Page 96 - HIVMED_v21_i1.indb

Page 5 of 34 Guideline

• Smoking is the most common form of use for cannabis, estimates of reported use and risks are under-reported.
methaqualone (mandrax), heroin (whoonga, nyaope, sugars) Research reflects increased trafficking of heroin in the
and methamphetamine (tik, crystal meth) in southern region and a review of substance use treatment data in
Africa. Onset of action is faster than other forms of use. South Africa points to a six-fold increase in heroin-related
Risks are related to airways and pulmonary disease. admissions over the last decade, with marked increases
• Nasal inhalation (snort, schnarf, toot, sniff) is often seen in methamphetamines and other stimulant-related
used for cocaine, but also heroin. Onset of action is admissions during the same period. 13
quick and is associated with risk of damage to the
nasal mucosa. BOX 3: Heroin has many names.
• Injecting (slam, spike, smoke) can be done through several Whoonga, nyaope, sugars and unga are all heroin-based drugs. They may have
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routes, most commonly IV. Heroin is the most injected ‘cutting’ agents (e.g. pharmaceutical opioids, caffeine and inactive powders),
which are used to decrease the strength of the drug and bulk up the volume to
drug, followed by methamphetamine and cocaine. increase profit. Contrary to popular belief, few tested samples of nyaope, whoonga
or unga have contained any traces of antiretroviral medication.
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Onset of action is very rapid. Risks are largely related to
the use of contaminated injecting equipment and poor
hygiene practices, including local and blood-borne BOX 4: Image and performance-enhancing drugs.
infections (notably HIV, hepatitis B virus [HBV] and Anabolic steroids, peptides and hormones are examples of drugs that may be
linked to appearance, the pursuit of health and youth, or a body image disturbance.
HCV). The risk of overdose is higher if drugs are Patterns of use may vary, with potential health risks related to the substances
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used, as well as the method of use (e.g. safe injecting or not).
injected. A proportion of people who use opioids
and/or stimulants for a long period of time will
transition to injecting. TABLE 3: Overview of substance use epidemiology (latest data). 14,15,16,17
Treatment† (%)
• Oral ingesting (pop) is the most common route for Drug Prevalence of (July–December 2018) Comments
use (%)
gamma-hydroxybutyric acid (GHB), alcohol, methadone (15–64 years)
and ecstasy, amongst others. Onset is slower and risks South Africa
may vary depending on the food or liquids consumed. Heroin 0.3 – 0.5 14,17 19 (2 – 34) 15 Prevalence of use
reflects use for
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• Rectal suppository or vaginal (booty bumping) Cocaine 1 3 (2 – 8) 15 15 different recall
10 (1 – 28)
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administration are less frequent methods of substance Methamphetamine 1 30 (22 – 38) 15 periods. The types
of substance used
4
Cannabis
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intake. Ecstasy ND < 0.5 15 vary by region.
Botswana
1.2.3 Drug classifications and common drugs Opioids < 0.05 16 ND Cross-sectional
Cocaine < 1 16 ND survey amongst
Drugs can be categorised into five broad classes according to Amphetamine-type 8 16 ND first-year university
students, reflecting
their primary effects: stimulants, depressants, hallucinogens, stimulants use in previous
cannabinoids and antipsychotics. An overview of common Cannabis 9 16 ND year.
drugs is given in Table 2. Ecstasy < 1 16 ND
ND, no data.
†, Reflects proportion of admissions for primary substance at treatment centres registered
1.2.4 Epidemiology of drug use in southern Africa with the South African Community Epidemiology Network on Drug Use. Data are presented
as median and range across regions of the country.
As a result of the illegal nature of drug use and associated
stigma, obtaining robust data on drug use is difficult and BOX 5: Drug, (mind-) set and setting. 8
data are limited (see Table 3). It is therefore likely that
The effect of a drug is not a predictable chemical cascade. Even when the same
person takes the same drug, in the same dose, the results may differ depending on
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BOX 2: Myths about drug use. a number of variables. Drug effect is mediated by the drug itself, the biology and
mindset of the person taking the drug and the setting and context in which the
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An excellent resource on myths about drugs and drug use is available at: https:// drug is taken. For example, heroin bought from a street dealer usually has a
www.changingthenarrative.news/. Common myths are described in detail in different effect to diamorphine given by doctor in a medical setting, even though
Appendix 1. they are the same drug.
TABLE 2: Overview of common drug types.
Category Description Common examples
Stimulants Also known as ‘uppers’, these drugs increase energy. Caffeine, cocaine, methamphetamine (tik), methcathinone, ecstasy,
methylphenidate†
Depressants Also known as ‘downers’, these drugs decrease brain activity and tend to have Sedative hypnotics (e.g. alcohol, barbiturates and methaqualone [mandrax ]),
a calmative effect, making people feel relaxed and drowsy and sometimes narcotic analgesics (morphine), heroin (nyaope/whoonga/sugars),
leading to a state of lucid dreaming benzodiazepines and GHB
Hallucinogens A diverse group of natural and synthetic drugs that alter consciousness, Lysergic acid diethylamide (LSD), psilocybin (magic mushrooms),
perception, thinking and can cause auditory and visual hallucinations. 3,4-methylenedioxymethamphetamine (MDMA, ecstasy or XTC) and ketamine
Cannabinoids The flowering head of the cannabis plant. The flowers can be processed into CBD and THC
resins (e.g. hashish) and oils or dried and smoked or turned into edibles. It is
used to treat nausea, pain, loss of appetite and spasticity. Cannabidiol (CBD)
can also act as an antipsychotic, whilst tetrahydrocannabinol (THC) can
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increase the move towards psychosis for people with a vulnerability to
psychosis (the relationship has not been proven to be causative).
Antipsychotics Used mainly for the treatment of psychotic disorders. They are seldom used Quetiapine, olanzapine and risperidone
outside a medical setting as there are unpleasant side effects that outweigh
the benefits for people without a diagnosis of a psychotic disorder.
CBD, cannabidiol; GHB, gamma-hydroxybutyric acid; LSD, lysergic acid diethylamide; MDMA, 3,4-methylenedioxymethamphetamine; THC, tetrahydrocannabinol.
†, Methamphetamine and methcathinone are part of the large group of amphetamine-type stimulants.
http://www.sajhivmed.org.za 88 Open Access