11-19 262 51 202 38 224 40 270 41 264 40 120 71 198 39 20-29 247 48 201 38 168 30 164 25 164 25 38 23 186 37 30-39 75 10 73 15 87 16 119 20 145 22 6 4 83 16
40-49 27 4 17 3 25 5 32 6 23 4 3 2 20 4 50-59 5 1 6 1 11 2 8 1 18 3 2 1 13 3 60-69 - - 1 <1 3 1 4 1 4 1 - - 3 1 Age unkno wn - - 7 1 5 1 3 1 - - - - 5 1 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 73 27 75 25 75 25 71 29 85 15 70 30 Dagga/Mandrax 100-94 6 81 19 81 19 100-90 10 Dagga 86 14 86 14 85 15 89 11 86 14 82 18 Crack Cocaine 76 24 68 32 86 14 60 40 61 39 67 33 Ecstasy - - - - 100 - - - - - - - OTC PRE 21 79 28 72 36 64 32 68 40 60 31 69 Heroin 90 10 75 25 69 31 75 25 75 25 67 33 Inhalants 100 - - - 100-100 - 100 - - - Methamphetamine 84 16 78 22 75 25 72 28 84 16 70 30 ( Tik ) Other - - - - - - - - - - - - Khat - - - - 100 - - - - - 100 - CAT 100 - - - 100-67 33 100-100 - LSD - - - - - - - - - 100 - - + *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 33 31 37 24 35 23 2-1 41 34 40 Dagga/ Mandrax 62 71 15 28 14 80 - - - 10 15 5 Dagga 29 32 16 49 57 53 - - 4 22 11 27 Crack Cocaine 3-7 30 54 11 13 8 15 54 38 67 Ecstasy - - - - - - - - - - - - OTC PRE 8-15 45 80 39 1-8 45 20 38 Heroin 50-22 - - 22 - - - 50 100 56
Methamphetamine 4 5 10 62 65 59 4-8 31 30 24 ( Tik ) Khat - - - - - - - - - - - 100 CAT - - - 33-25 - - - 67 100 75 Inhalants - - - - - - 100 - - - 100 - LSD - - - - - - - - - - 100 - *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 40 41 41 40 42 41 41 Dagga/ Mandrax 26 25 27 24 24 28 29 Dagga 21 24 23 22 21 19 27 Ecstasy - - - - - - - Cocaine Crack 30 29 32 30 32 29 35 OTC PRE 39 39 42 40 41 34 40 Heroin 30 24 28 27 24* 34* 23 Inhalants 14* 22* - 18* 32* 14* - Methamphetamine Tik 24 22 23 24 24 24 25 LSD - - - - - 19* - Cat - 25* - 28* 25* 25* - Khat 21* - - - - - 26* *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 422 57 299 58 338 63 317 56 366 56 71 42 298 58 Smoked 278 38 186 36 173 32 219 39 248 38 86 51 177 35 Snorted Sniffed 26 4 19 4 21 4 23 4 34 5 9 5 23 4 Injected 15 2 11 2 4 1 7 1 4 1 3 2 12 2 Other/ Combination - - - - - - - - 2 < - - - - *Snorted/sniffed combined 41
Table 77: Secondary substance of abuse (Port Elizabeth) n % n % n % n % n % n % Alcohol 17 11 18 14 12 10 23 13 16 22 10 8 Dagga/Mandrax 27 18 21 16 26 22 31 18 12 16 25 21 Dagga 38 25 44 34 33 26 64 37 25 34 43 35 Cocaine Crack 28 19 8 6 20 17 14 8 6 8 15 12 Ecstasy 5 3 2 2 - - 2 1 - - 1 1 LSD 1 1 - - - - - - - - - - OTC PRE 12 8 13 10 9 7 14 8 5 7 13 11 Heroin 3 2 4 3 3 3 - - 1 1 1 1 Inhalants - - - - 1 1 - - - - - - Khat - - - - - - - - - - - - Polysubstance - - - - - - - - - - - - Methamphetamine ( Tik ) 18 12 17 13 15 12 24 14 6 8 11 9 GHB - - - - - - - - - - - -Tobacco - - - - - - - - 1 1 2 2 Other - - 1 1 2 2 3 2 2 3 - - *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 2 14 14 24 13 13 10 6 23 5 Medical Aid 15 46 48 37 55 62 69 69 31 82 Family 40 20 27 24 20 17 13 14 42 9 Friends 1 1 1 1 1 1 <1 1 1 - Employer 7 4 2 5 4 4 2 4 2 1 Unknown 5 6 3 4 5 <1 3 1 1 2 Other 6 6 2 2 <1 1 1 1-1 State 25 3 3 4 2 2 2 3 - <1 Employer/Self <1 - - - - - - <1 - - 42
Table 79: Treatment population suburb of residence (Port Elizabeth) n % n % n % n % n % n % METRO SUBSTRUCTURE Bethelsdorp, Gelvandale, 64 12 36 7 37 7 29 4 8 5 8 5 Korsten, Malabar Roadhouse, New Brighton, Motherwell 65 13 47 9 9 2 30 5 15 9 15 9 Uitenhage, Despatch North End, Mount Road, Central 20 4 5 1 16 3 4 1 2 1 2 1 Walmer, Kabega Park, Summerstrand 21 4 2 <1 3 1 4 1 4 2 4 2 Port Elizabeth (other 355 69 482 90 437 77 498 76 39 23 39 23 parts) OTHER PARTS OF THE PROVINCE George, King Williams Town, Humansdorp, Maclear and East London 165 19 22 4 23 4 60 9 23 14 23 14 Unknown 3 <1 14 3 - - - - - - - - Other Provinces 47 5 25 5 19 3 21 2 21 12 21 12 Table 80: Tertiary substance of abuse (Port