1. 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

2. 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 – 1/3 rd population abuse alcohol regularly – 66% of grades 8-10 drink alcohol

3. 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

4. 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

5. Introduction “What are the current patterns of alcohol and drug abuse in patients presenting after interpersonal violence.”

6. Tik (Crystal Meth)

7. Methods Prospective study over 4 weeks at Groote Schuur Hospital Ethics approved > 18 years Screening (injuries < 6 hours) – AlcoholActive (BAC) and Passive – DrugsUrinalysis Cannabis Metamphetamines (tik) Cocaine Opiates Benzodiazepines Mandrax (single panel)

8. 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

9. 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

10. 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

11. 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

12. Results N = 122 patients (16 females) Mean Age 30 years ( 18-73) Percentages

13. Results Sentinel surveillance of substance abuse and trauma at GSH 1999-2000. Donson H, Peden M.

14. Results Mechanism of injury

15. Results Relationship of the perpetrator

16. 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

17. 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

18. Thank you