Draft Speaking Notes for the Director-General: Health National Conference on Substance Abuse and Family related interventions
Programme Director Deputy Minister of Social Development Me Henrietta Bogopane-Zulu
Minister of Social Development, Me Lindiwe Zulu,
Minister of Police Services, General Bheki Cele,
Ms Signe Rotberga, United Nations Office on Drugs and Crime
A very Good Morning
Allow me to tender an apology on behalf of the Minister of Health, Dr ZL Mkhize who was not able to attend this conference as he is currently assigned to other duties outside the country. The Minister has requested me to attend this conference and address you on his behalf.
Thank you for inviting the Department of Health to participate in such an important event.
The magnitude of substance abuse, and associated burden in terms of health and socio-economic consequences has been rapidly rising in South Africa. It is well acknowledged that substance abuse contributes significantly a range of health related conditions, including: deaths, injuries and violence; communicable diseases such as HIV/AIDS and tuberculosis; chronic diseases such as cardiovascular diseases, cancers and mental disorders.
Alcohol and drug abuse also contributes to maternal and child morbidity and mortality. The costs to individuals, families and society are staggering. If we fail to arrest the substance abuse scourge, our goal of “a long and health life for all South Africans” will remain elusive.
Not only is this phenomenon a significant public health challenge , but it also undermines the national economy and derails our national development goals.
In terms of empirical data, which I assume will be presented and interrogated in much more detail in the various plenaries and workshops during this conference, we know that alcohol and drug abuse/use is a global problem. The 2018 United Nations Office on Drugs and Crime (UNODC) annual report estimates that globally about 275 million people between the ages of 15 and 64 years used drugs at least once in 2016 and that over 31 million people who use drugs are estimated to suffer from drug use disorder.
Local research indicates ongoing spread of drug use especially among the youth. Epidemiological data on substance abuse collected by the South African Medical Research Council through the South African Community Epidemiology Network on Drug Use (SACENDU) shows that alcohol is the dominant substance used in most parts of the country among patients seeking treatment.
Cannabis is still the most common illicit drug used, especially among the youth attending specialist treatment centres. Across all provinces, between 33% of patients attending specialist treatment centres in the eastern part of the country and 50% in the northern parts had cannabis as their primary or secondary drug of use.
There is also some regional variation in drug use for specific drugs. For example, methamphetamine remains the most common primary drug reported by patients in the Western Cape. Heroin use is a growing problem across all provinces . The number of patients reporting nyaope/whoonga (a mixture of cannabis and heroin and ARVs) as their primary substance of use continues to rise.
The most recent data from the Medical Research Council showed that 20% of patients in Kwazulu-Natal, and 10% in Gauteng reported nyaope/whoonga as either their primary or secondary drug of use.
The MRC data also shows that the use of Over the Counter and Prescription Medications such as analgesics, and benzodiazepines (e.g. diazepam and flunitrazipam) continued to increase across all provinces. About 3% of patients that sought treatment for substance abuse reported the non-medical use of codeine. In addition, poly-substance use remains high across provinces, with between 41% in the Central parts of the country and 54% in the Western Cape of patients indicating the use of more than one substance.
Besides the impact of drug abuse on individual health, the Centre for the Study of Violence and Reconciliation has identified alcohol use as one of the drivers of violence in South Africa and called for a public health approach to violence prevention that includes interventions to curb alcohol use.
How do we address this problem?
South Africa is signatory to the three International Drug Control Conventions (the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol; the Convention on Psychotropic Substances of 1971 and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988).
In this regard, based on the common and shared responsibility, to effectively address and counter the world drug problem South Africa is already guided by these three International Conventions and the recommendations contained in the UNGASS 2016 outcome document.
Alongside other Member States during the 2016 UNGASS, we reaffirmed our determination to tackle the world drug problem and to actively promote a society free of drug abuse in order to ensure that all people can live in health, dignity and peace, with security and prosperity.
We also reaffirmed our determination to address public health, safety and social problems resulting from drug abuse. This affirmation enjoins the Social, Health, Safety and Security to work together and implement an integrated, comprehensive approach in dealing with substance abuse.