Elizabeth) n % n % n % n % n % n % Alcohol 18 27 19 33 11 25 8 20 15 24 11 26 16 25 White Pipe 11 1 4 7 8 19 10 24 13 21 9 21 8 13 Dagga 11 16 12 21 5 12 8 19 4 6 7 17 9 14 Cocaine Crack 10 15 11 19 9 20 6 15 13 21 2 5 13 21 Heroin 1 1 2 4 3 7 - - 1 2 2 5 - - Ecstasy 4 6 - - - - 1 2 5 8 2 5 8 13 Ecstasy/ Dagga 10 15 - - - - - - - - - - - - OTC/PRE 5 8 1 2 2 5 1 2 2 3 2 5 2 3 Methamphetamine 5 8 6 10 5 12 7 17 7 11 6 14 6 10 ( Tik ) Moonflower - - - - - - - - - - - - - - LSD - - 1 2 - - - - - - - - - - Khat - - - - - - - - - - - - 1 2 Other 1 1 1 2 - - - - 3 5 - - - - Inhalants 1 2 - - - - - - - - 1 2 - - *Crack/cocaine combined 43
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 8 7 3 3 5 9 9 9 10 8 - - 6 8 Dagga/ Mandrax 18 15 7 8 2 3 6 6 6 5 - - 4 6 Dagga 69 57 35 39 26 44 39 40 52 41 25 69 17 24 Cocaine Crack 5 4 7 8 1 2 1 1 3 2 1 3 1 1 Ecstasy - - - - - - - - - - - - - - Heroin 2 2 5 6 - - - - - - - - 3 4 OTC/PRE 1 1 2 2 - - 3 3 4 3 - - 3 4 Inhalants 3 3 1 1 - - 2 2 - - 1 3 - - Methamphetamine ( Tik ) 13 11 29 33 25 42 39 39 53 41 8 22 37 52 Other - - - - - - - - - - - - - - TOTAL 119 100 89 100 59 100 99 100 128 100 36 100 71 100 + 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 101 85 71 80 44 75 79 80 89 69 28 78 48 68 Female 18 15 18 20 15 25 20 20 39 31 8 22 23 32 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
Table 83: Race of patients younger than 20 years (Port Elizabeth) n % n % n % n % n % n % n % African 29 24 15 17 6 10 18 18 26 21 8 22 13 19 Asian 1 1 3 4 1 2 5 5 3 2 - - 3 4 Coloured 70 59 52 58 45 76 61 62 67 53 20 56 34 49 White 19 16 19 21 7 12 15 15 31 24 8 22 21 29 TOTAL 78 100 119 100 89 100 99 100 127 100 36 100 71 100 45
2e: SANCA East London treatment demand Table 84: Demographics (East London) Mr Roger Weimann n % n % n % n % n % GENDER Males 157 84 19 88 114 82 125 85 59 80 Females 30 16 136 12 25 18 22 15 18 20 TOTAL 187 100 155 100 139 100 147 100 77 100 ETHNIC GROUP African 98 52 84 54 85 61 96 65 46 63 Coloured 49 26 38 25 21 15 22 15 13 18 Asian 5 3 2 1 2 1 1 1 - - White 35 19 31 20 31 22 28 19 14 19 EMPLOYMENT STATUS Working full time 70 37 43 28 42 30 46 31 20 26 Working part time 6 3 4 3 2 1 5 3 1 1 Not working 69 37 67 43 56 41 60 41 37 48 Apprentice/intern - - 1 1 - - - - - - Student/learner 39 21 38 25 35 25 31 21 19 25 Disabled/medically boarded 2 1 - - 3 2 - - - - Pensioner 1 1 2 1 - - 4 3 - - Other - - - - - - - - - - Housewife - - - - - - 1 1 - - MARITAL STATUS Married, living with spouse 37 20 16 10 19 14 21 14 10 13 Married not living with spouse 4 2 4 3 3 2 4 3 8 10 Living together 20 11 8 5 12 9 17 11 1 1 Divorced 9 5 8 5 9 7 4 3 7 9 Widowed 5 3 4 3 4 3 2 1 - - Never married 112 60 115 74 91 66 99 67 51 66 Other - - - - - - - - - - None - - - - - - - - - - EDUCATION Grade 1-7 22 12 24 16 8 6 13 9 4 6 Grade 8-12 122 66 107 69 100 73 108 74 52 84 Tertiary 40 22 23 15 29 21 26 17 6 10 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
Table 85: Referral source (East London) Jan n % n % n % n % n % n % Self 59 31 48 26 45 29 41 30 44 30 12 16 Family or friends 76 40 85 45 73 47 75 55 68 46 37 50 Employers 33 17 22 12 14 9 9 7 14 10 10 13 Health Profession 4 2 8 4 8 5 3 2 8 5 3 4 Religious groups - - 3 2 2 1 1 1 - - 1 1 Hospital/clinic 1 1 2 1 2 1 1 1 2 1 - - Social Services 12 6 9 5 1 1 5 4 5 3 3 4 Courts/correctional services 1 1 - - - - - - - - 1 1 School 5 2 8 4 9 6 2 1 4 3 7 9 Other - - 2 1 1 1 - - 2 1 - - 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 % 10-14 5 2 7 4 12 8 2 2 5 3 3 6 15-19 47 25 33 17 36 23 32 23 27 18 16 24 20-24 31 16 35 19 27 17 29 21 36 25 14 21 25-29 23 12 29 16 29 19 12 9 24 16 6 9 30-34 24 13 30 16 15 10 24 17 11 7 7 11 35-39 17 9 15 8 11 7 9 7 12 8 9 14 40-44 11 6 12 7 8 5 9 7 10 7 2 3 45-49 9 5 13 7 6 4 10 7 7 5 5 8 50-54 12 6 11 6 4 3 6 4 6 4 1 2 55-59 8 4 1 1 4 3 3 2 3 2 2 3 60-64 1 1 - - 1 1 1 1 4 3 1 2 65 + 1 1 - - 2 1 - - 1 1 - - Table 87: Inpatient versus outpatient (East London) n % n % n % n % n % n % Inpatient 35 18 52 28 21 14 25 18 22 15 17 22 Outpatient 157 82 135 72 134 86 114 82 125 85 60 80 TOTAL 192 100 187 100 155 100 139 100 147 100 77 100 The majority of patients were treated on an outpatient basis (80%) 47
