Substance abuse and trauma in Cape Town.
Peden M., van der Spuy J., Smith P., Bautz P.
OBJECTIVE: To obtain baseline data on the incidence of acute alcohol intoxication, chronic alcoholism and illicit drug usage among a cohort of injured patients. DESIGN: A prospective, descriptive study of 254 injured patients presenting at the trauma unit of Groote Schuur Hospital over an idealized week in 1997. Alcohol consumption was assessed by means of the Lion SD2 alcolmeter. Chronic alcoholism was assessed using the CAGE questionnaire. Each patient's urine was analysed for four drugs (cannabis, morphine, opiates and methaqualone) using conventional 'wet' analysis. Sweat was tested for cannabis using a Drugwipe. MAIN OUTCOME MEASURES: Socio-demographics, cause of injury, injury severity, acute alcohol intoxication, chronic alcohol usage and illicit drug involvement. RESULTS: Patients were predominantly male, coloured and an average of 31.3 years old. The majority had been injured as a result of interpersonal violence. Self-reported alcohol consumption was reliable but this was not so for self-reported drug usage. Sixty per cent of patients had positive alcohol levels on breath analysis. More than one-quarter of all the patients could be classified as chronic alcoholics on the CAGE questionnaire. On urine analysis, 40% of patients were found to have used at least one illicit drug in the recent past. The most commonly abused drugs were cannabis or a combination of cannabis and Mandrax, locally called a 'white pipe'. Use of the white pipe was confined almost exclusively to patients injured as a result of interpersonal violence. CONCLUSIONS: Alcohol remains the most commonly abused substance among trauma patients, but there are growing numbers of patients who simultaneously abuse illicit drugs. This study will be conducted annually to detect trends and identify emerging problems.