“We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth

Abstract

Background Adolescence and young adulthood is an important period for substance use initiation and related harms. In the context of the ongoing opioid crisis, the risks for youth (ages 16–29) who use opioids are particularly heightened. Despite recommendations to adopt a developmentally appropriate and comprehensive approach to reduce opioid-related harms among youth, data continue to show that youth are not adequately engaged in opioid treatments and encounter many barriers. The aim of this study is to identify youth-centered opportunities for improving opioid treatment services. Methods This paper reports multi-site qualitative findings from youth participating in the ‘Improving Treatment Together’ project, a community-based participatory project being conducted in British Columbia and Alberta, two western Canadian provinces that have been dramatically impacted by the opioid crisis. Qualitative data were collected during three workshops with youth who used opioids and accessed opioid treatment services in the prior 12 months. These workshops were conducted in three communities following the core elements of human-centered co-design. A multi-site qualitative analysis was conducted to identify within- and between-site themes surrounding youths’ needs for improving opioid treatment service experiences and outcomes. Results Three overarching needs themes were identified from across the communities. The first reflected youths’ difficulties finding and staying connected to opioid treatment services, with the overarching need theme suggesting opportunities to reduce organizational and systems-related barriers to care, such as waiting times and wider information about service availability. The second area of need was rooted in youths’ feelings of judgment when accessing services. Consequently, opportunities to increase respectful and empathic interactions were the overarching need. The final theme was more nuanced across communities and reflected opportunities for an individualized approach to opioid treatment services that consider youths’ unique basic safety, social, and health needs. Conclusions This study identifies fundamental directions for the operationalization and implementation of youth-centered opioid treatment services. These directions are contextualized in youths’ lived experiences accessing services in their local communities, with overarching themes from across sites strengthening their transferability to other settings.

“The system always undermined what I was trying to do as an individual”: identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada

“…Improving Treatment Together (ITT) is a multi-phase project that aims to co-design health service innovations to improve youth opioid use services through youth, caregiver, and service provider engagement using community-based participatory research (CBPR) methods. The study design has been extensively described elsewhere [ 23 , 25 , 28 ]. Briefly, the project commenced in 2018 through a partnership between a national (Canada) and provincial organization (Foundry, British Columbia; BC), who then identified four community-based partners that provide mental health and substance use services to youth.…”

“…Recently, these gaps have motivated several calls to action to improve the quality of opioid use services/treatments for youth [ 13 , 23 , 25 – 27 ]. Examples include expansion of youth-led and youth-dedicated programs and services, non-stigmatizing and person-first language when delivering services, and youths’ self-determination in treatment decision-making [ 13 , 23 , 27 ]. These calls to action have significant implications for service providers/clinicians whose primary role is to implement and deliver care according to these recommendations.…”

“…Substance use among adolescents and young adults, collectively referred to as youth (ages [12][13][14][15][16][17][18][19][20][21][22][23][24], is a longstanding global health issue for families/caregivers, communities, and policy makers. Substance use typically begins and peaks during this period and can impede cognitive, emotional, and psychosocial development, potentially leading to further adverse outcomes (e.g., riskier substance use patterns, health burdens) [1][2][3][4].…”

“…Another potential source for these disparities is the incongruence between youths' treatment goals and preferences and the procedures and policies through which treatments are delivered. Studies have shown that youth have diverse goals when accessing MOUD, such as reducing opioid use, MOUD tapering, gaining employment, and improving mental health, that are not always compatible with current practices or standards (e.g., focus on abstinence and withdrawal symptoms, long-term retention) [13,18,[22][23][24].…”

Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic

“…Indeed, they conclude that “there is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time” ( Watson et al, 2022 ; 1). Equally, more work that considers the differential needs, experiences, and realities of OUD health providers are needed to explicate the social and structural drivers underpinning geographic variations to ensure opioid users have timely access to the full continuum of evidence-based interventions ( Marchand et al, 2022 ; McCann et al, 2022 ).…”