Table 88: First time admissions (East London) - n % n % n % n % n % n % n % No 9 7 20 11 32 18 138 7 15 11 116 16 77 100 Yes 118 93 167 89 149 82 11 93 120 89 22 84 - - 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 126 122 90 94 137 117 125 - One 9 3 17 22 8 9 11 - Two 2 2 4 3 3 3 8 - Three - - - 3-2 - - Four 1 - - 1 1-1 - >Four - - 81 2 6 8 2 - 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 25 17 13 25 37 No 68 83 87 73 63 line to answer 1 - - 2 - 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 71 52 87 45 90 48 60 39 60 43 57 39 30 39 Cocaine 6 4 17 9 11 6 8 5 9 7 10 9 6 8 Crack Dagga 40 30 48 25 50 27 47 30 41 29 40 27 25 33 Ecstasy - - - - 1 1 1 1 1 1 - - - - Heroin 1 1 17 9 13 7 6 4 6 4 5 3 2 3 PRE/OTC 5 4 3 2 4 2 2 1 1 1 2 1 - - 48
Mandrax 10 7 15 8 10 5 20 13 14 10 13 9 8 10 Inhalants - - 3 1 - - 2 1 - - - - - - Methamphetamine 3 2 2 1 8 4 8 5 7 5 13 9 6 8 Other - - - - - - - - - - - - - - CAT - - - - - - 1 1 - - - - - - TOTAL 136 100 192 100 187 100 155 100 139 100 147 100 77 100 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 93 49 100 54 65 42 64 46 61 41 30 39 Smoke 87 45 79 42 78 50 68 49 82 56 44 57 Snort/Sniff 10 5 6 3 12 8 6 4 3 2 3 4 Inject 2 1 2 1 - - 1 1 1 1 - - Other - - - - - - - - - - - - TOTAL 192 100 187 100 155 100 139 100 147 100 77 100 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 47 78 13 22 46 81 11 19 22 76 7 24 Cocaine Crack 4 44 5 56 6 60 4 40 5 83 1 17 Dagga 38 93 3 7 38 95 2 5 20 83 4 17 Heroin 3 50 3 50 5 100 - - 1 50 1 50 PRE/OTC - - 1 100 2 100 - - - - - - Ecstasy 1 100 - - - - - - - - - - Inhalants - - - - - - - - - - - - White Pipe 14 100 - - 12 92 1 8 7 100 - - Other - - - - - - - - - - - - Methampheta mine(tik) 7 100 - - 9 69 4 31 4 67 2 33 Tobacco - - - - 7 100 - - - - - - Most patients treated for dagga, dagga/mandrax and alcohol related problems were Black, whereas most methamphetamine patients were Coloured. 49
Table 94: Primary substance of abuse by race (East London) African Coloured Asian White % % % % Alcohol 63 82 64 12 2 11 - - - 25 16 25 Cocaine/ Crack 22 10 67-40 - 11 - - 67 50 33 Dagga 68 70 71 20 12 21 2 3-10 15 8 Heroin 50 20-17 40 100 - - - 33 40 - PRE/OTC 100 - - - 50 - - - - - 50 - Ecstasy - - - - - - - - - 100 - - 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 24 31 18 23 13 22 18 31 16 23 5 14 Cocaine Crack 9 12 12 16 4 7 8 14 3 4 3 8 Cat - - - - - - 1 2 - - - - Dagga 19 25 19 25 17 28 14 24 17 25 8 22 Ecstasy - - 4 5 - - - - - - 1 3 White Pipe 17 22 15 19 14 23 11 8 15 22 7 19 PRE/OTC 1 1 1 1 2 3 1 2 - - - - LSD - - - - - - - - - - - - White Pipe 86 69 63 14 23 12 - - - - 8 25 Methamphetamine 14 23 33 43 46 50 - - - 43 31 17 Inhalents - - - - - - - - - - - - Methamphetamine ( Tik ) 5 7 7 9 6 10 3 5 6 9 2 5 Heroin 1 1 - - 3 5 1 2 6 9 1 3 Inhalants - - 1 1 1 2 - - 1 1 - - Other 1 1 1 1 - - 1 2 1 1 - - Tobacco - - - - - - - - 4 6 10 27 50
Table 96: Tertiary substance of abuse (East London) n % n % n % n % n % n % Alcohol 2 11 8 25 5 25 3 18 4 21 1 10 Cocaine Crack 3 16 3 9 1 5 3 18 3 16 - - Dagga 3 16 5 16 4 20 3 18 1 5 2 20 Ecstasy 1 5 - - 1 5 3 18 1 5 1 10 Glue - - - - - - - - - - White Pipe 4 21 6 19 2 10 1 6 4 21 - - PRE/OTC - - - - 1 5 1 6 - - - - Heroin - - 1 3 - - 1 6 - - 1 10 LSD - - - - - - - - - - - - CAT - - - - - - - - - - - - Inhalents - - 1 3 3 15 - - - - - - Tik/Speed 2 10 2 6 3 15 2 12 4 21 1 10 Other 4 21 5 16 - - - - - - - - Tobacco - - - - - - - - 2 11 4 40 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 30 31 30 30 33 29 29 29 Alcohol 30 39 38 36 36 37 39 35 Dagga 21 21 22 22 21 21 21 21 Mandrax 23 21 20 23 24 21 22 27 Cocaine/crack 30 25 26 27 29 29 31 34 Ecstasy - - - 19* 23* 33* - - Heroin 27* 19* 24 25 26 24 24 31 OTC - 32 41* 39* 34* 35* 39* - Inhalants 12* - 13* - - - - - Other - - - - - - 22 - Methamphetamine (tik) 20* 28* 20* 23 22 30 23 23 * n < 5 51
