Drug policy for methamphetamine use urgently needed

During 2004 there have been media reports of a dramatic
increase in the use of methamphetamine (MA), locally known
as ‘tik’, in the Western Cape. These reports have been
supported by findings from the South African Community
Epidemiology Network on Drug Use (SACENDU) Project.1
SACENDU is an alcohol and other drug (AOD) sentinel
surveillance system operational in Cape Town, Durban, Port
Elizabeth (PE), Mpumalanga, and Gauteng (Johannesburg/
Pretoria). The system monitors trends in AOD use and
associated consequences on a 6-monthly basis from multiple
sources, including over 50 specialist treatment centres.
SACENDU findings reveal that the proportion of clients at
specialist substance abuse treatment centres reporting MA as
their primary and/or secondary drug of abuse increased
significantly between the first half of 2002 and the first half of
2004, from 4 patients seen at 23 centres to 241 patients seen at
25 centres (Table I). The sharp increase in the number of
clients seeking treatment for MA-related problems is
unprecedented in the country. Data from other sites suggest
that while MA use is increasing elsewhere the extent of use is
greatest in Cape Town.2 In addition, in Cape Town MA has
rapidly become the third most commonly reported primary
illicit substance of abuse (after methaqualone and cannabis),
where previously it was rarely reported as a problem drug.3
Not only does the rapidly growing popularity of MA point to
the urgent need to address this problem in the Western Cape,
but the demographic profile of clients in treatment for MArelated
problems also highlights this urgency. MA is the drug
of choice for young people; the average age of patients who
reported MA as their primary substance of abuse in the first
half of 2004 was 20 years, with 60% of patients being younger
than 20 years of age. This is cause for concern given that
adolescents are particularly vulnerable to the neurotoxic effects
of MA.
More specifically, MA’s potent and toxic action on the
sympathetic and central nervous systems makes a strong case
for the urgency with which MA use should be addressed,
especially in the Western Cape. Positron emission tomography
(PET) imaging and postmortem studies in humans provide
evidence of MA’s neurotoxicity, with regular users showing a
loss of dopamine nerve terminals in the caudate and putamen,
reduced glucose metabolism in the thalamus, caudate and
putamen, and increased glucose metabolism in the parietal
cortex.4 These structural brain changes are associated with
long-term impairment in cognitive processing, memory and
emotion.5 Other MA-related chronic health problems include
cardiovascular and pulmonary complaints such as myocardial
infarction, arrhythmias, cerebral oedema, hyperpyrexia, chronic
pulmonary congestion, seizures and strokes; psychiatric
consequences such as paranoia, acute and chronic MA-induced
psychosis, hallucinations, depression, anxiety and
uncontrollable anger; dermatological problems; malnutrition
and weight loss; and the risk of overdose and death.5 In
addition, the behaviours associated with MA use, which
include high-risk sexual behaviours, place MA users at
increased risk for HIV and other infectious disease
transmission.6
Based on a review of the international literature and advice
from colleagues in other countries, it is clear that there are a
variety of potentially useful interventions that should be
considered in dealing with this new public health threat.
Raising awareness and providing accurate information to the
public and policy makers on MA and introducing specific,
science-based prevention programmes that target individual,
family and community risk and protective factors for substance
use appear to be the most promising prevention strategies.
In terms of treatment, consideration should be given to: (i)
ensuring that there is adequate access to affordable and
effective treatment in general; (ii) establishing MA treatment
protocols in public hospitals and specialised care facilities; (iii)
training health and social service providers to identify, assess
and manage MA-induced psychosis, anxiety, withdrawal and
Drug policy for methamphetamine use urgently needed
Table I. Patients in specialist substance abuse treatment centres in Cape Town with methamphetamine as primary or secondary substance of
abuse (2002 - 2004)
2002a 2002b 2003a 2003b 2004a
N % N % N % N % N %
Primary 4 0.3 13 0.8 38 2.3 38 2.3 241 10.7
Secondary 7 0.4 19 1.2 43 2.6 83 5.0 188 8.3
Overall* 11 0.7 32 2.1 81 4.8 121 7.3 429 19.0
Total no. of
patients 1 608 1 551 1 686 1 659 2 255
* Patients who have methamphetamine as primary or secondary substance of abuse.
a = data collected between January and June; b = data collected between July and December.
SCIENTIFIC LETTER
overdose; (iv) specifically equipping primary health care
providers and emergency room personnel to provide brief
screening and interventions; and (v) introducing science-based
models of substance abuse treatment into community settings,
especially cognitive-behavioural approaches.
Interdiction strategies should include: (i) monitoring the
distribution and use of precursor chemicals used in the
manufacture of MA; (ii) investigating companies that distribute
precursor chemicals (e.g. pseudoephedrine, ephedrine,
anhydrous ammonia and red phosphorous) or equipment used
in clandestine methamphetamine laboratories; (iii) expanding
community policing strategies to engage the public in MA
issues; and (iv) continuing to put pressure on drug-related
organised crime (especially focusing on drug-related crimes
such as perlemoen (abalone) smuggling and high-intensity
drug dealing/trafficking areas).
Provincial responses during 2004 have focused almost
exclusively on social service and policing interventions. Given
the likely future burden of MA on the health sector, a greater
public health response to this threat is urgently required.
C D H Parry
B Myers
A Plüddemann
Alcohol and Drug Abuse Research Group
Medical Research Council
Tygerberg
1. Parry CDH, Bhana A, Plüddemann A, et al. The South African Community Epidemiology
Network on Drug Use (SACENDU): Description, findings (1997 - 1999), and policy
implications. Addiction 2002; 97: 969-976.
2. Plüddemann AP, Parry CDH, Bhana A, Harker N, Potgieter H, Gerber W. Monitoring alcohol
and drug abuse trends in South Africa (July 1996 - December 2003): Phase 15. SACENDU
Research Brief 2004; 7(1): 1-12.
3. Myers B, Parry CDH, Plüddemann A. Indicators of substance abuse treatment demand in
Cape Town. Findings from the SACENDU Project 1998 - 2002. Curationis 2004; 5: 27-31.
4. McCann UD, Ricaurte GA. Amphetamine neurotoxicity: accomplishments and remaining
challenges. Neurosci Biobehav Rev 2004; 27: 821-826.
5. Brecht ML, O'Brien A, von Mayrhauser C, Anglin MD. Methamphetamine use behaviours
and gender differences. Addict Behav 2004; 29: 89-106.
6. Semple SJ, Patterson TL, Grant I. The context of sexual risk behaviour among heterosexual
methamphetamine users. Addict Behav 2004; 29: 807-810.