Decline in adolescent treatment admissions for methamphetamine use in Cape Town
1 Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Cape Town, South Africa
Department of Psychiatry,
Stellenbosch University, Stellenbosch, South Africa
Background and objectives. The purpose of this report is to describe the changing trends in adolescent treatment admissions for methamphetamine in Cape Town, and to discuss possible implications.
Method. Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town, every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel for each patient to collect demographic and substance abuse data.
Results. The results indicate that between 2004 and 2006, a significant increase in the proportion of adolescent treatment admissions for methamphetamine abuse occurred, while a significant decrease occurred between 2006 and 2011.
Conclusions. The initial increase in
adolescent treatment admissions for methamphetamine abuse from
2004 to 2006, and subsequent decrease between 2006 and 2011,
may suggest a change in methamphetamine abuse patterns among
adolescents in Cape Town.
S Afr Med J 2013;103(7):478-480.
The 2011 United Nations World Drug Report identified South Africa (SA) as one of the countries still experiencing ‘some increase’ in the use of ‘undefined amphetamines’. Other countries and regions included were Australia and South-East Asia.1 In SA, the major contributor to an increase in the use of amphetamine-group substances has been an increase in consumption of methamphetamine in Cape Town and the surrounding Western Cape Province, documented via admissions to treatment centres and surveys among adolescents attending high schools.2-5 These studies indicated an increase in admissions to specialist substance abuse treatment centres for methamphetamine abuse from <1% of patients in 2002, to 42% in the second half of 2006. High school surveys conducted between 2005 and 2008 indicated a lifetime prevalence of methamphetamine use among learners of between 9% and 13%.2-5
The purpose of this report is to describe changes in adolescent
treatment admissions for methamphetamine-related problems in
Cape Town between 2004 and 2011, and to discuss the
Established in 1996, the South African Community Epidemiology
Network on Drug Use (SACENDU) is a network of researchers,
practitioners and policymakers from 6 regions in SA who meet
bi-annually to share community-level public health surveillance
information about alcohol and other drug (AOD)-related trends.
All AOD treatment centres are invited to volunteer to join the
network. SACENDU collects data from more than 80% of treatment
centres in Western Cape Province (most based in Cape Town) and
includes state-funded, private non-profit, and private
for-profit facilities in its network. Data therefore reflect the
activities of treatment centres in the region. The focus of this
paper is data obtained from between 23 and 27 specialist
substance abuse treatment centres between 2004 and 2011. (The
number of centres declined slightly over the 7 years, as a few
small centres closed.)
For the purpose of
monitoring, a standardised 1-page form is completed for each
person treated by a given centre during a particular 6-month
period. The form records responses concerning the source of
referral for treatment, biographical information, the type of
treatment received (in- and/or outpatient), the primary and
secondary substances of abuse (including alcohol,
over-the-counter and prescription medicines, and illicit
drugs), the mode(s) of use, frequency of use, age at first use
and whether the person had received treatment prior to the
current episode. The form is based on the instrument developed
by the Pompidou Group in Europe in the early 1990s and, more
recently, on the Treatment Demand Indicators (TDI) used by the
European Monitoring Centre for Drugs and Drug Addiction.6
ensure data quality, treatment centre personnel regularly
receive training in data collection, and completed forms are
checked for missing information and possible miscoding. Forms
are completed by treatment centre personnel upon admission or
Ethical approval for this study was provided by the South
African Medical Research Council’s Ethics Committee and the
University of Stellenbosch’s Health Research Ethics Committee.
The study is a record review, and consent from patients was
therefore not required.
Data were analysed using IBM SPSS version 20 and SAS. The
Cochran-Armitage trend test was used to test for significant
trends over time.
Fig. 1 indicates that the
proportion of adolescents (i.e. patients <20 years
old) seeking treatment with methamphetamine as their primary
substance of abuse increased steadily from 24.2% in the first
half of 2004 (n=138/571) to 60.2% in the first
half of 2006 (n=436/724). This proportion,
however, steadily began to decline from the second half of
2006 (58.6%: n=446/761) to the second half of
2011 (24.5%: n=105/429). The Cochran-Armitage
Trend test showed this decrease to be significant (z=-20.06, p<0.0001).
Notably, during the same time period, the proportion of adult
patients (≥20 years old) reporting methamphetamine as their
primary substance of abuse increased significantly from 28.7%
(n=551/1 927) in the first half of
2006 to 41.5% (n=949/2 288) in the second half
of 2011 (z=7.19, p<0.0001).
Fig. 1. Proportions of patients reporting methamphetamine as a primary substance of abuse by 6-monthly reporting period: patients aged ≤19 (youth ) v. patients aged ≥20 (adults).
Between 2006 and 2011, the total number of adolescent and adult
patients admitted to treatment centres during each 6-month
period remained fairly constant, generally ranging between 2 600
and 2 900 patients. Table 1 shows the proportions (as
percentages) of different primary drugs reported by adolescent
patients between 2006 and 2011. The decline in methamphetamine
as a primary substance of abuse was accompanied by a
proportional increase in abuse of cannabis, and not other ‘hard
drugs’. First-time admissions for adolescent patients remained
between 80% and 93% of all admissions between 2006 and 2011,
leaving fairly low numbers of previously treated patients.
