Manyane, Tabea Thama2024-03-142024-03-142024https://hdl.handle.net/10539/37913A research report submitted in partial fulfilment of the requirement for the degree of Master of Medicine (MMed) in Public Health Medicine to the Faculty of Health Sciences, University of the Witwatersrand, School of Public Health, Johannesburg, 2023Background: Substance abuse is a growing public health challenge in South Africa. It contributes significantly to the burden of disease. Integrated treatment approaches are required to address the substance abuse problem. The aim of this study was to determine the of risk of harm associated with substance use in subjects enrolled in the community-oriented substance use program (COSUP) in the City of Tshwane, South Africa, using the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) tool and determine the demographic characteristics that might be associated with the changes in the ASSIST risk scores and the levels of risk of harm in those subjects. Methodology: A cross-sectional study design was used to retrospectively analyze secondary data collected from subjects enrolled into COSUP at time of enrolment and three-months follow-up from time of enrolment. Descriptive statistics were used to analyze the demographic characteristics. Univariate and multivariate logistic regression analyses of moderate- to high-risk opioid use in relation to demographic characteristics were done. Results: Most subjects were males (91.2%), single (79.8%), black (85.6%) and they were relatively young (median age 31+6.4 years). The high level of risk was found with the use of opioids (74.5%, 607/805), cannabis (28.8%, 232/805), and tobacco (16.1%, 130/805). Moderate levels of risk were found with tobacco (63,9%, 514/805), cannabis (25.6%, 206/805) and opioids (5.1%, 41/805). Moderate and high level of risk was found to be more in males (p=0.03) and in the black race (p=0.02). Multivariate analysis found moderate- to high-risk of opioid use to be positively associated with being married (adjusted odds ratio (aOR) 11.90, 95% confidence interval (CI) 1.30 – 108.20). Conclusion: Hazardous and harmful use of substances was found among users of opioids, cannabis and tobacco. Screening and harm reduction treatment interventions for substance use should be integrated within primary health care. Further research on the perceptions of substance users about harm reduction treatment interventions is required.enHarm reductionOpioid substitution therapySubstance abuseCOSUPDissertation