Transcript (% as primary drug of abuse) - Under 20s Treatment

Substance abuse treatment
demand among young people
in South Africa
(based on data from the SACENDU Project)
Charles Parry, PhD
Andreas Plüddemann, MA
EMCDDA TDI Annual Expert Meeting, Lisbon (2006)
Funded by the National Departments of Health & Social Development
OUTLINE
Overview of methodology used in the South
African Community Epidemiology Network
on Drug Use (SACENDU)
 Selected findings and recommendations from
Phase 19 (July – December ‘05) particularly
as they relate to young people
 Concluding comments

SACENDU OBJECTIVES






Develop networks of local role players in the substance abuse
area
Identify changes in nature/extent of AOD use & emerging
problems
Identify changes in AOD-related negative consequences
Inform policy, planning and advocacy efforts at local & other
levels
Stimulate research in new/under-researched areas that is likely to
provide useful data to inform policy/planning
Facilitate SA’s full participation in international fora focusing on
epidemiological surveillance of drug abuse
Core features of SACENDU



An alcohol and other drug (AOD)
sentinel surveillance system
operational in Cape Town, Durban,
Port Elizabeth (PE), East London
(EL), Gauteng & Mpumalanga
operational since July 1996
It monitors trends in AOD use and
associated consequences on a 6monthly basis from multiple sources
Establishment of site specific networks
& implementation of a “basic”
surveillance system in each site with
particular emphasis on substance
abuse treatment centres





Collection of data on 6monthly basis
6-monthly site report back
meetings -> collation &
validation of data
Multi-pronged approach to
disseminate findings
Ongoing improvement of data
collection systems (training)
Funded by WHO, Gauteng
Social Services; NDOH &
DoSS (currently)
Main data sources (2005b)
CT
Treatment 25
(40%)
centres
# of
2131
patients (30%)
# patients
under 20
Dbn
PE
(Pmb) (Umt)
EL
Gtg
Mpum
Total
5
4
6
18
4
62
(8%)
(6.5%)
(10%)
(29%)
(6.5%)
(100%)
846
426
267
2848
562
7080
(12%)
(6%)
(4%)
(40%)
(8%)
(100%)
647
250
88
35
575
103
(30%)
(30%)
(21%)
(13%)
(20%)
(18%)
1698
(24%)
Referral source
Gender
Age
Race
Suburb
Education
Employment
Marital status
Inpatient/outpatient
1st – 4th substance of abuse
Mode of use
Frequency of use
Age of 1st use
Prior Rx/# of times
Sources of payment
Treatment demand trends: Age <20 years (%)
35
30
25
20
15
10
5
96
b
97
a
97
b
98
a
98
b
99
a
99
b
00
a
00
b
01
a
01
b
02
a
02
b
03
a
03
b
04
a
04
b
05
a
05
b
0
Cape Town
Gauteng
Durban
PE
Mpumalanga
EL
Primary drug of abuse 2005b (%) – selected drugs
Alcohol
Age
Cape Town Durban
All
25
58
58
52
54
3
24
19
11
21
All
11
28
13
21
23
LT 20
22
65
39
63
57
All
6
3
8
3
0.5
LT 20
7
4
12
5
0
All
8
7
11
10
6
LT 20
1
2
10
5
3
All
14
1
5
8
10
LT 20
13
1
11
7
10
35
0
2
0.2
0.5
53
0
10
0.2
1
LT 20
Cannabis
Methaqualone
Cocaine
Heroin
Methamphetamine All
LT 20
E-Cape Gauteng Mpum
Demographic & other information
(under 20s) – 2005b
Min.
age
% school
referrals
% male
%
African
%
inpatient
1st
admission
Cape Town
10
8.7
71.4
6.8
34.4
90.0
Durban
PE
E London
Gauteng
Mpumal
11
12
14
9
9
10.0
26.8*
2.9
23.0
<1
88.9
67.0
88.6
83.0
82.4
53.8
27.3
77.1
60.3
57.4
6.6
60.2
20.0
22.3
25.0
92.4
89.3*
91.2
90.1
89.8
* - partial data
Treatment demand trends:
Alcohol (% as primary drug of abuse) - Under 20s
35
30
Cape Town
Gauteng
Durban
PE
Mpumalanga
EL
25
20
15
10
5
0
03a
03b
04a
04b
05a
05b
Treatment demand trends: Cannabis
(% as primary drug of abuse) - Under 20s
80
70
Cape Town
Gauteng
Durban
PE
Mpumalanga
EL
60
50
40
30
20
10
0
03a
03b
04a
04b
05a
05b
Treatment demand trends:
Cannabis + Methaqualone (%
as primary drug of abuse) – Under 20s
60
50
Cape Town
Gauteng
Durban
PE
Mpumalanga
EL
40
30
20
10
0
03a
03b
04a
04b
05a
05b
Treatment demand trends: Cocaine (% as primary
drug of abuse) – Under 20s
16
14
Cape Town
Gauteng
Durban
PE
Mpumalanga
EL
12
10
8
6
4
2
0
03a
03b
04a
04b
05a
05b
Proportion (%) of persons in treatment with heroin as
their primary drug of abuse – Under 20s (selected sites)
20
18
16
14
12
10
8
6
4
2
0
Cape Town
Gauteng
Mpumalanga
03a
03b
04a
04b
05a
05b
Proportion of heroin patients
reporting some injecting: 2005b
(selected sites)
Under 20s
All ages
Cape Town
3%
8%
Gauteng
18%
39%
Mpumalanga
10%
35%
Age distribution of patients with methamphetamine
as primary substance of abuse vs patients abusing
illicit drugs other than methamphetamine
(Cape Town, 2005b)
50
40
30
%
20
10
0
10--14 15-19
20-24
25-29
30-34
Meth
35-39
Othr Drg
40-44
45-49
50+
% of patients having methamphetamine (“Tik”) as a primary
or secondary drug of abuse in Cape Town
70
60
50
%
40
Under 20
20 & above
30
20
10
0
a
2
0
20
2b
0
20
a
3
0
20
3b
0
20
a
4
0
20
4b
0
20
a
5
0
20
5b
0
20
Selected implications for policy: 2005b
Ensure provision of affordable treatment for persons who
cannot pay for services & for young people in general. This
needs to be at various levels of intensity.
Ensure that there is adequate aftercare (including vocational
opportunities and housing) for persons who have gone to drug
rehabilitation
Intensify efforts to address methamphetamine use in Cape
Town + ensure that other parts of the country are prepared
Intensify efforts to address inhalant abuse by young people
in Gauteng and Mpumalanga.
Undertake regular qualitative research among school-going
youth to assess changes in drug use practices.
Address the drop in school referrals to drug treatment
CONCLUSION


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Ongoing advocacy is need to highlight increasing Rx demand
by young persons & to ensure Rx services are responsive to
issues of young people [not just available, but suitable]
Urgent steps are needed to address increasing use of
methamphetamine by young people in Cape Town [school +
community survey]
Strategies are needed to complement data coming from Rx
centres to ensure a more complete picture of drug abuse
situation among young people– e.g. from community surveys &
focus group interviews
Information collected on patients @ Rx centres should be
complimented by collecting information on Rx services [audit
in SA based on norms & standards]
www.sahealthinfo.org.sa/admodule/sacendu.htm