The data analysed in this survey indicate a significant decline in adolescent patients reporting methamphetamine as a primary substance of abuse between 2006 and 2011. Over the same period, a more gradual but significant increase in the proportion of adult patients reporting methamphetamine as a primary substance of abuse was observed. High school surveys conducted in Cape Town or Western Cape Province between 2005 and 2008 indicated self-reported lifetime prevalence of methamphetamine use of between 9% and 13%.3-5 However, a random survey of 227 000 high school students in the Western Cape in 2011 found a lifetime prevalence of only 2%, with consistent proportions across the various ‘school districts’ within the province.7
Similar trends have been found in some other countries. A study in Canada found a decline in primary methamphetamine-related admissions to youth residential substance abuse treatment facilities. Comparing the years 2005 - 2006 and 2009 - 2010, the authors found that the estimated proportion of youth admissions to inpatient substance abuse treatment centres, primarily owing to methamphetamine, declined from 21% in 2005 - 2006 to 6% in 2009 - 2010.8
The decline was hypothesised as resulting from changes in government policy and legislation concerning regulation of precursor chemicals and an accompanying increase in law enforcement. By comparison, proportions of adolescent patients admitted for treatment in the USA were relatively low between 2006 and 2010, with 3.8% of patients aged 12 - 17 years admitted for amphetamines (including methamphetamine) in 2006, but gradually declining to 2.6% in 2010.9 In Australia, treatment for amphetamines constituted only 7% of all treatment episodes in 2009/2010 and showed a slight decline between 2006 and 2010. In 2009/2010, <5% of treatment episodes for 10 - 19-year-olds were related to amphetamines.10
The fact that, in the present study, the decline in adolescent treatment admissions for methamphetamine was accompanied by an increase in the proportion of adolescent patients reporting cannabis as their primary drug, and not other ‘hard drugs’, is encouraging, as cannabis is considered less harmful than methamphetamine.
Over the period reported, efforts at addressing the abuse of methamphetamine included general information campaigns on the dangers of the drug, media coverage of methamphetamine-related crimes (that are often violent), and reports of increasing arrests for possession and dealing in methamphetamine. Interestingly, it appears that while this may have resulted in a downward trend of adolescent methamphetamine-related treatment admissions, the proportion of adult admissions continued to increase gradually. Foxcroft and Tsertsvadze11 recently conducted three Cochrane systematic reviews on universal alcohol absuse prevention programmes for children and adolescents, and found that some universal interventions, particularly multi-component interventions, were effective in reducing alcohol consumption. Although alcohol and methamphetamine may not be entirely comparable, adolescents may be more susceptible to universal prevention messages aimed at adolescent substance use.
It remains a concern that the proportion of adult patients admitted for methamphetamine has continued to increase gradually since 2006, suggesting a need for further intervention strategies that specifically target adults.
A limitation of this study was that it relied mainly on a single data source (although supported by high school surveys), and other data such as adolescent arrest data, presentations to trauma or psychiatric units at hospitals, or data from other health practitioners (e.g. general practitioners) could not be accessed as they are not routinely available in SA.
In conclusion, our findings indicate a significant decline in
adolescent treatment admissions for methamphetamine abuse. This
is an encouraging trend, and may suggest that preventive
interventions are particularly effective among adolescents, who
are a particularly vulnerable group. Further research is needed
to establish the reasons behind the decline and which components
of the prevention strategy have been most effective.
Acknowledgments. The authors thank
the South African National Department of Health (Mental Health
and Substance Abuse Directorate) for their funding of this
project, and all the staff at participating substance abuse
treatment centres for regularly submitting data.
1. United Nations Office on Drugs & Crime (UNODC). World Drug Report 2011. Vienna: UNODC, 2011.
2. Plüddemann A, Myers BJ, Parry CD. Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: Implications for public health. Drug Alcohol Rev 2008;27:185-189. [http://dx.doi.org/10.1080/09595230701829363]
3. Plüddemann A, Flisher AJ, Mathews C, Carney T, Lombard C. Adolescent methamphetamine use and sexual risk behaviour in secondary school students in Cape Town, South Africa. Drug Alcohol Rev 2008;27:687-692. [http://dx.doi.org/10.1080/09595230802245253]
4. Plüddemann A, Flisher AJ, McKetin R, Parry C, Lombard C. Methamphetamine use, aggressive behavior and other mental health issues among high-school students in Cape Town, South Africa. Drug Alcohol Depend 2010;109:14-19. [http://dx.doi.org/10.1016/j.drugalcdep.2009.11.021]
5. Reddy P, James S, Sewpaul R, et al. Umthente Uhlaba Usamila - The South African Youth Risk Behaviour Survey 2008. Cape Town: Medical Research Council, 2010.
6. Simon R, Donmall M, Hartnoll R, et al. The EMCDDA/Pompidou Group treatment demand indicator protocol: A European core item set for treatment monitoring and reporting. Eur Addict Res 1999;5:197-207. [http://dx.doi.org/10.1159/000018994]
7. Morojele N, Myers B, Townsend L, et al. Survey on Substance Use, Risk Behaviour and Mental Health among Grade 8-10 Learners in Western Cape Provincial Schools. Cape Town: Medical Research Council, 2012.
8. Verdichevski M, Burns R, Cunningham JK, Tavares J, Callaghan RC. Trends in primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005-2006 and 2009-2010. Can J Psychiatry 2011;56:696-700.
9. Substance Abuse & Mental Health Services Administration. Treatment Episodes Data Set (TEDS), United States. http://wwwdasis.samhsa.gov/webt/newmapv1.htm (accessed 27 September 2012).
10. Australian Institute of Health and Welfare. Alcohol and other Drug Treatment Services in Australia 2009-2010: Report on the National Minimum Dataset. Drug Treatment Series no. 14. Cat. no. HSE 114. Canberra: Australian Institute of Health and Welfare, 2011.
11. Foxcroft DR, Tsertsvadze A. Universal alcohol misuse prevention programmes for children and adolescents: Cochrane systematic reviews. Perspect Public Health 2012;132:128-134. [http://dx.doi.org/10.1177/1757913912443487]
Accepted 17 January 2013.
Full text views: 2762