Table 98: Source of payment (East London) n % n % n % n % n % n % State 2 1 2 1 1 1 2 1 18 12 11 14 Self 43 22 33 18 42 27 37 27 27 18 8 11 Medical aid 32 17 36 20 11 7 13 9 13 9 9 12 Employer 17 9 10 6 6 4 7 5 11 7 5 7 Family 89 46 85 46 89 57 78 56 64 43 40 52 Friends 1 1 1 1 1 1 - - 4 3 - - Unknown 5 3 11 6 2 1 1 1 5 3 1 1 Other combinations 2 1 5 2 3 2 1 1 5 3 2 3 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 5 12 7 15 6 18 2 6 2 11 Cocaine Crack 1 3 1 2 - - - - 1 5 Dagga 24 60 31 65 19 56 18 56 14 74 Ecstasy 1 3 - - - - - - - - Methamphetamine 1 3 3 6 2 6 3 9 1 5 White pipe 5 12 4 8 6 17 6 19 1 5 PRE/OTC - - - - - - - - - - Heroin/Opiates 3 7 - - 1 3 - - - - Inhalants - - 2 4 - - - - - - Other - - - - - - - - - - Tobacco - - - - - - 3 10 - - TOTAL 40 100 48 100 34 100 32 100 19 100 52
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 96 85 92 88 87 72 Female 4 15 8 12 13 28 ETHNIC GROUP African 67 60 54 82 66 63 Coloured 19 33 46 12 12 26 Asian - 2-6 3 - White 14 5 - - 19 11 53
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 20 31 36 36 7 6 1 - - SANCA Lulama 51 10 12 (Durban) 15 24 20 26 33 52 Newlands Park Centre 4 3 1 - - - - - - SANCA Pietermaritzburg 20 23 26 12 33 31 35 31 25 Chatsworth Anti- Drug Forum 29 17 - - - - - - - SANCA Newcastle 6 5 3 1 - - 1 2 - SANCA Zululand 7 10 19 27 12 24 23 12 18 South Coast 4 - - - - 6 7 4 5 Jullo centre - - - - 29 6 - - - Persons treated over all centres 1575 1138 1009 669 720 610 569 813 934 2008 Jan - % % % % % % % % % % Yes 78 81 74 80 82 82 77 79 76 82 No 22 19 26 20 18 18 23 21 24 18 Most patients were treated on an outpatient basis during this period. 54
Table 103: Type of treatment received (KZN) Jan Jan - Jul - % % % % % % % Inpatient 23 26 51 42 30 27 22 Outpatient 77 74 49 58 70 73 78 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 - - - 33* - - 33* - - 33* - - SANCA Lulama (Durban) 59 57 69 4 12 9 19 22 14 19 10 8 SANCA Pietermaritzburg 68 86 67-9 6-11 8-12 19 Chatsworth Anti- Drug Forum - - - 9 - - 11 - - 12 - - South Coast 10* 3** 8* 5* 6* 4* 3** - 4 82 88 83 SANCA Newcastle 50* 41-50* - - - 29* - - 29* - SANCA Zululand 84 86 78 1* - 2 5 5 6 9 9 14 Overall Race 64 61 67 5 9 7 12 17 11 19 13 16 *: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 89 90 87 86 88 88 87 90 88 Female 11 10 13 14 12 12 13 10 12 ETHNIC GROUP African 32 44 58 56 55 59 64 61 67 Coloured 7 8 10 9 6 6 5 9 7 Indian 45 34 17 16 25 13 12 17 11 White 16 14 15 19 14 22 19 13 15
EMPLOYMENT STATUS Employed (full-time) 35 37 37 42 43 45 42 36 32 Employed (part-time) 10 8 3 2 1 2 2 2 2 Not Working 32 25 26 31 28 25 25 31 27 Apprenticeship/ Internship <1 <1 1 1 - <1 <1 <1 <1 Student/pupil 20 26 29 21 19 25 28 28 35 Disabled 1 1 1 1 1 1 <1 1 1 Housewife <1 - <1 1 <1 - - - <1 Pensioner 1 1 1 <1 1 1 <1 <1 1 Other 1 2 3 1 6 1 1 1 2 MARITAL STATUS Married, living with spouse 17 17 15 19 21 18 16 15 13 Married, not living with spouse 5 5 5 5 2 5 4 3 4 Living in a nonmarried intimate relationship 9 7 6 6 4 6 6 5 5 Divorced 5 6 4 4 6 3 5 5 3 Widowed 1 1 1 2 1 1 2 1 1 Never married (& not living in nonmarried intimate relationship) 63 64 68 63 65 68 67 72 74 Other <1 <1 1 1 1 6 - - - EDUCATION Pre-Primary - - - - - - - - - Primary 6 6 10 7 5 5 7 8 8 Secondary 81 77 73 75 75 76 72 75 73 Tertiary 12 17 17 17 19 19 21 16 18 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 50 38 41 40 61 41 36 42 42 Social Service/ Welfare 4 5 7 5 3 5 7 7 7 Employer/Work 13 18 19 22 13 21 21 17 13 Court/Correctional Services 8 13 6 6 1 2 2 2 2
