Did You Know?

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.

This year’s World Autism Awareness Day (WAAD) event is highlighting youth voices. In a panel discussion titled “The Future is Neurodiverse,” young autistic leaders will share their lived experiences and explore themes of dignity and belonging, exclusion, opportunity, and visions for the future. They will also share a message to global leaders about what they want policymakers to hear and act on.

The panel discussion is part of a WAAD broadcast organized by the Institute of Neurodiversity (ION) and supported by the United Nations. ION is a global membership organization dedicated to fostering neurodiversity awareness and advocating for the rights of neurodiverse people.

World Autism Awareness Day was designated by the UN in 2007. It advocates for the human rights and fundamental freedoms of autistic individuals, and it promotes an inclusive future where every autistic person can thrive. The theme of this year’s observance is “Autism and Humanity — Every Life Has Value,” a call to fight misinformation and move beyond limiting narratives.

You can learn more and find links to the broadcast at the United Nations website.

Following substantial increases in prescription opioid misuse in Canada and elsewhere beginning in the 1980s, 10 practitioner groups have acted to reduce unnecessary prescribing of these drugs. For example, Canadian guidelines for chronic (non-cancer) pain have de-emphasized opioids. And organizations such as BC’s College of Physicians and Surgeons, among others, have issued updated practice standards on safe opioid prescribing.

Data suggest that prescribing practices are changing. The proportion of Canadians living in BC, Ontario and Saskatchewan being prescribed opioids fell from 14.3% to 12.3% between 2013 and 2018. For children under age 15, these prescriptions fell from 2.0% to 1.0% in the same time period, while for teens and young adults ages 15 to 24, the percentages dropped from 8.7% to 7.1%.

Initiatives to reduce the supply of unused opioid medications can also help. For example, a US project encouraged people to drop off unused medications to prevent them from being misused. Despite a budget of less than $1,000 and a time frame of only four hours, this project resulted in people turning in 1,798 opioid dosing units — showing what communities can do.

But much more needs to be done, and the needs have never been greater. In particular, it is essential to consider prevention programs for young people — to intervene effectively before opioid misuse starts. These programs are typically informed by the research on risks and can complement broader public health efforts to address problematic opioid use.

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

March 21 marks the International Day for the Elimination of Racial Discrimination.

Established by the United Nations, the day commemorates the Sharpeville Massacre of 1960, when police in South Africa opened fire on peaceful protestors demonstrating against racist “pass laws.” Sixty-nine people were killed in the massacre.

Since then, the day has raised awareness and encouraged global action to combat racism. But there is still much more work to do.

Racism continues to result in avoidable and unfair disparities in power, resources and opportunities — for individuals and groups and within institutions and social systems. It has profound impacts on children’s lives, including on their physical health.

A study that included more than 95,000 American children aged 18 and younger found that those who experienced racial discrimination had a significantly lower likelihood of reporting that they were in excellent health, compared with those who did not have such experiences. To learn more, see Vol. 15, No. 3 of the Children’s Mental Health Research Quarterly.

A group of researchers set out to identify risk and protective factors for problematic opioid use among American Indigenous youth. Their efforts were prompted by the lack of research on Indigenous youth and by the disproportionate impact of the opioid crisis on Indigenous people due to the effects of historical trauma and ongoing racism. Two factors emerged as protective against prescription opioid misuse: family disapproval of substance use and better school performance. However, neither was protective against heroin use. In contrast, having peers who used substances was a risk factor for both prescription opioid misuse and heroin use. In BC, efforts by the First Nations Health Authority and others are building on these kinds of findings, with the goal of supporting wellness and healthy development for all Indigenous young people.

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

Researchers have identified many risk factors for opioid misuse — including some that can be modified. A Canadian study of Ontario and Alberta secondary students examined the risks for misusing three types of prescription opioids: oxycodone, fentanyl and/or others (which included codeine, morphine and Tylenol #3). Use of other substances was a particularly potent risk factor. Binge drinking, mixing alcohol and energy drinks, using cannabis, vaping and smoking cigarettes resulted in 39% to 511% higher odds of misusing prescription opioids.

School experiences also influenced risk. Skipping classes, failing to complete homework (often or usually) and viewing school as very unsupportive in helping students resist or quit substances resulted in 41% to 358% higher odds of misusing opioids. As well, the availability of spending money from allowances or part-time employment was associated with 38% to 56% higher odds of misusing codeine, morphine and/or Tylenol #3.

An American study assessed the impact of another potential risk factor — adverse childhood experiences. To understand these experiences, researchers surveyed more than 10,500 public middle- and high-school students in Ohio, asking about 10 forms of adversity. These included emotional, physical and/or sexual abuse; physical and/or emotional neglect; witnessing intimate partner violence; living with someone who had substance use problems, had a mental illness or was incarcerated; and parental separation or divorce. All were linked with youth opioid misuse. Sexual abuse produced the greatest risk, with 6.8 times increased odds of opioid misuse. As well, experiencing multiple or cumulative adverse experiences greatly increased the odds. Young people with five or more of these negative early experiences had more than 15 times increased odds of misusing opioids.

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

Held annually in communities across Canada, Pink Shirt Day encourages people to take a stand against bullying and discrimination.

Also known as Anti-Bullying Day, the event asks participants to show their support by wearing pink to their schools and workplaces. This year’s official t-shirts feature the theme “Sprinkle Kindness” — a playful reminder that kindness grows when shared.

Pink Shirt Day organizers also promote kindness and inclusion through school outreach, offering a special 45-minute broadcast educators can sign up to receive. The broadcast is organized by WITS Foundation, a Canadian charity dedicated to creating safe environments for children and youth. Learn more on the Pink Shirt Day Canada website.

Events like Pink Shirt Day matter because the effects of bullying extend far beyond childhood. Being victimized early in life has been linked to anxiety, depression and suicidality, and studies show these mental health challenges can persist into middle age. To learn more about how bullying impacts child mental health, read Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

Young people typically access opioids in one of three ways. Health practitioners may prescribe opioids, to address post-operative pain, for example. Some youth also take opioids that were prescribed to others, both with and without the others’ knowledge. As well, a small number of young people obtain opioids outside the health care system, including unregulated substances such as non-medical heroin or illegally manufactured fentanyl.

A survey of more than 1,000 American adolescents who had misused prescription opioids provides further insight regarding how these substances were obtained. The most common sources were friends or relatives. Similarly, an online survey of Canadians, including youth, found that 34% of those who had misused opioids obtained these substances from friends or relatives who had prescriptions.

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

The Canadian Student Tobacco, Alcohol and Drug Survey has been providing data on past-year opioid misuse for students in Grades 7 to 12 since 2014. Its four surveys have shown that over time, heroin use has remained stable, with 0.5 to 0.8% of youth misusing this substance. Misuse of fentanyl and oxycodone also remained relatively stable, at around 1.0%. For other opioids — namely, morphine, codeine and/or Tylenol #3 (i.e., acetaminophen with codeine) — misuse rates were higher, ranging from 2.3 to 2.8%.

The BC Adolescent Health Survey also provides information on opioid misuse for students in Grades 7 to 12 in the province. Data from the 2023 survey, which included more than 38,000 youth, found that 1% reported ever using heroin, fentanyl or other opioids. The 2018 survey similarly found that 1% of youth reported ever using heroin (other opioids were not included in that survey).

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