South African Community Epidemiology Network on Drug Use (SACENDU)
KEY ALCOHOL AND DRUG ABUSE TRENDS: JULY – DECEMBER 2000
Charles Parry, Andreas Plüddemann, Arvin Bhana, Sanchia Matthysen, Hennie Potgieter, & Welma Gerber

Update
(June 2001)

Background
The SACENDU Project is an alcohol and other drug (AOD) sentinal surveillance system operational in Cape Town, Durban, Port Elizabeth (PE), Mpumalanga, and Gauteng (Johannesburg/Pretoria). The system monitors trends in AOD use and associated consequences on a six-monthly basis using multi-source information from specialist treatment centres (50+), psychiatric hospitals, mortuaries, trauma units, the police (SA Narcotics Bureau (SANAB), Organised Crime Units & Forensic Science Laboratories (FSL)), and from research conducted in schools and with sex workers, street children, service providers, persons attending primary health care clinics, arrestees, and persons attending rave parties.

Key findings
The proportion of patients under 20 years old has increased substantially over time (e.g. in Cape Town from 6% in 1996 to 24% in 2000, and in Gauteng from 11% in 1998 to 18% in 2000).

Latest key findings by substance of abuse (unless stated otherwise the findings relate to the 2nd half of 2000):
Alcohol is still the dominant substance of abuse across sites and has a major impact on individuals and society particularly in the area of violence and traffic-related morbidity and mortality. In PE 92%, Cape Town 52% and Durban 40% of trauma patients had positive breath-alcohol, and in Cape Town 56% of mortuary cases in 2000 had blood-alcohol concentrations 0.05 g/100ml.

Use of cannabis (“dagga”) and Mandrax alone or in combination (“white-pipes”) continues to be high. Across sites between 13% (Mpumalanga) and 32% (Cape Town) of patients attending specialist treatment centers had cannabis and/or Mandrax as their primary drug of abuse. About 20% of trauma patients in PE and 35% of trauma patients in Cape Town and Durban in 2000 tested positive for cannabis. In Cape Town 19%, PE 11% and Durban 7% of trauma patients in 2000 tested positive for Mandrax. Across sites, between 24% (Gauteng) and 50% (Cape Town) of arrestees tested positive for cannabis, and between 5% (Gauteng) and 32% (Cape Town) of arrestees tested positive for Mandrax. Across sites, over 60% of persons arrested on drug/alcohol charges or for housebreaking tested positive for cannabis, and over a third of persons arrested for housebreaking tested positive for Mandrax. Over 2 million Mandrax tablets were seized nationally in the 2nd half of 2000.

The proportion of patients in treatment for cocaine has been increasing over time. Between 7% and 12% of patients in Cape Town, Gauteng and Durban had cocaine as their primary drug of abuse.

Sixty-five kilograms of cocaine powder was reported as being seized in Gauteng in the 2nd half of 2000, up from 48 kgs seized in the 1st half of the year. The proportion of arrests for dealing has shown a substantial increase over time in Cape Town and Gauteng.

Across sites between 3% (Cape Town) and 6% (Durban) of arrestees tested positive for cocaine. Cocaine positive arrestees were most likely to be found in police stations like Sea Point, Hillbrow and CR Swart that serve high density residential areas, and for the first time among younger arrestees (20 years). In Cape Town 3%, Durban 4% and PE 14% of trauma patients in 2000 tested positive for cocaine.

The proportion of heroin abusing patients appears to have increased in both Cape Town and Gauteng, especially in younger and female patients. Most heroin is sniffed (“chasing the dragon”), but 36% of patients in Gauteng and 47% of patients in Cape Town having heroin as their primary drug of abuse report some injection use. Heroin seizures showed a substantial increase in Gauteng (from less than 1 kg to over 12 kgs between the 1st and the 2nd half of 2000).

Club drugs in general appear to be entrenched in the rave culture. Twenty percent of ravers studied in Gauteng report weekly use of Ecstasy.

The abuse of over-the-counter and prescription medicines, such as slimming tablets, headache medications and analgesics, and benzodiazepines continues to be an issue across sites.

The following were among regional differences that were noted:

• The level of drug use as well as the range of drugs used is higher in Cape Town and Gauteng as compared to PE, Durban and Mpumalanga.
• Heroin use, in particular, continues to be lower in Durban, Mpumalanga and (especially) PE as compared to Cape Town and Gauteng.
• The use of Mandrax is more common in Cape Town and PE than in the other sites.
• Durban experienced a major increase in patients coming to treatment for problems associated with cocaine use. Cocaine now appears to be firmly rooted in Durban.
• In more rural Mpumalanga the main substance abuse problems appear to be alcohol and dagga, although there is evidence of an increase in use of harder drugs (e.g. cocaine).

Selected implications for policy/practice

• Equip teachers to identify AOD use and refer.
• Implement measures to combat increase in heroin use by young persons in Cape Town and Gauteng.

Selected issues to monitor

• Changes in user demographics
• Increase in IV use (especially heroin)

Selected topics for further research

• The drug/crime link focusing on juveniles
• The relationship between drug use and HIV