Health Professionals 5 5 5 9 3 5 6 6 3 Hospital/Clinic 2 2 2 2 2 2 3 3 4 School 12 11 11 5 10 13 15 13 19 Religious Group 1 1 1 <1 <1 1 1 - <1 Other 5 7 9 11 7 9 8 8 11 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 - % % % % % % % % % % 10-19 20 25 28 33 22 25 27 27 29 34 20-24 24 23 17 15 15 17 18 14 16 16 25-29 16 15 14 14 14 13 12 17 16 14 30-34 11 10 10 10 13 13 12 10 11 12 35-39 7 9 10 8 11 9 9 11 10 6 40-44 7 6 7 7 9 8 8 7 8 7 45-49 7 5 6 7 8 7 7 6 5 5 50-54 4 4 4 3 4 4 5 5 3 3 55+ 3 3 4 4 4 4 3 3 2 3 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 122 34 184 37 261 42 232 66 308 63 361 58 Coloured 11 38 29 41 31 48 18 62 42 59 33 52 Indian 15 22 39 28 28 28 52 82 98 72 71 72 White 14 13 19 18 30 21 91 87 88 82 116 79 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
Table 109: HIV Test (KZN) Jan - Jul - Tested for HIV in the past 12 months % % % % % Yes 39 35 35 31 30 No 56 63 62 67 69 line to answer 5 2 3 2 1 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 41 47 55 55 63 67 65 51 51 Cannabis 20 28 33 26 17 16 19 25 31 Mandrax ( white 1 1 2 2 1 3 1 1 1 pipe ) Crack/Cocaine 7 6 4 6 7 5 6 4 6 PRE/OTC 1 1 <1 2 1 <1 1 1 1 Ecstasy <1 <1 <1 <1 - <1 1-1 Heroin ( sugars ) 29 17 5 9 10 6 4 6 6 Inhalants 1 <1 1 <1 1 1 1 1 1 Cannabis/ Cocaine - - - - - - - - - LSD - - - - - - <1 <1 - CAT - - - <1 <1 1 2 1 2 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 23 20 31 15 39 77 80 69 85 61 Cannabis 54 72 30 72 35 56 28 70 28 65 CAT - - - - 25* - - - 100** 75* Dagga/ 33* 53 14* 36** 50* 67** 47** 86** 64 50* Mandrax Crack 13 6** 22** 9** 37 87 94 88 91 63 Cocaine Heroin 40 43 36** 28 47 60 57 64 72 53
Sugars Ecstasy 1* - - - 17** 99* 100** 100* - 83** * PRE/OTC 13* 13* 14* - 20* 66** 66** 86** 100** 80* Solvents 100* 100** - 60** 71* - - 100* 40** 29* * Tik/Speed - 67** - - - - 33** - 100** 100* Tobacco - - - 49 - - - - 51 - *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 36 35 37 40 37 33 33 29 33 27 Cannabis 22 21 21 20 22 22 19 29 20 28 Mandrax 29 29 32 21 25 26 21 26 25 32 Crack 31 Cocaine 31 30 31 29 28 31 28 29 26 Ecstasy 26* - - 26* 24* - 32* 35* - 28 OTC/PRE 33 40 38 40* 41 43 37* 43 38* 31 Heroin ( sugars ) 22 22 22 22 24 23 23 29 24 25 Inhalants/ Solvents 18 18 18 13** 14* 15** 15* 34* 18* 25 CAT - - 20** 14** 14* 23 23 30 30 25 Methamphetime (Tik) - - 23* 17* - 21** - - 25* 36 Ketamine - - - - - - - - - 23 *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 - 28 29 31 31 29 30 29 28 27 59
Table 114: Primary Substance of Abuse by Race (KZN) AFRICAN COLOURED ASIAN WHITE % % % % Alcohol 67 64 67 6 6 7 16 16 10 15 14 16 Cannabis 61 56 71 4 14 6 3 22 11 23 8 12 Mandrax 83 73 67-9 33-18 - 17 - - Crack/ Cocaine 64 22 58 3 19 9 20 31 16 14 28 17 Ecstasy 25-50 25-17 - - 17 50-17 Heroin ( Sugars ) 63 56 71-10 9 8 15 12 25 19 7 OTC/PRE 29-55 14 20 11 62 40 11 27 40 22 CAT 22 12 6-13 - - 13 12 77 62 81 Inhalants 33 60 86 - - 14 - - - 33 40 - Methamp hetamine (Tik) *n=1 **n=<10 60 - - - - 25 - - - - - 75 100 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 85 15 87 13 88 12 88 12 90 10 89 11 Cannabis 94 6 97 3 93 7 86 14 91 9 89 11 Dagga/ Mandrax 86 14 100-87 13 86 14 91 9 100 - Crack Cocaine 74 26 81 19 82 18 94 6 88 12 82 18 Ecstasy 33 67 - - 50 50 100 - - - 83 17 OTC/PRE 42 58 38 62-100 43 57 60 40 80 20 Heroin ( sugars ) 93 7 89 11 97 3 96 4 90 10 86 14 Inhalents/ Solvents 100-80 20 67 33 100-100 - 86 14 Heroin - - - - - - - - - - - - CAT 100-50 50 86 14 67 33 38 62 62 38 Methamp hetamine (Tik) 100 - - - 33 67 - - 50 50 100 - *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.
