Illicit Drug Use and Treatment in South Africa: A Review

Abstract

This review synthesizes available epidemiological data on current drug use and substance user treatment admissions in South Africa since 1994, and how changes in the political, economic, and social structures within South Africa, both before and after Apartheid, has made the country more vulnerable to drug use. Based on national surveys, current use of cannabis ranged among adolescents from 2% to 9% and among adults it was 2%, cocaine/crack (0.3%), mandrax/sedatives (0.3%), club drugs/amphetamine-type stimulants (0.2%), opiates (0.1%), and hallucinogens (0.1%). The use of primary illicit substance at admission to South African drug user treatment centers was cannabis 16.9%, methamphetamine (tik) 12.8%, crack/cocaine 9.6%, cannabis and mandrax 3.4%, heroin/opiates 9.2%, and prescription and OTC drugs 2.6%. An increase in substance user treatment admissions has increased. While the prevalence of illicit drug use in South Africa is relatively low compared to the United States and Australia, prevention and intervention policies need to be designed to reduce these levels by targeting the more risky subpopulations identified from this review.

RÉSUMÉ

Cette revue synthétise des données épidémiologiques disponibles sur l'utilisation de drogue et le nombre d’admissions en traitement en Afrique du Sud depuis 1994, et comment les changements de structures politiques, économiques et sociales avant et aprèsl’Apartheid rendent le pays plus vulnérable à l'utilisation de drogue. Selon des sondages nationaux, l'utilisation actuelle de cannabis chez les adolescents va de 2% à 9% et parmi des adultes est de 2%; la cocaïne/crack 0.3%, le mandera/sédatifs 0.3%, les stimulants et drogues de club type amphétamines 0.2%, les opiacés 0.1% et les hallucinogènes 0.1%. Les substances illicites principales à l'admission en traitement en Afrique du Sud sont le cannabis (16.9%), la met amphétamine (‘Tik’:12.8%), le crack/cocaïne (9.6%), le cannabis et le mandrax ensemble (3.4%), l’héroïne et autres opiacés (9.2%), et les médicaments - sur ordonnance ou en vente libre, 2.6%. Le nombre d’admissions en traitement d'abus de substance a grossi. Tandis que le taux d’utilisation de drogue en Afrique du Sud est relativement bas comparée aux Etats-Unis et à l'Australie, des règles de prévention et d'intervention doivent être développées pour minimiser ces taux en visant les groups les plus vulnérables identifiés dans cette revue.

RESUMEN

Este estudio sintetiza datos epidemiológicos disponibles sobre admisiones actuales del tratamiento del abuso de drogas en Sudáfrica desde 1994, y cómo los cambios en las estructuras políticas, económicas y sociales dentro de Sudáfrica antes y después de Apartheid hacen el país más vulnerable. De acuerdo con los exámenes nacionales, el uso actual de marihuana se extendie de el 2% hasta el 9% entre adolescentes y entre adultos el 2%, cocaina/crack (0.3%), mandrax/sedativos (0.3%), los estimulantes/amfetaminas (estilo club drugs) (0.2%), los narcóticos (0.1%) y los alucinogenos (0.1%). En cuanto a la sustancia ilícita primaria resultante en la admisión a los centros sudafricanos del tratamiento de la droga, son marihuana 16.9%, methamfetamina (Tik) 12.8%, cocaina/crack 9.6%, marihuana y el mandrax 3.4%, heroina/opioides 9.2%, y medicinas recetadas (de prescripción y OTC) 2.6%. Un aumento en admisiones del tratamiento del abuso de sustancias ha ocurrido. Mientras que el predominio del uso ilícito de drogas en Sudáfrica es relativamente bajo comparado a los Estados Unidos y Australia, las políticas de la prevención y de la intervención necesitan ser diseñadas para reducir estos niveles apuntando a las más arriesgadas subpoblaciones identificadas en este estudio.

Keywords :

• South Africa
• epidemiology
• substance abuse treatment
• cannabis
• mandrax
• cocaine
• crack
• heroin
• methamphetamine
• tik

THE AUTHORS

Karl Peltzer, Ph.D., is Research Director in the research program Social Aspects of HIV/AIDS and Health, Human Sciences Research Council, and an extraordinary professor of psychology at Free State University, South Africa. He is a prevention researcher and evaluator with over 20 years of experience in the study of health promotion, risk behavior, disease prevention, and socio-behavioral interventions. Dr Peltzer has published extensively on health behavior and health interventions (13 books and 300 articles). He has worked extensively on public health subject areas of substance use, cancer, tuberculosis and HIV control; nutrition, physical activity, hypertension, mental health, injury and violence prevention, and health systems.

Shandir Ramlagan, M.S., is a senior researcher in the Social Aspects of HIV/AIDS and health research program. He obtained his master's degree in development studies from the University of Natal and is currently studying for his doctoral degree. He has experience in social science research, especially in the areas of qualitative research design and methodology, planning and management of surveys, and design of research instruments. His project experience includes work for organisations such as the W.K. Kellogg Foundation, Nelson Mandela Children's Fund, the World Bank, Population Council, and various government departments. His publication record spans progress reports, coauthored chapters for SIDA and the World Bank, literature reviews, coauthored peer-reviewed journal articles, conference presentations, conceptual and epidemiological models, and design questionnaires.

Bruce D. Johnson, Ph.D., is an American authority on the criminality and illicit marketing of drugs in the street economy and among arrestees and minority populations. He directs the Institute for Special Populations Research at the National Development and Research Institutes. He is a professional researcher with five books and over 130 articles based upon findings emerging from over 30 different research and prevention projects funded by the National Institute on Drug Abuse and National Institutes of Justice. He also directs the nation's largest pre- and postdoctoral training program in the United States. He visited South Africa in 2006 and collaborated in submitting proposals with other authors in 2007.

Nancy Phaswana-Mafuya, Ph.D., (Health Social Work) from the University of the North in South Africa. She is currently research director at the Human Sciences Research Council based in the Social Aspects of HIV/AIDS and Health Research Program and an extraordinary visiting professor at the Social Work department of the University of the Western Cape. Research interests include social aspects of public health, HIV/AIDS, injury prevention, substance use and misuse, environmental health, and social work applied to health.

Notes

1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.