Tailored care needed for B.C. youth using drugs: Report

Current approaches to treatment for youth using substances aren’t meeting their needs, according to a new report from the B.C. Centre on Substance Use.

Many youth expressed suspicion or aversion to “overly medicalized care” such as opioid agonist therapy (OAT), instead preferring care “focused on relationship- and trust-building,” the report authors wrote.

Opioid agonist treatment uses medications like Suboxone and methadone to treat opioid addiction.

“Youth want treatment that allows them to build connections, build relationships, perhaps work on things that are priorities for them, whether it’s getting back to school or getting a job or working on their relationships,” said Danya Fast, a research scientist at the B.C. Centre on Substance Use and author of the report.

The report drew from a series of studies conducted in B.C. over the past several years. Participating youth self-identified as having experience with substance use alongside unstable housing or homelessness and were between ages 14 and 28. Participants were based in Metro Vancouver, Kelowna and Prince George.

It noted that hospitals, in particular, were seen as unsafe spaces for many youth. They were often viewed as part of a series of institutions, including group and foster homes, and child apprehension or psychiatric wards, that have been sources of harm.

“The fear is absolutely shaped by very negative — traumatizing in some cases — moments of institutionalization,” Fast said, adding that those experiences shape how young people approach treatment with a primarily medical focus.

She said that typical approaches to treatment, which prioritize medication and monitoring, runs the risk of pushing youth away from care.

“What we’re hearing from young people is, ‘It doesn’t matter how low-barrier and low-threshold and youth-friendly the service is, if I feel like medications are being pushed on me, I’m out of there,’ ” Fast said.

“We need to be listening to what young people are saying in terms of how this approach of really focusing on getting them on opioid agonist therapies, for example, is not working,” she said. “We need to be careful that our best intentions and efforts to save lives are not actually driving young people away from care.”

Kali Sedgemore, a youth peer outreach worker in Vancouver, said it was essential to meet youth where they’re “not where we want them at.”

“You should not have to wonder, once you feel like you’ve been cut off from services, ‘Where do I go now?,’ ” Sedgemore said.

Tony, a young man from Kelowna, felt the focus on OAT programs was misguided.

“I think we should stop focusing on treatment and start focusing on housing,” he said. (Family names of youth were redacted for privacy.)

“They just pass you pills, and it kind of makes you feel better — better for the day,” said Cory, another of the youth mentioned in the report.

Illustrations of conversations held during a 2019 summit event in Vancouver to generate dialogue on response to the overdose crisis among youth in B.C.Fast said she understood the push to get young people into OAT programs, given the unprecedented numbers of deaths from the toxic drug crisis but she said the programs have shown to be most effective when they run for a year or more, something she said didn’t align with needs expressed by youth.

“What we heard overwhelmingly was that young people did not picture opioid agonist therapies as a part of their futures. They viewed them as this short-term tool to mediate withdrawal and cravings,” she said.

Fast said she was encouraged by programs run by Foundry and Family Services of Greater Vancouver (FSGV) that offered a range of services for youth, from meals and simply a place to rest to health, social services and more.

Sedgemore, who used FSGV youth services from age 18 to 25, called Directions Youth Services “kind of amazing.”

“They really helped me get my feet,” Sedgemore said. “They definitely care and they have a lot of different programming they try to engage you with to get a break from the streets.”

Fast said it was important not to underestimate the value of being able to go to a drop-in and just be able to rest, eat and connect with people.

“If young people are just coming again and again to a service to connect and rest, I see that as a great thing because when that person is ready to move forward with something like methadone or counselling they’re going to have the trust in that place to have that conversation,” she said.

@njgriffiths

ngriffiths@postmedia.com

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