South African Community Epidemiology Network on Drug Use (SACENDU)
July - December 1997 (Phase 3)
Charles Parry, PhD
Medical Research Council

SACENDU - HIGHLIGHTS
(May 1998 )
The focus of this Brief is on the findings of Phase 3 of the SACENDU Project, an alcohol and other drug (AOD) sentinal surveillance system operational in Cape Town, Durban, Port Elizabeth and Gauteng. The system monitors trends in AOD use and associated consequences on a six-monthly basis using multi-source information (from specialist treatment centres, psychiatric hospitals, mortuaries, trauma units, the police, and from research conducted in schools and with sex workers, street children and persons attending rave parties). The project is at different stages of development in each of the sites.

Overview
Alcohol is still by far the major substance used/abused in each site. Other major drugs of use/abuse continue to be cannabis alone, or in combination with Mandrax (Methaqualone). Other drugs used/abused to a lesser extent are over-the-counter (OCM) and prescription medicines, cocaine powder/crack, Ecstasy, heroin, LSD, Speed, solvents, and amylnitrate. Other new substances have entered the market (e.g. Liquid Ecstasy (Gamma Hydroxy Butyrate)).

The study highlights several conditions that need to be carefully monitored over time:

• The changing profile (gender, age, race) of persons coming to specialist treatment centres
• Changing patterns in crack cocaine, Ecstasy and heroin use, and associated problems
• Gaps in services available to women and Black-African populations
• AOD use among adolescents, and the age of first use of drugs
• The production and use of synthetic drugs
• The association between AOD use and crime, premature death, and injury
• Changes in the quality of drugs (e.g. Mandrax, Ecstasy, heroin and Speed)
• Changes in the street price of drugs
• Changes in mode of drug use (especially IV drug use among heroin users).

Review by substance of abuse
Alcohol
Alcohol is still the most common primary substance of abuse among patients seen at specialist treatment centres, accounting for 62% to 78% of admissions in Cape Town, Durban and P.E. Such patients tend to be older and are more likely to be male. Alcohol-related diagnoses are common in psychiatric patients. Alcohol is frequently abused by street children. In comparison with data collected in 1990, a substantial increase in binge drinking among male and female standard 6 and 9 (Grade 8 and 11) students in Cape Town was noted. The association between alcohol use and non-natural death and trauma unit visits was again highlighted.

Cannabis and cannabis/Mandax
These substances are the second and third most common primary substances of abuse among patients seen at specialist treatment facilities, together accounting for 15% to 27% of admissions in Cape Town, Port Elizabeth and P.E. Drug (especially cannabis) -related psychiatric diagnoses are also common. Across all four sites Mandrax-related arrests were up in the second half of 1997. Cannabis-related arrests, however, were down at all sites except Gauteng. From treatment centre statistics most users tend to be male and younger than for other substances of abuse. These were the most common drugs for which persons were arrested for dealing in three of the four sites, accounting for 66% - 96% of arrests by SANAB in the second half of 1997. Research shows that these substances are used by sex workers and street children in Cape Town. Lifetime use of these substances appears to have increased among male and female students in standards 6 and 9 attending schools in Cape Town. These substances (particularly cannabis/Mandrax in combination) have been associated with trauma unit visits resulting from interpersonal violence.

Cocaine/Crack
The proportion of cases in which cocaine/crack is the primary substance of abuse among persons coming to specialist treatment centres is still low (i.e. less than 1% to 4% of admissions), but is generally higher than for drugs such as Ecstasy and heroin. Some treatment centres, especially in Cape Town report a dramatic increase in cocaine/crack-related admissions. The proportion of cocaine/crack-related admissions increased in Durban from 1% to 3% of admissions in the second half of 1997, and the proportion of arrests for dealing/possession increased from 11% to 22% of SANAB arrests in that city. These substances also appear as secondary substances of abuse. Use of these substances is less of a male phenomenon than for many other substances. They are commonly used by sex workers.

Ecstasy/LSD/Speed
The proportion of persons using specialist treatment services whose primary drug of abuse was Ecstasy, LSD, or Speed is still low across all sites (less than 2%). However, many patients have these substances as secondary drugs of abuse. SANAB arrests and seizures for dealing/possession of Ecstasy were up in three of the four sites. Police reports of large seizures of Liquid Ecstasy (GHB) manufactured in South Africa were also noted. A higher proportion of males and females in standards 6 and 9 in schools in Cape Town reported lifetime use of Ecstasy than crack cocaine.

Heroin
The proportion of persons using specialist treatment services whose primary drug of abuse was heroin is still low across all sites (less than 2%). Use of heroin is less of a male phenomenon than for many other substances. Some IV drug use was reported among heroin users (e.g. 10 out of 24 patients in specialist treatment centres in Cape Town). SANAB seizures for dealing and possession of heroin were up in three of the four sites.

Inter-site comparisons
For a comparison of key patterns and trends across sites see Table 1.

Table 1: Comparison of key patterns and trends across sites