South
African Community Epidemiology Network on Drug Use (SACENDU)
ALCOHOL AND DRUG ABUSE TRENDS: JULY – DECEMBER
2001
Charles
Parry, Andreas Plüddemann, Arvin Bhana, Nadine Harker,
Hennie Potgieter, & Welma Gerber
Update
(April 2002)
Background
The SACENDU Project is an alcohol and other drug (AOD) sentinel
surveillance system operational in Cape Town, Durban, Port Elizabeth
(PE), Mpumalanga, and Gauteng (Johannesburg/Pretoria). The system,
operational since July 1996, monitors trends in AOD use and
associated consequences on a six-monthly basis from multiple
sources. Data are collected from over 50 specialist treatment
centres, psychiatric hospitals, mortuaries, trauma units, and
the police (SA Narcotics Bureau (SANAB), Organised Crime Units,
& Forensic Science Laboratories (FSL)). Other data sources
are included when available.
Latest
key findings by substance of abuse (unless
stated otherwise the findings relate to the 2nd half of 2001)
Alcohol remains the dominant substance of abuse across
sites. Between 46% (Cape Town) and 69% (Mpumalanga) of patients
have alcohol as their primary substance of abuse. In PE in 2001,
57% of trauma patients had breath-alcohol concentrations $0.05g/100ml,
compared to 31% in Cape Town and 22% in Durban. Up to 75% of
violence-related trauma patients were alcohol positive (in PE),
and up to 45% (in Cape Town) of persons injured as a result
of transport accidents were alcohol positive. Alcohol positive
patients were more likely to have had prior trauma unit visits.
Use of cannabis
("dagga") and Mandrax (methaqualone) alone or
in combination ("white-pipes") continues to be high.
Across sites between 18% (Mpumalanga) and 37% (Cape Town) of
patients attending specialist treatment centres had cannabis
and/or Mandrax as their primary drug of abuse. There has been
a steady increase in treatment demand for cannabis-related problems
over time in Cape Town, Durban, and Gauteng, and for Mandrax-related
problems in Cape Town. There has also been a steady increase
in the percentage of trauma patients in Cape Town and Durban
testing positive for THC, the active ingredient in cannabis
(from 33% in 1999 to 44% in 2001 in Cape Town, and from 31%
to 44% in Durban). The percentage of trauma patients testing
positive for methaqualone, the active ingredient in Mandrax,
has remained constant at 22% in Cape Town and 11% in PE, but
has increased to 19% in Durban. The proportion of arrests for
dealing in cannabis has decreased over time in all sites. With
regard to Mandrax the major change has been an increase in the
proportion of arrests for dealing in Durban (to 40% of all arrests).
Increased seizures of Mandrax were reported in most sites.
The increases
in treatment demand for cocaine over time reported earlier
for Cape Town, Durban and Gauteng have not continued and there
has been a leveling off in treatment demand (Fig. 1). Treatment
demand for cocaine remains low in PE and Mpumalanga. In Gauteng
increases were, however, noted in the proportion of females
reporting cocaine/crack as their primary drug of abuse. Nine
percent of trauma patients in Cape Town tested positive for
cocaine in 2001 (up from 3% in 1999/2000). In 2001, 3% of trauma
patients in Durban and 0% in PE tested positive for cocaine.
Increases in arrests for dealing in cocaine were reported in
3 of the 4 sites for which data were available, and large seizures
were reported by the FSL in the Western Cape/Cape Town (166
kg).
Over time,
there has been a dramatic increase in treatment demand for heroin
as a primary drug of abuse in Cape Town and Gauteng (Fig. 2).
In Cape Town, this is particularly evident among females less
than 20 years of age (Fig. 3). Most heroin is smoked ("chasing
the dragon"), but an increasing proportion of patients
with heroin as their primary drug of abuse report some injection
use (36% of patients in Gauteng and 51% of patients in Cape
Town). Police seizures, however, decreased in all sites.
Club
drugs - Treatment demand for Ecstasy or LSD as primary drugs
of abuse is low. These drugs more often appear as secondary
drugs of abuse. In three sites there was an increase in arrests
for dealing in Ecstasy and large seizures of amphetamine type
stimulants (ATS) were reported in Durban and Gauteng. Over 100
000 ATS tablets were processed by the FSL in Pretoria alone.
An increase in seizures of LSD was reported by the FSL in Pretoria
and Cape Town and by SANAB/OCU in PE. Arrest and seizure indicators
for Speed are stable or showed a decline across sites.
The abuse
of over-the-counter (OTC) and prescription medicines
such as slimming tablets, analgesics (especially products containing
codeine), and benzodiazepines (e.g. valium) continues to be
an issue across sites, but treatment demand indicators are stable
except in Mpumalanga where an increase was reported. In both
Cape Town and Mpumalanga, increases in the percentage of abuse
by males was noted.
There were
isolated reports from certain treatment providers regarding
the use of Phencyclidine (PCP) in Cape Town and Gauteng,
and khat in Gauteng.
Poly-substance abuse remains high (but stable), with
31% of patients in specialist treatment centres in Gauteng reporting
more than one primary substance of abuse (19%, 7% and 6% respectively
reporting two, three and four substances of abuse). The corresponding
percentages for Cape Town were 40% reporting more than one substance
of abuse, with 21%, 11% and 7% respectively reporting two, three
and four substances of abuse. Various drug combinations were
reported including RedBull (an energy drink) with alcohol and
Ecstasy, cocaine and heroin, cannabis and Mandrax, and LSD and
Ecstasy.
The following regional differences
were noted
- The
level of drug use, as well as the range of drugs used, is
highest in Cape Town and Gauteng.
- The
percentage of trauma patients with alcohol levels above 0.05g/100ml
is higher in PE than in Cape Town and Durban.
- The
use of Mandrax is more common in Cape Town and PE than in
the other sites.
Other
key findings
All sites for which age data are available have shown an increase
in treatment demand by persons less than 20 years of age (Fig.
4). All sites reported an increase in the proportion of Black/African
patients receiving treatment, especially persons under 20 years
of age.
Selected implications for policy/practice
- Address
the increasing abuse of drugs by young persons
- Address
abuse of alcohol among pregnant women in high risk communities
- Investigate
the need for educational and other strategies to address IV
drug use
- Continue
and expand programmes designed to reduce alcohol-related injuries.
Selected
issues to monitor
- Patterns
of referral to treatment centres
- Decreases
in the age of initiation into drug use
- Spread
of heroin and other hard drugs into traditionally Black/African
residential areas
- Poly-drug
use.
Selected
topics for further research
- The abuse
of OTC and prescription medicines by young people, including
school-age youth
- The role
of cannabis in traffic and violence-related injuries
- The increasing
abuse of OTC and prescription medicines by males in some sites
- Drug
using practices among heroin users
- Accessibility
to treatment services for females and Black/Africans
- Reasons
behind the increase in drug use by youth
- The role
of alcohol in violence-related injuries and in pedestrian
traffic injuries.
We
acknowledge the financial support of the National Department
of Health & Gauteng's Department of Social Services and
Population Development
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