.The 2030 Agenda for Sustainable Development (aka SDGs), target 3.5 commits Governments to “strengthen the prevention and treatment of substance abuse”, and a range of other targets are of particular relevance to drug control, particularly target 3.3 on “ending the AIDS epidemic and combating hepatitis”; target 3.4 on “prevention and treatment of non-communicable disease and promotion of mental health”; target 3.8 on “universal health coverage” and target 3.b on essential to medicines.
It should be noted that there are various streams of work that the Department of Health is engaged in to give effect to the Sustainable Development Goals. The Health Sector Drug Master Plan provides details on the health sector efforts regarding target 3.5.
Similarly, the South Africa’s National Strategic Plan for HIV, TB and STIs 2017-2022 deals with aspects in target 3.3.
The Department of Health has embarked on the review of the Non-Communicable Diseases Strategy, which addresses target 3.4.
The National Health Insurance Bill which is before Parliament is aimed at introducing “universal health coverage”. We hope that we will receive inputs through the public participation process on issues relating to the health sector’s responsibilities regarding substance abuse prevention and how these services can be strengthened .
SDG target 3.b on essential medicines requires that the medicine system is strengthened to ensure availability of drugs for medical and scientific purpose while simultaneously preventing their diversion, abuse and trafficking.
In collaboration with the South African Health Products Regulatory Authority, the Department of Health endeavors to strengthen regulation of the cultivation, production, possession, manufacturing, storage, trade and distribution of narcotic and psychotropic substances for medical, scientific and research purposes through:
- Law enforcement by SAHPRA in collaboration with the South African Police Services;
- Regulating industrial and commercial establishments which manufacture narcotic and psychotropic substances;
- Determining the estimates of quantities of narcotics and psychotropic substances and products to be consumed for medical and scientific purposes;
- Determining the estimates of quantities of narcotic substances to be utilized for the manufacture of other narcotic substances;
- Reporting on quantities of stock of drugs to be held in each year as required by the Drug Control Conventions;
- Reporting on the estimates, quantities of synthetic narcotic substances to be manufactured;
- Identifying, monitoring and reporting on trends in the composition, production, prevalence and distribution of new psychoactive substances
In addition, the National Development Plan 2030 instructs us to introduce appropriate measures to address the social determinants that affect health and disease and to prevent and reduce the disease burden and promote health. Evidence based policies and legislation aimed at regulating or modifying the environment within which we live in and work must therefore be developed and implemented.
The UNODC International Standards on Drug Use Prevention also provides us with a series of recommendations that are evidence based interventions that we must invest in, including:
- Family interventions such as “parenting skills”;
- Community based-multi component initiatives;
- Prevention education based on personal and social skills and social influences;
- Early childhood education;
- Strengthening alcohol and tobacco policies;
- Strengthen workplace interventions;
- Screening and brief interventions in the health care services. It is important to recognize that substance use disorders can present subtly and may not be obvious until they are enquired about or noted by the keen health practitioner.
As recommended in the UNGASS 2016 outcome document, more attention must be given to “implementing age-appropriate practical measures tailored to the specific needs of children, youth and other vulnerable members of society, in the legislative, administrative, social, economic, cultural and educational sectors, including measures to provide them with opportunities for healthy and self-sustained lives”.
While we know that drug addiction is a social problem, there is empirical evidence from neurobiology that suggests that it is dangerous to wait for an individual with a drug addiction problem to seek treatment for her/his condition. Drug addiction is a brain disease due to the pathological effects of substance use, even after first time use, on the brain and should therefore not be viewed as wishful behaviour on the part of the user.
This evidence has implications for the treatment of addictions and suggests that we should not stigmatise these individuals.
From the evidence it is clear that we need a multisectoral approach to substance abuse and addiction. This means that no sector working alone can solve or manage this challenge.
The Department of health will continue to work with all relevant stakeholders, including government departments, civil society, research institutions and the academia to ensure implementation of evidence based interventions.
I thank you for your attention.