Table 116: Secondary Substance of Abuse (2 nd most frequently used) (KZN) Jan - % Alcohol 29 28 21 18 16 14 15 16 20 Cannabis 31 22 28 28 42 25 31 40 32 Mandrax 5 6 6 6 4 2 3 3 4 Crack/Cocaine 16 12 5 8 10 9 8 7 6 Heroin Sugars 3 5 3 2 6 2 3 3 2 Ecstasy 3 2 1 1 2 2 3 - - PRE/OTC 2 1 1 1 1 1 1 2 1 LSD - - - - - <1 - - - Methamphetamine - <1 - - - - - - - Inhalants <1 1 1 <1 1 <1 1 1 <1 Other (including cigarettes) 11 23 32 36 20 47 32 23 33 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 186 28 183 26 164 27 204 37 337 42 405 43 Self 109 16 105 15 115 19 90 16 132 16 155 16 Medical Aid 127 19 323 45 166 27 115 21 154 19 139 15 State 14 2 22 3 63 10 30 5 44 6 55 6 Employer 85 13 37 5 56 9 65 12 83 10 67 7 Other/ Unknown 123 19 37 5 37 6 38 7 40 5 105 11 Friends 2 <1 6 1 5 1 4 1 4 1 3 <1 Unable to 17 3 - - 2 1 2 <1 10 1 2 <1 pay Employer/Se - - 1 <1 - - 2 <1 1 <1 - - lf Total 663 100 714 100 608 100 550 100 805 100 931 100 61
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 93 51 76 47 109 69 56 23 169 53 Cannabis 57 31 63 39 30 19 132 54 98 31 Mandrax 2 1 6 4 1 1 4 2 2 1 Cocaine Crack 1 1 - - 7 5 2 1 20 6 Ecstasy - - - - - - - - - - OTC/PRE 1 1 - - 1 1 - - 2 1 Heroin (including Sugars) 21 11 12 7 8 5 12 5 23 7 Inhalants/Solvents 5 3 3 2 - - 3 1 4 1 CAT 2 1 - - 1 1 - - 2 1 Methamphetamine - - 1 1 - - - - - - (tik) TOTAL 182 100 161 100 157 100 243 100 320 100 62
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 75 74 79 SANCA 8 8 15 Goldfields SANCA 17 19 6 Sasolburg SANCA 74 100 - Kimberley SANCA 25 - - Upington SANPARK 100 100 100 Klerksdorp Total in treatment 516 370 368 299 50-117 75 104 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 84 78 77 99 100-70 75 78 No 16 22 23 1 - - 30 25 22 63
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 51 63 67 5 2-91 97 99 Outpatient 49 37 33 95 98-9 3 1 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 11 12 14 16 14-23 22 17 Family/friends 20 28 24 32 40-9 11 28 Work/employer 29 30 25 4 4-24 24 28 Doctor/psychiatrist/ nurse (Health professional) 7 8 13 17 8-7 3 6 Religious body 1 2 1 - - - 1 - - Hospital/clinic <1 1 <1 4 2-1 3 - Social 9 9 11 19 28-27 27 18 services/welfare Court/correctional 2 2 2 1 2-2 8 1 School 21 8 10 7 11-7 3 1 Other e.g. radio <1 - - <1 24-1 - 1 64
Table 123: Population profile Free State Northern Cape North West % % % GENDER Male 84 67 87 75 87-79 88 88 Female 16 33 13 25 13-21 12 12 ETHNIC GROUP Asian <1 - <1-1 - - - - Black 47 44 47 46 54-59 65 60 Coloured 25 56 17 50 5-6 4 5 White 28-35 4 41-35 31 36 EMPLOYMENT STATUS Working fulltime 37 28 45 16 46-52 49 55 Working parttime 3-4 11 3-6 1 7 Not working 27 56 25 40 32-24 35 31 Apprentice/ internship <1 - <1 2 - - - - - Student/learner s 31 17 24 20 10-13 11 6 Disabled: not working <1 - <1 4 1 - - 1 - Housewife 1-1 3 2-1 - - Pensioner/ retired 1-2 4 5-4 - - Other - - - - 1 - - 3 - MARITAL STATUS Married, living with spouse 23 28 23 11 32-23 15 16 Married, not living with spouse Living together 4-6 4 6-7 11 5 7-10 20 14-8 7 7 Divorced 7-7 1 11-9 7 10 Not married- 55 72 53 61 36-45 47 57 *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
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 % % % 5-9 1 - - - - - - - - 10-14 6 3 4 10 10 - - - - 15-19 23 16 21 20 36-13 13 5 20-24 9 14 10 11 22-15 20 24 25-29 13 16 12 9 2-13 13 20 30-34 10 14 19 14 12-10 11 14 35-39 9 9 10 11 10-19 11 13 40-44 11 7 10 9 4-9 15 7 45-49 8 9 7 9 2-10 11 6 50-54 7 78 6 4 2-4 1 5 55-59 2 2 1 2 - - 5 4 6 60-64 2 2 1 - - - 1 1 1 65+ <1 <1 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 35 22 50 38-51 No 58 78 46 57-47 line 6-4 5-2 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 52 56 50 59 39-62 60 53 Cannabis 30 21 28 19 10-21 19 18 Cannabis/Mx 2 1 2 3 - - 3 4 2 66
