According to an editorial published in the Canadian Medical Association Journal (CMAJ) and authored by Shannon Charlebois and Shawn Kelly, Canada is failing to provide adequate, evidence-based treatment for youth affected by opioid use disorder. According to recent data, more than 18 people in Canada still die every day from opioid toxicity, and many deaths from the illicit opioid supply occur in youth. For instance, in British Columbia, illicit drug toxicity became the leading cause of death among youth aged 15 to 18 years in 2021.
Furthermore, early initiation and an increase in opioid use among youth have also been overlooked. The results of the 2023 McCreary Adolescent Health Survey in British Columbia showed that 14% of youth had used substances beyond alcohol and cannabis, with 1% having tried illicit opioids and higher opioid use was observed among youth experiencing food insecurity. Furthermore, in Ontario, nonmedical use of prescription opioid pain relievers rose sharply from 12.7% in 2021 to 21.8% in 2023, particularly among students in grades 7 to 9. There is also research evidence that some young people begin using opioids as early as ages 10 to 12 years, which substantially increases the risk of developing long-term substance use disorders.
Research shows that in 2021, a total of 9% of all opioid-related emergency department visits and 8% of deaths related to opioids in Ontario occurred among young people aged 15 to 24 years. Importantly, despite their proven efficacy, medications to treat substance use disorders are under-prescribed for youth in Canada. For instance, in Ontario, the use of medications for treating addiction in youth has decreased, while rates of opioid-related deaths in the province have increased from 2.6 to 12.2 per 100 000 population over the period spanning from 2013 to 2021. In addition, medication prescriptions for opioid use disorder (OUD) issued to youth were at their lowest in 2024.
“Clinicians’ unwillingness to prescribe to this age group has been cited as an explanatory factor,” reads the editorial. “Treating youth with medications for OUD may, to some, seem like resignation or giving up, but such treatment keeps young people alive long enough to recover from their addiction. Any physician who sees youth in Canada can prescribe buprenorphine, but many lack the basic training to feel comfortable doing so.”
The 2024 American Society of Addiction Medicine Criteria recommends matching adolescents’ substance use disorder severity to an appropriate level of care, ranging from outpatient to intensive outpatient or partial hospitalization. However, in Canada, youth-focused services are limited and difficult to access, leaving families to navigate long wait-lists, limited psychosocial therapies, and barriers to opioid agonist treatment, often relying on emergency departments or privately funded supports instead.
“This is unacceptable for a leading cause of pediatric death in Canada,” concluded the authors. “Treatment for OUD in children and youth should be funded by Canada’s public health systems — including family therapy and medications for opioid and other substance use disorders — to remove out-of-pocket costs. Interventions that are effective, replicable, and cost-effective should be provided, and they can mostly be delivered in community settings.”