The End of addiction. Dr Volker Hitzeroth

current cannabis use 2.3%, although urine testing revealed current cannabis use of 9.1%. A further study of arrestees who were tested and interviewed in three major cities in South Africa revealed that only 54% who tested positive for cannabis reported using the drug in the last month.

      Heroin in South Africa

      A number of household, school and community surveys on drug abuse have been conducted in this country. The results indicate that a range of approximately 1% to 4% of respondents reported using heroin at least once in their life, with between 1% to 3% reporting current use of heroin. Studies done at various rave parties found that between 4.8% and 12% reported using heroin at least once in their life.

      A Cape Town study that investigated heroin use and HIV-related risk behaviour interviewed 239 heroin users in Cape Town. This group indicated a large proportion of polydrug use with tobacco, alcohol, cannabis, methamphetamine (tik) and mandrax being the most common other drugs used. The average age of onset of heroin use was 20 years. The majority of those who had tried other drugs prior to heroin began with cannabis and mandrax. Of this sample, 24% had injected heroin in the last month, while 77% of these injectors had injected heroin in the past three days, and 80% had injected heroin daily. The average starting age for injecting heroin was 22 years. Injecting would mostly occur in their homes, their friends’ homes, or their dealers’ homes. No less than 89% of the heroin users who reported injecting in the past month had shared a needle at least once during that period, with either a close friend or their regular sex partner or a casual sex partner. Reusing needles was also common. Among the respondents, 61% had been tested for HIV at least once. Of those, 88% reported that the test had been negative, 6% reported that the test had been positive, and another 6% replied that they did not know the result. Of the respondents, 52% had been tested for hepatitis C, with 7% of these being positive, and 47% had been tested for hepatitis B.

      SACENDU

      The South African Community Epidemiology Network on Drug Use or SACENDU as it is commonly known, is an alcohol and drug surveillance system that operates throughout South Africa. SACENDU has been operational since 1996 and monitors trends in alcohol and drug use, as well as its associated consequences. The surveys are repeated every six months by analysing information received from drug- and alcohol-treatment centres. SACENDU was established by the Medical Research Council of South Africa in association with various partners, stakeholders and funders. It comprises a network of researchers, practitioners and policy-makers who provide community level public health surveillance data of drug and alcohol use throughout the country. SACENDU therefore measures drug and alcohol trends indirectly by monitoring those who seek treatment at treatment centres across South Africa.

      During the Phase 24 SACENDU analysis (June 2008), alcohol remained the most common primary substance of abuse across South Africa, except in the Western Cape, where methamphetamine was the most common drug. The treatment seekers who sought help with an alcohol problem were mostly young to middle-aged males. Cannabis also remained very common, with 11% to 50% of treatment seekers across South Africa reporting cannabis use as their primary problem. Cocaine and crack were the primary drugs of abuse for between 5% and 20% of treatment seekers throughout the country. They were often used in combination with other drugs, and were mostly used by younger adults.

      Heroin was used by between 1% and 23% as their primary drug across South Africa. It was found that 11% of heroin users in the Western Cape were injecting, compared with 24% of users in Gauteng. Stimulants such as ecstasy and khat were reported as very low primary drugs of abuse. In the Western Cape however, methamphetamine (tik) was the primary drug of abuse for approximately 36% of treatment seekers. Over-the-counter and prescription medication abuse and dependence was responsible for seeking help in between 1% and 7% of the respondents. Over-the-counter and prescription medication use was mostly combined with alcohol and other drugs.

      Having explored the overall scope of the drug and alcohol problem at community level, we can now consider individual patterns of drug and alcohol use.