Crack/Cocaine 4 7 5-2 - 3-9 Heroin 1 2 2 - - - 4 7 7 Methampheta 2 2 2 7 - - 2 1 4 mine Ecstasy - - - - - - - - 1 Inhalants 6 2 2 11 6-2 - - Methcathinone 1 4 7 1 - - 3-7 OTC/PRE 3 2 2 <1 - - 2 1 - 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 65 69 62 64 40-85 80 67 Cannabis 39 33 42 26 36-40 44 36 Cannabis/Mx 6 5 5 16 18-6 8 7 Crack/Cocaine 8 13 11 2 6-8 13 13 Ecstasy 2 1 1 - - - <1 4 2 Heroin <1 3 4 - - - 7 8 10 Inhalants 7 4 2 15 12-4 5 2 Khat - - - - - - - - - LSD - - - - - - - - - Methamphetam 4 2 4 11 12-3 7 7 ine Methcathinone 3 6 11 2 4-4 19 17 OTC/PRE 5 5 7 <1 - - 7 3 6 Tobacco - 3 - - 54 - - 11 - 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
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* - - - - 20** 43* Heroin Table 129: Mean age by primary substance *n=<10; **n=1 Years Free State Northern Cape North West Alcohol 39 39 38 36 32-39 38 38 Cannabis 19 19 20 20 23-24 24 38 Cannabis/ 24 23 23 24 - - 31* 21* 22* Mandrax Crack/Cocaine 32 28 32-31** - 31* - 24 Ecstasy - - - - - - - - 32** Heroin 26 28 27 - - - 24 25* 26 Inhalants 16 16 17 14 14* - 29* - - Khat - - - - - - - - - Methamphetami 26 27 29 26 - - 25* 19** 31 ne Methcathinone 26 27 27 28* - - 29* 27 24 OTC/PRE 42 41 47 53** - - 42* 39** - Overall mean age 31 32 31 30 24-34 33 33 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
Table 130: Gender, by primary substance of abuse for the Free State Free State % % % M F M F M F Alcohol 87 13 86 14 85 15 Cannabis 87 13 96 4* 97 3* Cannabis/Mandrax 100* - 100* - 88 12** 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* 71 28 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 61 39 89 11 - - Cannabis 93 7* 80* 20** - - Cannabis/Mandrax 10 - - - - - Crack/Cocaine - - 100** - - - Ecstasy - - - - - - Heroin - - - - - - Inhalants 91 9* 100* - - - Khat - - - - - - Methamphetamine 100 - - - - - Methcathinone 50** 50** - - - - OTC/PRE 100** - 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 130-132). Table 132: Gender, by primary substance of abuse for the North West North West % % % M F M F M F Alcohol 73 27 91 9* 89 11 Cannabis 96 4** 93 7* 95 5** Cannabis/Mandrax 67* 33** 100* - 100* - 69
Crack/Cocaine 100* - - - 89 11** Ecstasy - - - - 100** - 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 53 61 52 12 10 10 <1 - - 34 30 37 Cannabis 51 77 59 38 10 29 - - - 12 13 13 Cannabis/ Mandrax 53* - 38* 37* 100* 50* - - - - - 13* Crack/ Cocaine 30* 15* 29* 10* 33 18* - 4* - 60 48 53* Ecstasy - - - - - - - - - - - - Heroin 33* - 22* 17* - - - - - 50* 100* 78* Inhalants 30* 38* 17** 67 25* 83* - - - 3** 38* - Khat - - - - - - - - - - - - Methamph etamine - 11** - 67* 44* 14** - - 43* 33* 44* 43* Methcathi none - 6** 13* 17** 6** 8* 33* - - 50* 88 79 OTC/PRE - - - 33* 17** 22* - - - 67 83* 78* Tobacco - 50* - - 50* - - - - - - - *n=<10; **n=1 Table 134: Race by primary substance of abuse for the Northern Cape BLACK COLOURED ASIAN WHITE % % % % % % % % % % % % Alcohol 58 47-38 47 - - - 4 5 - Cannabis 32 60* - 65 40* - - - - 4* - - Cannabis/ Mandrax Crack/ Cocaine 40* - - 60 - - - - - - - - - - - - 100* -* 70 - - - - - - -
BLACK COLOURED ASIAN WHITE % % % % % % % % % % % % Ecstasy - - - - - - - - - - - - Heroin - - - - - - - - - - - - Inhalants 30 67* - 70 33** - - - - - - - Khat - - - - - - - - - - - - Methampheta mine OTC/PRE *n=<5; **n=1 14* - - 81-41 - - 55 - - - - - 5** - - - - - Table 135: Race by primary substance of abuse for the North West - 100* * BLACK COLOURED ASIAN WHITE 5** - % % % % % % % % % % % % Alcohol 56 71 69 7* 2** - - - - 37 27 31 Cannabis 71 79 74 8* - 5** - - - 21* 21* 21 Cannabis/ 67* 100* 100* - - - - - - 33* - - Mandrax * * Crack/ 67* - 33* - - 44* - - - 33* - 22* Cocaine * Ecstasy - - 100** - - - - - - - - - Heroin 100* 40* 29* - - - - - - - 60* 71 Inhalants 100* - - - - - - - - - - - Khat - - - - - - - - - - - - Methcathino ne Methamphet amine OTC/PRE *n=<5; **n=1-17** 29* - 17** - 100 - - - * - - - - 100* 25** - - - 100 * * - - - - - - - - - 100 * 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
