Prioritizing youth voices amidst the opioid overdose and health crises  

There may be a widespread perception that opioid use only impacts older adults. However, evidence now shows that the opioid overdose and health crises has, and continues to have, deleterious effects on youth and young adults ages 15-24. There is some evidence in Canada that shows the pandemic and the associated restrictions exacerbated morbidity and mortality due to opioids among young people. Contemporary journalistic exposes have also revealed the heartbreaking consequences of the contaminated drug supply for youth who have been exposed to fentanyl and other high potency synthetic drugs.

Since we began our research with young people in 2018, it has become clear that the youth opioid overdose epidemic is a complex multi-dimensional societal problem that involves many different stakeholders. Over the past few years, we engaged in research with several different youth populations in Canada who had diverse experiences with opioids. We found few evidence-based interventions for youth who are using or contemplating using opioids. Experimental treatments recruited mostly male youth and were focused on pharmacological treatments for youth with more severe opioid use problems. These interventions are perceived by youth as paternalistic and atomistic, representing a primarily reactionary approach to the crises. Like their adult counterparts, youth desire positive, empowering, non-judgmental and non-stigmatizing, face to face interactions with healthcare providers during their recoveries and treatments. Our data indicated that youth sometimes felt not ‘heard’ or were seen as suspicious.

Youth were supportive of harm reduction because it worked towards reducing the stigma of substance use (not just opioid use). However, they also described how pharmacological treatments failed to include other important supports and resources, such as for housing or income.

We also engaged with youth who had been prescribed opioids for pain management—a group that is particularly vulnerable. Among those, many had experienced surgery for scoliosis, were in remission from cancer and/or had suffered acute injuries. They discussed their experiences of overlapping stigmas and prejudicial attitudes about their physical conditions, their opioid use and the lack of mental health supports during recovery journeys.

It is overwhelmingly evident there is a need for the development of holistic youth-informed treatments and integrated services, adjuncts for pharmacological interventions and supports to help them actualize their goals, including mental health, income, and stable housing. This is not merely the case for youth already engaged in opioid agonist therapy, but also those prescribed opioids for pain management.

Harm reduction is supported by youth, and awareness of interventions like Naloxone appears to be improving both with regards to uptake and support. Of note, family members and caregivers of youth using opioids or youth who had died due to opioid poisoning appear to be a particularly neglected group and need more robust supports.

There is also a dire need to introduce new approaches for youth that move away from paternalism— an approach that prioritizes ‘adult’ assessments of what is in young people’s ‘best interests’. Movement towards a paradigm that authentically values, trusts, and puts youth evaluations of their own needs and circumstances on equal- footing will go a long way to youth empowerment and the creation of better, more effective policies and treatment programs.

Reacting to and treating the ‘symptoms’ of the opioid overdose and opioid health crisis is not sufficient. There needs to be a greater emphasis on equipping young people with tools early in their lives to delay the onset of substance use and/or reduce reliance on substances to cope with difficult physical, psychological and sociocultural challenges.

The implementation of preventative interventions in community, clinical and school-based settings was identified by youth as one step that healthcare and teaching professionals and policy makers could take towards reducing the impact of potential drivers of substance use among youth, and towards mitigating the long- term consequences. 

Stephanie Nairn is a PhD Candidate in Sociology and Social Studies of Medicine at McGill University and is the lead researcher and coordinator for the Emerging Health Threat study about at-risk youth and newer users of opioids at Sainte-Justine Research Center in Montreal, Quebec.

Dr. Patricia Conrod holds a Tier 1 Canada Research Chair in Preventative Mental Health and Addiction. She is a Clinical Psychologist and Professor of Psychiatry at The University of Montreal.

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