Substance use among emergency department patients in a South African tertiary public institution
Date
2021
Authors
Ibisomi, Fathullah
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Abstract
Substance use disorder (SUD) is a medical condition wherein the use of one or more substances leads to
a clinically significant impairment in an individual. The psychoactive nature of alcohol, nicotine, illicit
substances, and some prescriptions medicines, can result in accidents and injuries due to a substance
abuser’s inability to exercise control of his/her mental state. The high prevalence of substance-related
injuries, which is estimated to be half of South African emergency department (ED) cases, gives us an
opportunity to investigate substance misuse with the use of a substance use screening interview.
Aim: To investigate the prevalence and sociodemographic risk factors of substance use in patients
presenting to the emergency department of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
Method: This cross-sectional study made use of a screening tool that included a sociodemographic
information sheet as well as the World Health Organization (WHO) Alcohol, Smoking and Substance
Involvement Screening Tool (ASSIST). In this study, a total of 237 ED patients were interviewed between
the 2nd of September and the 1st of December 2019. The study was ethically approved by the Human
Research Ethics Committee (HREC) (Appendix A).
Results: For participants that ever used a substance in their lifetime (lifetime use), alcohol use had a
prevalence of 66,2% among study participants. This was followed by tobacco (46,8%), cannabis (33,8%),
opioids (13,1%), cocaine and sedatives (9,3% each), amphetamine type stimulants (ATS) (7,6%),
hallucinogens (4,2%), and inhalants (3,8%). For patients that used a substance within three months of
being interviewed (past 3-month use), prevalence of use in alcoholic beverages was 40,1%, with the
prevalence of use in tobacco product at 32,1%; cannabis at 16,9%; opioid at 4,6%, ATS at 2,1%; sedatives
at 2,1%; cocaine at 0,8%; and lastly hallucinogens and inhalants with a 0,0% prevalence of use among
interviewed patients. Multivariable logistic regression showed that tobacco, alcohol and cannabis use
were predominantly associated among male patients and participants of younger age for both lifetime
and past 3-month substance use. Assessments on the health and social risk involved with the use of
substances found that 54,9% of the study sample was classified as low risk, 27,4% as medium risk, and
17,7% classified as high risk.
Conclusion: Alcohol remains the most used substance in South Africa, with cannabis being the most
prevalent illicit drug. Efforts to reduce substance use and prevent SUD are integral to reducing the
occurrence of substance-related cases in the ED.
Description
A dissertation submitted in fulfilment of the requirements for the degree of Master of Pharmacy to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2021