Table 136: Multiple substance use Free State Northern Cape North West n % n % n % n % n % n % Primary substance only 258 70 237 64 29 58 - - 33 44 57 55 Primary +2 nd substance 68 18 83 23 6 12 - - 16 21 30 29 Primary+2 nd +3 rd substance 32 9 29 8 10 20 - - 18 24 10 10 Primary +2 nd 3 rd +4 th substance 12 3 19 5 5 10 - - 8 11 7 7 Total no. of patients 370 100 368 100 50 100 - - 75 100 104 100 Table 137: Source of payment Free State Northern Cape North West % % % Self 9 12 10 - - - 3 1 8 Medical Aid 26 35 36 4 - - 46 41 52 State 42 25 29 95 100-39 37 23 Family 13 15 14 <1 - - 2 15 13 Friends 1 1 1 - - - - - 2 Work/ employer 7 7 8 <1 - - 6 3 3 Unknown <1 1 1 - - - - - - Other/ combinations 2 5 1 - - - 3 3 - 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
Tables 138-140 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* 4 39 29 37 55 66 58 Cannabis 4 4* 5 5 3* 4* 31 18 21 60 75 71 Cannabis/M ax - - - - - - 13** 20** 25* 87 80* 75 Crack/Coca ine - 4** 6** 20* 4** 24* 30 41 18* 50 51 53 Ecstasy - - - - - - - - - - - - Heroin 17** - - - - - - - - 83* 100* 100 Inhalants 3** 13** - 3** - 17** 50 25* 33* 43 62* 50** Methamphe tamine - - - 11** - 14** 11** 33** - 78 67 86 Methcathin 17** - one 8* 17** 13* - 33** 34 50 33* 50 42 OTC/PRE - 17** - - - - 7** - - 93 83* 100 Tobacco - - - - 14** - - - - - 86 - *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** - 30 0-61 90 - Cannabis - - - 4* - - 39 20** - 57 80* - Cannabis/ - - - - - - - - - 100 - Mx - Crack/ - - - - - - - 0-100* 100** Cocaine - Ecstasy - - - - - - - - - - - - Heroin - - - - - - - - - - - - Inhalants - - - - - - 24 0-76 100** - Methamp - - - - - - 38 - - 62 - hetamine - OTC/PRE - - - - - - - - - 100** - - Tobacco - - - - - - - 0 - - 100-73
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 89 97 95 88 100-93 70 100 Female 11 8 5 12 - - 7** 30* - ETHNIC GROUP African 44 74 54 34 44-87 70 80* Coloured 48 19 36 64 52 - - 10* - Asian - - - 2* 4** - - - - White 8 7 10 - - - 13* 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** 22 31 22 72 67 76 Cannabis - - - - - - 8* 33* 16* 92 67* 84 Cannabis/ - - - - - - - 33** - 100* Mx * 67* 100* Crack/ - - - 33** - - 67* - 56 - Cocaine - 44* Ecstasy - - - - - - - - 100* - - - * Heroin - - 14** - - - 40* - - 60* 100* 86 Inhalants - - - 50** - - - - - 50** - - Khat - - - - - - - - - - - - Methcathi none OTC/PRE - - - - - - 50** - - 50** 100* * - - - 33** - 16** 33** 33* 43* 33** 67* 43* - 74
Table 142: Primary substance of abuse of patients <20 years Free State Northern Cape North West n % n % n % n % n % n % Alcohol 9 13 4 4 3 13* - - 1 10** 1 20** Cannabis 49 70 76 84 - - - - 5 50 2 40* Cannabis/ Mandrax 1 1** 3 3 4 5* - - 1 10** - - Cocaine/ crack - - - - - - - - - - 1 20** Heroin - - - - - - - - 1 10** - - Methamphe tamine - - - - - - - - 1 10** - - Inhalants 6 9 4 4 - - - - - - - - OTC/PRE - - - - - - - - - - - - Methcathino ne - - 4 4 - - - - 1 10** 1 20** Total 70 100 91 100 23 100 - - 10 100 5 100 Tables 143-145 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* 100-100 - Cannabis 88 12 96 4* 99 1* Cannabis/Mandrax 100** - 100* - 67* 33* Crack/Cocaine - 100** - - - - Heroin 100** - - - - - Ecstacy - - - - - - Methamphetamine 100** - - - - - Inhalants 96 4* 100 - - - OTC/PRE 100** - - - 100 - Tobacco - 100 - - - 75
Table 144: Primary substance by gender of patients <20 years (%) for the Northern Cape Northern Cape % % % M F M F M F Alcohol 57 43 100* - - - Cannabis 94 6* - - - - Cannabis/Mandrax 100* - - - - - Crack/Cocaine - - - - - - Heroin - - - - - - Methamphetamine 100* - - - - - Inhalants 100* - 100* - - - OTC/PRE - - - - - - Tobacco - - 100 - - - * (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 100-20** 80* 100* - Cannabis/Mandrax - - 100** - - - Crack/Cocaine - - - - 100** - Heroin 100** - 100** - - - Methamphetamine - - 100** - - - Inhalants - - - - - - Methcathinone - - - 100** 100** - * (n<5), ** (n=1) 76
77