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Findings from a systematic review by the Children’s Health Policy Centre suggest six implications to better serve young people in BC who are experiencing opioid use disorder:

• Ensure that all young people in need can access timely treatment. Every young person experiencing opioid use disorder needs quick access to effective treatments — and needs to know how to get help in safe ways. While efforts are being made to increase access to this vital form of care, many young people still lack even a primary health care provider. As well, treatments may need to continue over extended periods, or be restarted, given frequent reoccurrence of opioid use following discontinuation of treatment.
• Match the treatment to the individual. Young people with opioid use disorder require a treatment plan that fits with their stage of recovery. For example, abruptly stopping opioid use can cause painful withdrawal symptoms. So for young people at the beginning of their treatment, managing withdrawal symptoms through buprenorphine/naloxone can be helpful.
• Help youth by helping family members. When a young person is struggling with opioid use, everyone around them is deeply affected. Family members often experience great challenges — both in supporting the young person and in coping with the consequences in their own lives. Interventions that include family members are therefore always worth considering.
• Ensure strong practitioner supports. The Compass Mental Health program at BC Children’s Hospital provides support to health care providers treating children and youth with substance use challenges. The BC Centre on Substance Use, through its Provincial Opioid Addiction Treatment Support Program, also provides additional education and training for prescribers, including online courses and preceptorships.
• Conduct more research with young people. Rigorous research is greatly lacking on treatments for opioid use disorder in young people. As a result, practitioners must resort to prescribing medications that have not been optimally evaluated. So new treatment research is urgently needed.
• Remember prevention. Even with adequate treatment, preventing opioid misuse is crucial to meet the collective goal of having fewer young lives harmed or cut short. Prevention is also the most effective way to enable more young people to enjoy years of positive development by avoiding opioid use disorder.

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

To determine how many BC youth with opioid use disorder are treated with medications, researchers reviewed prescriptions in health administrative databases. They found that of 446 adolescents with this diagnosis, 36.5% were prescribed a related medication between 1996 and 2018. Among these young people, 60.1% received buprenorphine/naloxone and 38.0% methadone. Still, researchers found that teens were about half as likely to receive a medication for opioid use disorder compared with older adults — despite this treatment being an important component in addressing the opioid crisis.

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

A large US study offered insight on how variations in opioid prescribing can increase risk for detrimental outcomes — namely, opioid use disorder or opioid overdose. Researchers searched a comprehensive database of health insurance claims for individuals with employer-provided coverage, identifying more than three million 11- to 25-year-olds by their first opioid prescription. They found that longer-acting medications led to 159% increased risk of being diagnosed with opioid use disorder or experiencing an opioid overdose in the year following the initial prescription — compared with outcomes for shorter-acting formulations.

Duration also made a difference. Prescriptions for 15 days or longer increased risk by 96%, while those for seven to 14 days increased risk by 15% — compared with prescriptions for three days or fewer. As well, higher daily doses (i.e., morphine equivalents of 90 milligram or greater) increased risk for detrimental outcomes by 23% compared with doses of less than 30 milligrams. These findings highlight the importance of using caution when prescribing opioids to young people.

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

Image credit: CIRA

This year marks the 30th anniversary of National Indigenous Peoples Day. Held annually on June 21, National Indigenous Peoples Day celebrates the cultures, traditions and contributions of First Nations, Métis and Inuit peoples.

The day was originally declared as National Aboriginal Day by Governor General Roméo LeBlanc in 1996, following years of consultation and calls for the creation of such a day by the Assembly of First Nations and other Indigenous groups. It was renamed National Indigenous Peoples Day in 2017. June 21 was chosen because it is the summer solstice, a day of spiritual and cultural significance for many Indigenous peoples.

Every year, Indigenous communities hold events to celebrate and share their diverse cultures. You can find a list of public gatherings in British Columbia at Indigenous Tourism BC.

Cultural connections, like those celebrated during the summer solstice, can promote the wellbeing of Indigenous children and youth. For example, research suggests that strengthening these connections can help lower rates of suicide for Indigenous young people. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

June is Pride Month. Around the world during Pride, communities gather to celebrate LGBTQ+ people and their achievements. These gatherings also protest ongoing anti-LGBTQ+ discrimination and advocate for equality, freedom and safety for all.

Today’s Pride gatherings trace their history back to the Stonewall Uprising of 1969, a multi-day series of demonstrations sparked by a police raid on a popular gay bar in New York City. The first Pride marches were held one year later, in 1970.

Now, 56 years later, Pride events around the world continue to bring LGBTQ+ community members and allies together to support one another — including LGBTQ+ youth.

LGBTQ+ youth often face serious social inequities, including discrimination. But research has shown that being part of supportive communities can help protect these youth against negative mental health outcomes.

For example, LGBTQ+ youth are less likely to attempt suicide if they live in communities generally supportive of their rights, such as those with greater protections for same-sex couples and with schools that have supportive policies. Additionally, LGBTQ+ young people who feel supported by their parents and schools have better mental health outcomes.

This highlights the importance of addressing discrimination and supporting LGBTQ+ youth, for everyone’s benefit. For more information, see Volume 11, No. 2 of the Children’s Mental Health Research Quarterly.

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.