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.