British Columbia stands at a critical impasse; innovative and coordinated approaches are needed to address the public health emergency resulting from the proliferation of a toxic street drug supply. Of the overdose fatalities in BC, approximately 15% to 20% are youth under 30 years of age.[1] In response to the growing rate of overdose events and opioid diagnoses among youth, the province has implemented several measures, including youth-based outpatient and supportive recovery programs. Yet overdose fatalities remain high, prompting the question: how can fatal overdose events among youth be mitigated in the context of the opioid crisis?
BC has seen acute care diagnoses of opioid use disorder among youth quadruple over the past 20 years.[2] While there has been an expansion in harm reduction services and innovative treatments, engagement among youth remains poor.[3] Emerging literature demonstrates that providing a safe environment, innovative care, involvement with treatment decisions, and engagement with peers can help facilitate better health and care outcomes among youth with opioid use disorder.[4,5] However, in many circumstances, access to treatment and harm reduction services for youth can be a prohibitive and taxing experience. Youth often report that they do not know where they can go to access services or care, and when they do find a place, they often report feeling unsafe or unwelcome among a predominantly older male patient population.[6] Additionally, young people’s opinions and needs may not be considered during the development of treatment plans, further hindering motivation to access services.
It is, therefore, not surprising that even among those receiving treatment for opioid use disorder, retention among youth in BC is estimated to be less than 9% after 1 year.[3] Multiple integrated low-barrier approaches are needed if we are to close this gap for youth treatment and reduce overdose fatalities. Youth are also more likely than adults to engage in polysubstance use and consume substances among peers for social reasons.[7,8] Youth in BC have suggested developing public, accessible, and centrally located youth drop-in centres, harm reduction sites, and substance-use treatment programs.[6] Providing an environment in which youth can safely access and consume substances, and engage in care with peers, can help normalize the experience and reduce stigma. Implementing such initiatives can also remove the barriers youth face in terms of knowing where to go and feeling uncomfortable among older patient populations.
Treatment for youth with opioid use disorder must also shift to providing the full spectrum of low-barrier innovative options in order to have a meaningful impact. Innovative treatments, such as injectable opioid agonist treatment, can be used to engage a minority of youth for whom traditional treatments do not work. Unfortunately, injectable opioid agonist treatment is among the treatments often seen as a last line of defense only after oral opioid agonist treatment has failed. This mentality acts to further encourage youth receiving oral opioid agonist treatment to supplement their opioid needs with toxic street drugs. Further research is needed to examine how alternative care approaches can be used to integrate and retain youth in care.
With projected overdose fatalities in BC in 2021 anticipated to be at a record high—a substantial portion of which will include youth—there is a dire need for youth-centred treatment and harm reduction services, and it is imperative that the voices and perspectives of youth be prioritized in decision making. If we do not act on these options, we risk losing an opportunity to meaningfully improve the management of youth opioid use disorder and overdose fatalities.
—Tianna Magel, BA
School of Population and Public Health, University of British Columbia
—Eugenia Oviedo-Joekes, PhD
School of Population and Public Health, University of British Columbia
Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital
References
1. British Columbia Coroners Service. Illicit drug toxicity deaths in BC: January 1, 2011 -September 30, 2021. Accessed 1 December 2021. www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf.
2. Krebs E, Zhou C, Min JE, et al. Diagnosis of opioid use disorder by youths assessed in acute care settings in British Columbia, Canada. J Pediatr 2021;232:243-250.
3. Krebs E, Min JE, Zhou H, et al. The cascade of care for opioid use disorder among youth in British Columbia, 2018. J Subst Abuse Treat 2021;130:108404.
4. Cornelius T, Earnshaw VA, Menino D, et al. Treatment motivation among caregivers and adolescents with substance use disorders. J Subst Abuse Treat 2017;75:10-16.
5. Barton J, Henderson JL. Peer support and youth recovery: A brief review of the theoretical underpinnings and evidence. Can J Fam Youth 2016;8:1-17.
6. BC Representative for Children and Youth. Time to listen: Youth voices on substance use. Accessed 1 December 2021. https://rcybc.ca/reports-and-publications/reports/reviews-and-investigations/time-to-listen-youth-voices-on-substance-use.
7. BC Centre on Substance Use. Treatment of opioid use disorder for youth. 2018:1-32. Accessed 1 December 2021. www.bccsu.ca/wp-content/uploads/2018/06/OUD-Youth.pdf.
8. Gerrard M, Gibbons FX, Houlihan AE, et al. A dual-process approach to health risk decision making: The prototype willingness model. Dev Rev 2008;28:29-61.
This post has not been peer reviewed by the BCMJ Editorial Board.