BREAKING TABOOS TO FIGHT DRUG ABUSE

The draft of South Africa's second five-year plan to combat drug
abuse proposes controversial measures such as needle-exchange
programmes and methadone treatment, writes Wendell Roelf

With children as young as 10 experimenting with drugs, authorities
have mooted potentially controversial new measures to combat abuse.

Needle-exchange programmes to help reduce the spread of HIV infection
among intravenous drug users and methadone maintenance treatment for
heroin addicts are suggested in the national drug masterplan.

A draft of the plan has been drawn up under the aegis of the Central
Drug Authority (CDA).

"The focus is on first reducing the harm associated with drug use,
rather than on reducing or eliminating drug use per se," the draft
reads in part.

"When used in secondary and tertiary prevention, the harm-reduction
approach should be complemented with supply and demand reduction."

David Bayever, acting chairman of the CDA, said despite
needle-exchange programmes enjoying internationally acceptance, they
had not been introduced in South Africa for fear of sending the wrong message.

"We need to look at the pros and cons. While it can be misread that
we are condoning the use of needles as long as they are clean, this
is not the case.

"We don't want needles to be used at all, but at the same time we
recognise that having clean needles could reduce the spread of
HIV/Aids and other diseases," said Bayever.

On methadone, Bayever said the Medicines and Related Substance
Control Act subjected the use of methadone to strict control.

Methadone could only be used in controlled environments, such as
hospitals, where the person administering it was a specialist.

Bayever said that some private drug rehabilitation centres were using
methadone-related substances not governed by legislation.

Methadone and related substances do not guarantee success in treating
addiction.

South Africa's second five-year plan, for 2005-10, sets out the
country's policies and priorities, and emphasises an intensification
of the anti-drug campaign by community participation through
establishing provincial forums and local drug action committees.

"The scourge of substance abuse continues to ravage our communities,
families and particularly our youth, the more so as it goes hand in
hand with poverty, crime ... escalation of chronic diseases and
premature death," Social Development Minister Zola Skweyiya writes in
the foreword.

The plan acknowledges tobacco and alcohol as the "gateway" to the use
of other drugs, with substances abused divided into three categories,
according to popularity of use.

In South Africa, the most common are alcohol and tobacco, followed by
cannabis and the cannabis-mandrax combination known as a "white pipe".

"Considerable abuse of over-the-counter and prescription medicines,
cough mixtures and slimming tablets, as well as solvents (especially
glue) also causes concern," reads the report.

It mentions the use of home-brewed alcohol, which could contain
poisonous additives, as another problem area.

Cocaine, LSD and Ecstasy, crack cocaine ("rocks") and methamphetamine
("tik") are listed in the second category. But the report says the
use of rocks and tik is growing fast.

In the third category are substances such as opium, the date-rape
drug Rohypnol, Wellconal and methcathinone ("khat").

"The health and socio-economic consequences of substance use, abuse
and dependency are a great concern, the more so as the abuse of
alcohol and trafficking in drugs undermine democracy and good
governance and have a negative impact on the environment," the draft states.

The plan identifies nine priority areas. These include crime, youth,
research, international involvement and capacity building.

"Specific treatment services have to be provided for young people, as
their needs are different from those of adults... Major gaps still
exist with regard to intervention programmes for the youth,
especially in rural areas."

The draft recognises the role of communication in determining the
success of the plan.

"... Previous drug awareness efforts failed to reach their target
audiences because of inappropriate, viewer-insensitive
presentations," it states.

It says there is a "great need" to train doctors, nurses, social
workers and psychologists on substance abuse and other addictions.

It proposed a professional licensing or qualifications board be
established to devise standards for skills training in aspects of
addiction management.

"In the long term, however, the failure to address substance abuse
adequately could jeopardise the attainment of real reconstruction and
development in South Africa... Substance abuse is a unique social
evil, and needs special attention," the authors conclude.