Transcript A research agenda for (youth) violence prevention

VIOLENCE AND SUBSTANCE ABUSE AT
A CAPE TOWN TRAUMA CENTRE
Astrid Leusink ,Andrew Nicol, Katherine Sorsdahl, Ross Hoffman, James
Burger, Sean Tromp, Patricia Leighton, Robyn Richmond Cathy Ward,
Richard Matzopoulos, Pradeep Navsaria, Dan Stein, Guy Lamb.
Funded from a research grant from SAVI
Introduction
• Violence and associated injuries second
leading cause of death in SA
• Alcohol and drugs major risk factor
– One of highest levels of alcohol consumption per
capita in the world
– 1/3rd population abuse alcohol regularly
– 66% of grades 8-10 drink alcohol
Introduction
• Study in Cape Town in 2000
– 60% of patients treated for injury tested positive
for alcohol
– ¼ could be classified as alcohol dependent
– Prior to surge in methamphetamine (“tik”)
• Alcohol abuse estimated to cost the country
around R9 billion per annum
Introduction
• Address linkages between alcohol/drug use
and trauma
• Drug usage patterns among violence cases
presenting to Trauma Centres
– assists in planning and implementation of suitable
interventions
Introduction
“What are the current patterns of alcohol and
drug abuse in patients presenting after
interpersonal violence.”
Tik (Crystal Meth)
Methods
• Prospective study over 4 weeks
at Groote Schuur Hospital
• Ethics approved > 18 years
• Screening (injuries < 6 hours)
– Alcohol
– Drugs
Active (BAC) and Passive
Urinalysis
•
•
•
•
•
•
Cannabis
Metamphetamines (tik)
Cocaine
Opiates
Benzodiazepines
Mandrax (single panel)
Methods
• Medically administered opiates or
benzodiazepines excluded from analysis
• Patient demographics, personal information
and injury details recorded
• Patients positive for drugs or alcohol
– Referred to Cape Town Drug Counselling Centre
Results
• 122 patients for analysis
• Mean age 30 years
• Preponderance of males
– 87%
• 40% unemployed
– 38% employed part-time
• 14% completed Grade 12
– 3 patients with tertiary education
75-year old female stabbed by
her grandson
Results
• 55% of incidents occurred in the street
– 6% in bar or shebeen
• Athlone and Philippi – 15% of incidents combined
• Most injuries occurred predominantly on
Saturdays and Sundays
– Most injuries between 16h01 to 04h00
– Peak between 20h01 and midnight
Results
• Interpersonal violence commonest cause of
injury – 69%
– 12% gang activity
• 34% required surgery
• 57% required a CT scan
• 3 patients (3%) died
18 year-old girl stabbed at
school
Results
60
50
49
41
Percentages
40
30
20
33
25
14
10
1
0
0.1
N = 122 patients (16 females) Mean Age 30 years ( 18-73)
Trends
2000 to 2012
Results
65
70
60
50
49
41
40
39
33
30
25
20
10
10
0
14 8
3
0
Alcohol
1
Cannabis
Tik
Mandrax Opiates
Cocaine
0
0.1
2000
2012
Benzo
Sentinel surveillance of substance abuse and trauma at GSH 1999-2000. Donson H, Peden M.
Results
Unknown
Human Bites
Strangulation
15%
Blunt/Penetrating
48%
Penetrating
Blunt
33%
0
10
20
30
Mechanism of injury
40
50
60
70
Results
Unknown
27%
Police/Legal
36%
Stranger
27%
Friend
Relative
Spouse/Partner
0
5
10
15
20
25
30
Relationship of the perpetrator
35
40
45
50
Conclusion
• Alcohol and THC continued major links with
injury
• Major concern - Increase in Tik (0-33%) and
Mandrax (25%) Heroin (14%) abuse
• Low cost, availability and highly addictive nature
of Tik
– Massive concern for all in health care
Conclusion
• Potential for prevention of large number of
injuries with identification and control of alcohol
and drug abuse
• Mandatory alcohol and drug screening after
injury at Level 1 Trauma Centres in SA
• System in place for effective intervention
– Screening and Brief Intervention (SBI)
– Recommended by SAVI
Thank you