Substance abuse treatment Substance abuse treatment demand among young peopledemand among young people

in South Africa in South Africa (based on data from the (based on data from the SACENDUSACENDU Project) Project)

Charles Parry, PhDAndreas 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) An alcohol and other drug (AOD) sentinel surveillance system sentinel surveillance system operational in Cape Town, Durban, operational in Cape Town, Durban, Port Elizabeth (PE), East London Port Elizabeth (PE), East London (EL), Gauteng & Mpumalanga (EL), Gauteng & Mpumalanga operational operational since July 1996since July 1996

It monitors trends in AOD use and It monitors trends in AOD use and associated consequences on a 6-associated consequences on a 6-monthly basis from multiple sourcesmonthly basis from multiple sources

Establishment of site specific Establishment of site specific networks & implementation of a networks & implementation of a “basic” surveillance system in each “basic” surveillance system in each site with site with particular emphasis on particular emphasis on substance abuse treatment centressubstance abuse treatment centres

Collection of data on 6-Collection of data on 6-monthly basismonthly basis

6-monthly site report back 6-monthly site report back meetings -> collation & meetings -> collation & validation of datavalidation of data

Multi-pronged approach to Multi-pronged approach to disseminate findingsdisseminate findings

Ongoing improvement of data Ongoing improvement of data collection systems (training) collection systems (training)

Funded by WHO, Gauteng Funded by WHO, Gauteng Social Services; NDOH & Social Services; NDOH & DoSS (currently)DoSS (currently)

Main data sources (2005b)

CTCT Dbn Dbn (Pmb)(Pmb)

PE

(Umt)

EL GtgGtg MpumMpum TotalTotal

Treatment Treatment centrescentres

25 25 (40%)(40%)

5 5 (8%)(8%)

4(6.5%)

6(10%)

1818(29%)(29%)

44(6.5%)(6.5%)

6262(100%)(100%)

# of # of patientspatients

21312131(30%)(30%)

846846(12%)(12%)

426(6%)

267(4%)

28482848(40%)(40%)

562562(8%)(8%)

70807080(100%)(100%)

# patients # patients under 20under 20

647647(30%)(30%)

250250(30%)(30%)

88(21%)

35 (13%)

575575(20%)(20%)

103103(18%)(18%)

16981698

(24%)(24%)

Referral source

Gender

AgeRace

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 (%)

0

5

10

15

20

25

30

35

Cape Town Gauteng Durban PE Mpumalanga EL

Primary drug of abuse 2005b (%) – selected drugs

AgeAge Cape TownCape Town DurbanDurban E-CapeE-Cape GautengGauteng MpumMpum

AlcoholAlcohol AllAll 2525 5858 5858 5252 5454

LT 20 3 24 19 11 21

CannabisCannabis AllAll 1111 2828 1313 2121 2323

LT 20 22 65 39 63 57

MethaqualoneMethaqualone AllAll 66 33 88 33 0.50.5

LT 20 7 4 12 5 0

CocaineCocaine AllAll 88 77 1111 1010 66

LT 20 1 2 10 5 3

HeroinHeroin AllAll 1414 11 55 88 1010

LT 20 13 1 11 7 10

MethamphetaminMethamphetaminee

AllAll 3535 00 22 0.20.2 0.50.5

LT 20 53 0 10 0.2 1

Demographic & other information (under 20s) – 2005b

Min. age

% school referrals

% male % African

% inpatient

1st admission

Cape Town 1010 8.78.7 71.471.4 6.86.8 34.434.4 90.090.0

Durban 1111 10.010.0 88.988.9 53.853.8 6.66.6 92.492.4

PE 1212 26.8*26.8* 67.067.0 27.327.3 60.260.2 89.3*89.3*

E London 1414 2.92.9 88.688.6 77.177.1 20.020.0 91.291.2

Gauteng 99 23.023.0 83.083.0 60.360.3 22.322.3 90.190.1

Mpumal 99 <1<1 82.482.4 57.457.4 25.025.0 89.889.8

* - partial data

Treatment demand trends: Alcohol (% as primary drug of abuse) - Under 20s

0

5

10

15

20

25

30

35

03a 03b 04a 04b 05a 05b

Cape Town

Gauteng

Durban

PE

Mpumalanga

EL

Treatment demand trends: Cannabis (% as primary drug of abuse) - Under 20s

0

10

20

30

40

50

60

70

80

03a 03b 04a 04b 05a 05b

Cape Town

Gauteng

Durban

PE

Mpumalanga

EL

Treatment demand trends: Cannabis + Methaqualone (%

as primary drug of abuse) – Under 20s

0

10

20

30

40

50

60

03a 03b 04a 04b 05a 05b

Cape Town

Gauteng

Durban

PE

Mpumalanga

EL

Treatment demand trends: Cocaine (% as primary drug of abuse) – Under 20s

0

2

4

6

8

10

12

14

16

03a 03b 04a 04b 05a 05b

Cape Town

Gauteng

Durban

PE

Mpumalanga

EL

Proportion (%) of persons in treatment with heroin as their primary drug of abuse – Under 20s (selected sites)

02

468

10121416

1820

03a 03b 04a 04b 05a 05b

Cape Town

Gauteng

Mpumalanga

Proportion of heroin patients reporting some injecting: 2005b

(selected sites)

Under 20sUnder 20s All agesAll ages

Cape Town Cape Town 3%3% 8%8%

GautengGauteng 18%18% 39%39%

MpumalangaMpumalanga 10%10% 35%35%

Age distribution of patients with methamphetamine as primary substance of abuse vs patients abusing

illicit drugs other than methamphetamine (Cape Town, 2005b)

0

10

20

30

40

50

10--14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+

%

Meth Othr Drg

0

10

20

30

40

50

60

70

Under 20

20 & above

% of patients having methamphetamine (“Tik”) as a primary or secondary drug of abuse in Cape Town

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 rehabilitationIntensify efforts to address methamphetamine use in Cape Town + ensure that other parts of the country are preparedIntensify 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

Ongoing advocacy is need to highlight increasing Rx demand Ongoing advocacy is need to highlight increasing Rx demand by young persons & to ensure Rx services are responsive to by young persons & to ensure Rx services are responsive to issues of young people [not just available, but suitable]issues of young people [not just available, but suitable]

Urgent steps are needed to address increasing use of Urgent steps are needed to address increasing use of methamphetamine by young people in Cape Town [school + methamphetamine by young people in Cape Town [school + community survey]community survey]

Strategies are needed to complement data coming from Rx Strategies are needed to complement data coming from Rx centres to ensure a more complete picture of drug centres to ensure a more complete picture of drug abuseabuse situation among young people– e.g. from community surveys & situation among young people– e.g. from community surveys & focus group interviewsfocus group interviews

Information collected on patients @ Rx centres should be Information collected on patients @ Rx centres should be complimented by collecting information on Rx services [audit complimented by collecting information on Rx services [audit in SA based on norms & standards]in SA based on norms & standards]

www.sahealthinfo.org.sa/admodule/sacendu.htm