A large study of Americans aged 18 and older pointed to the role of adverse childhood experiences in the development of opioid use disorder. Researchers surveyed more than 36,000 individuals who were representative of the US population, asking about their experiences with 10 different forms of early adversity, such as childhood physical abuse, and their prescription opioid use as adolescents and adults. They found that early adverse experiences significantly increased the odds for misusing prescription opioids at or before age 17 and the odds for ever being diagnosed with opioid use disorder. And opioid risk rose as the number of adversities rose. Notably, most of these adversities were avoidable.

For more information, see Vol. 18, No. 3 of the Children’s Mental Health Research Quarterly.

Opioid use disorders, like most mental disorders, have complex origins. Determining modifiable risk factors is particularly crucial in informing early intervention efforts. Findings from three large studies that included participants who were 18 years or younger shed light on these risk factors.

An Alberta study examined the link between mental disorders and the later development of opioid use disorder in nearly 2,000 young people aged 18 to 25 years. Researchers identified young adults with opioid use disorder in provincial health administrative databases. Individuals were then matched based on age and sex with more than 7,000 individuals without this diagnosis. Researchers found that alcohol use, anxiety and depressive disorders predicted the development of opioid use disorder. Alcohol use disorder was particularly potent, increasing risk more than sixfold, while anxiety and depressive disorders each more than doubled the risk.

A US study involved nearly 77,000 youth aged 14 to 18 years who were enrolled in a Colorado health maintenance organization. Researchers first identified 108 youth who had opioid use disorder and then identified preceding risk variables. Having a substance use disorder or using substances resulted in about five times higher likelihood of being diagnosed with opioid use disorder. And having other mental health diagnoses (i.e., anxiety, adjustment, conduct, depressive and/or eating disorders) resulted in four times higher likelihood.

The third study was a survey of more than 41,000 youth who were representative of American 12- to 17-year-olds — and highlighted similar risks. Past-year substance use and depression were both risk factors for developing prescription opioid use disorder. Specifically, the odds of developing this disorder increased by 522% for “illicit” drug use; 176% for cannabis use; 102% for alcohol use; and 237% for depression.

Taken together, the findings of these three studies demonstrate that mental health conditions confer considerable extra risk for young people regarding opioid misuse.

For more information, see Vol. 18, No. 3 of the Children’s Mental Health Research Quarterly.

Small moments of care can make a big difference. That’s the message behind Child and Youth Mental Health Day, marked annually on May 7.

Child and Youth Mental Health Day advocates for meaningful conversations about mental health between children and the caring adults in their lives. It raises awareness and works to break down stigma that prevents families from accessing mental health services.

The day was established by FamilySmart, a BC-based organization, in 2007.

This year, FamilySmart is partnering with the BC School Counsellors Association to host a special online event that shares experiences, insights and practical ways to support the mental health of children and youth. You can learn more and access resources on FamilySmart’s website.

Beyond raising awareness, providing effective mental health treatment is an important way we can support young people who are struggling. But stark shortfalls persist in specialized mental health treatment services for Canadian children and youth.

Barriers to access include a lack of trained practitioners (particularly in remote communities), long waiting lists, stigma and the need to travel long distances to access care. Novel treatment approaches that address these barriers, including self-delivered treatments accessed online, may be an effective way to reach more children in need.

To learn more, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

Nearly 200 BC youth aged 18 years or younger died in the past decade after using unregulated toxic drugs — especially opioids. In fact, in 2023, 84.8% of these deaths involved fentanyl and 20.6% involved other opioids. (The total exceeds 100% because more than one substance was often identified for a given individual.) Between 2019 and 2023, unregulated drug toxicity was the leading cause of unnatural deaths for youth in BC (i.e., deaths not due to a disease).

Research evidence is also emerging that adolescents are at particular risk for death from opioids. Among people in BC with an opioid use disorder who received at least one prescription for an opioid agonist, a medication used to treat this condition, those younger than 20 years had the highest relative risk of death of any age group.

Parallel with increasing opioid deaths, more BC youth are being diagnosed with opioid use disorder. In 2017, 285 young people between 12 and 18 years received such a diagnosis according to records from health administrative sources, a quintupling since 2007. The actual number of youth with an opioid disorder is likely an underestimate given that this condition frequently goes undiagnosed. Hypotheses for this underdiagnosing include limited practitioner training and stigma around substance use.

For more information, see Vol. 18, No. 3 of the Children’s Mental Health Research Quarterly.

Research identified through a systematic review by the Children’s Health Policy Centre indicates that it is possible to avert opioid misuse by focusing on prevention in childhood. Evidence for the US-based Strengthening Families program was particularly compelling, with three studies showing that the program significantly reduced prescription opioid misuse over 12 to 14 years of follow-up. These enduring benefits likely conferred protection during important periods of child and adolescent development. Project PATHS also reduced the frequency of heroin use two years after the program ended, according to one study.

These findings suggest five implications for practice and policy.

• Intervene early. Both successful programs began in Grade 6 or 7, when most children were only 11 or 12 years old. So efforts to prevent opioid misuse need to start before adolescence, the time when young people are more likely to first try an opioid.
• Empower parents. Strengthening Families recognized the crucial roles that parents play in supporting children and strengthening their resilience. Therefore, practitioners should always consider including parents (and other caregivers) in opioid prevention programs.
• Reach more children by delivering programs efficiently. Both programs reached large numbers of children — more than 12,000 in one Strengthening Families study — while enhancing efficiencies through group delivery. The use of school settings added to the efficiencies. Training for facilitators and teachers was also concise — just two days for Strengthening Families and three days for Project PATHS. These approaches can be models for reaching more children and youth across BC.
• Take a broad approach to prevention. Strengthening Families originally aimed to prevent substance misuse in general, while Project PATHS aimed to promote positive development and reduce problem behaviours. Focusing on more than opioids likely played a role in Strengthening Families reducing the use of cannabis, ecstasy, cocaine, methamphetamine and LSD, and Project PATHS reducing the use of cannabis, ecstasy, ketamine and solvents. Addressing factors that apply to all substances, such as building refusal skills, likely contributed to success in reducing prescription drug misuse, even without opioid-specific content.
• Build on successful programs to grow the options in BC. The programs we reviewed were delivered in the 1990s or 2000s, which could result in materials requiring updates. Strengthening Families has already been updated; the current version of this program includes new material, such as information on prescription drug misuse, as well as a video series and updated handouts. Project PATHS may also require updating to ensure the content is current. In addition, adaptations may be needed for the Canadian context and for cultural relevance, given that Strengthening Families was mainly evaluated with white American children and Project PATHS with children from Hong Kong. As well, made-in-BC evaluations are needed to confirm the benefits here.

For more information, see Vol. 18, No. 2 of the Children’s Mental Health Research Quarterly.