If this is a medical emergency, call 10177 (ambulance) or go to your nearest emergency room immediately.
SANCA helpline: 0800 126 453 (toll-free) SADAG 24-hour support: 0800 567 567 (toll-free)
This article covers medical emergencies related to substance use disorder, psychiatric crises, and what your medical aid must cover.
Medical Emergencies from Substance Use — Act Immediately
These are life-threatening situations. Call 10177 or go to the nearest ER without delay:
| Emergency | Signs | Action |
|---|---|---|
| Alcohol withdrawal seizures / Delirium Tremens | Seizures, confusion, fever, tremors in a heavy drinker who has stopped or reduced drinking | Call 10177; go to ER immediately |
| Benzodiazepine / sedative withdrawal | Seizures, extreme anxiety, confusion after stopping prescribed or illicit sedatives | Call 10177; go to ER immediately |
| Opioid overdose | Unresponsive, slow/no breathing, pinpoint pupils, blue lips | Call 10177 immediately; naloxone if available |
| Stimulant crisis (meth, cocaine) | Chest pain, irregular heartbeat, severe agitation, psychosis | Call 10177; go to ER immediately |
| Acute alcohol poisoning | Unresponsive, breathing slowly, cannot be roused after drinking | Call 10177; recovery position; do not leave alone |
| Suicidal crisis | Expressed intent, plan, or attempt | Call 10177 or SADAG 0800 567 567; do not leave alone |
Alcohol and benzodiazepine withdrawal are the only withdrawal syndromes that can be directly fatal. If someone is physically dependent on alcohol or benzodiazepines and has stopped or reduced abruptly — treat this as a medical emergency.
PMB Coverage for Substance Use Emergencies
| Situation | PMB Status | Notes |
|---|---|---|
| Alcohol withdrawal seizure / delirium tremens | Yes — emergency PMB | IV fluids, benzodiazepine protocol, thiamine; ICU if needed |
| Opioid overdose (naloxone administration, resuscitation) | Yes — emergency PMB | Emergency DTP |
| Acute psychosis from stimulant use | Yes — emergency PMB (psychiatric) | MHCA applies; ER psychiatric assessment |
| Acute cardiac event from stimulant use | Yes — PMB (MI/cardiac DTP) | Cocaine/meth: high cardiovascular risk |
| Acute psychiatric admission for SUD-related crisis | Yes — acute psychiatric crisis PMB (MSA regs, DTP 910T, up to 3 days) | Suicidal ideation, acute psychosis, psychiatric emergency |
| Inpatient detox — acute phase | Yes — substance dependence PMB (MSA regs, DTP 182T, hospital-based management up to 3 weeks/year) | Must be at DSP facility; pre-authorise except emergency |
If Someone Is Overdosing Right Now
Opioid overdose: Naloxone (Narcan) reverses opioid overdose. If you have access to naloxone, administer it while calling 10177. Naloxone is available at some South African pharmacies without prescription. If someone close to you uses opioids, speak to a pharmacist or GP about keeping naloxone available.
Alcohol or other substance overdose: Maintain the person in the recovery position (on their side) to prevent choking on vomit. Do not leave them alone. Do not give coffee or cold water — these do not help and can worsen outcomes.
Activating the 21-Day PMB in a Crisis
If someone needs emergency inpatient rehabilitation due to a SUD crisis:
Emergency: Go to the nearest psychiatric hospital or ER. You do not need pre-authorisation in an emergency. Notify your scheme within 24–48 hours with the admission details.
Urgent (not immediately dangerous): Call the scheme's mental health PMO number and request urgent pre-authorisation. State: "This is a request for urgent pre-authorisation for acute inpatient rehabilitation for substance use disorder — a Prescribed Minimum Benefit (MSA regulations, DTP 182T). The patient is [acute risk / medical detox required]."
If Your Scheme Refuses the PMB
A scheme that refuses to fund an acute hospital admission for substance dependence (DTP 182T, up to 3 weeks a year) is refusing a PMB. This is a formal dispute:
- Request written reasons immediately.
- Your treating doctor or admitting facility should resubmit with clinical motivation referencing the PMB obligation.
- Internal appeal — submit in writing; escalate to scheme management if the call centre cannot help.
- Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za — the CMS adjudicates PMB disputes. Rulings are binding on schemes.
The CMS process can be invoked the same day as a denial in urgent cases — do not wait for multiple rounds of internal escalation when someone's safety is at risk.
Relapse After Discharge — It Is Not a Failure
Relapse is common in SUD recovery — it is part of the medical reality of a chronic relapsing condition, not a moral failure. If a relapse occurs after discharge:
- Contact the treating psychiatrist or GP immediately — do not wait for a crisis.
- If the relapse requires medical management, the 21-day PMB (DTP 182T) resets each calendar year. A second inpatient admission in the same year is generally not PMB-covered, but an emergency medical admission (for overdose, withdrawal, or acute psychiatric crisis) remains PMB as an emergency.
- Contact SANCA for outpatient support: 0800 126 453.
- Reconnect with AA/NA — free, immediately available, proven effective.
Resources and Helplines
Emergency services: 10177 (ambulance) | 10111 (police) SANCA: 0800 126 453 (toll-free) | sanca.org.za SADAG: 0800 567 567 (24-hour, toll-free) | sadag.org Alcoholics Anonymous (SA): alcoholics-anonymous.org.za Narcotics Anonymous (SA): natorsa.org.za Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →
What the PMB covers, in the regulation’s terms
- For substance abuse or dependence, the PMB is up to 3 weeks (21 days) a year of hospital-based care. (182T. Medical Schemes Act regulations, Annexure A.)
- For an acute psychiatric crisis (delusional, mood, anxiety, personality or perception disorders), the PMB is up to 3 days of hospital-based care. (910T. Medical Schemes Act regulations, Annexure A.)