The drug toxicity crisis in British Columbia claimed the lives of over 150 young people between January and June 2022. A new study led by UBC medicine researcher Dr. Danya Fast highlights the importance of collaborating with youth who use drugs to find possible solutions to this crisis.
The study, published in the International Journal of Drug Policy, examined how young people navigate treatment options such as opioid agonist therapy (OAT) and reveals changes that could improve youth access and engagement with these important treatments and harm reduction services.
“Youth use opioids for many different reasons,” explains Dr. Fast, an assistant professor in UBC’s department of medicine and research scientist at the BC Centre on Substance Use. “They are consumed for pleasure and as part of socialising, but also to treat physical, emotional, psychological and even economic pain, such as the pain of crushing, entrenched poverty.”
“When I first started working in this field, I would say that there was a lot more hopefulness among youth who use drugs,” says Dr. Fast, who has over 15 years of experience working with young people. “Since the beginning of the COVID-19 pandemic, I have seen a lot more cynicism and despair from these youth about their opportunities for housing, employment and education.”
OAT is a medication-based treatment for people who are dependent on opioid drugs, including heroin, oxycodone and fentanyl. It is often combined with other supports, such as counselling, and can help manage withdrawal symptoms and lower the risk of drug-related harms, such as fatal overdose and the transmission of hepatitis C or HIV, leading to improved treatment retention and outcomes.
Despite being recognized as a critical tool for the treatment of opioid use disorder and harm reduction among youth, Dr. Fast notes that previous UBC research has shown that Canadian youth who use drugs are significantly less likely to access OAT than adults.
Improving youth access and adherence to OAT
For her research, Dr. Fast interviewed 56 young people between the ages of 14 and 26 who reported using heroin or fentanyl two or more times per week and received some form of drug treatment therapy within the past six months. The research team used an interview guide developed in collaboration with a Youth Advisory Council of eight youth with lived experience of substance use and mental health concerns.
Interview topics included living conditions, drug use history, substance use treatment and service access across time, and also addressed how OAT impacted relationships with family, friends, health care professionals and romantic partners over time.
“This work can be challenging and heartbreaking, but I always value my time with all the young people who have crossed my path. There has been a lot of laughter and fun, along with tears,” says Dr. Fast.
The study found that participants’ perceptions of OAT were often shaped by their peers, family members and romantic partners, some of whom raised concerns about such things as side effects and the potential efficacy and long-term health implications of the therapy.
Daily witnessed dosing at a pharmacy, which have limited hours of operation, was also identified by youth as a significant barrier to accessing and sticking with OAT. Many juggled poverty, various health challenges and unstable housing or homelessness, along with work and family commitments, which made the dispensing requirements unrealistic or burdensome, Dr. Fast explains.
“This work can be challenging and heartbreaking, but I always value my time with all the young people who have crossed my path. There has been a lot of laughter and fun, along with tears.”
Dr. Danya Fast
One participant noted the challenges of OAT: “I’ve got, you know, doctor’s appointments. I’m homeless so I’ve gotta figure out food in a day. I’ve got to figure out… shelter. I’ve got to figure out how to help my partner.”
While take-home OAT was available to some participants, the study found that accessing these ‘carries’ was often difficult and out of reach for many young people.
“I tried to call my pharmacy to get more carries, and they were like, ‘No’,” recalled a study participant, who eventually found a pharmacy willing to offer OAT due to temporary access measures introduced during the pandemic.
The researchers say developing treatment interventions that better align with and address the needs of youth who use opioids could help improve treatment retention and outcomes.
“We need to make sure that we are listening to and connecting with young people who use drugs, and then seeing how we can work with them and not against them,” says Dr. Fast.
Along with OAT and other harm reduction measures, Dr. Fast believes that treatment interventions should focus on the full spectrum of livelihood needs among young people.
“This includes housing, employment, income support, opportunities for leisure and recreation, as well as cultural and spiritual practices,” she says. “Things that we all reach for in our lives.”
A version of this story originally appeared on the Vancouver Coastal Health Research Institute website.