How to be more effective at helping youth prevent illicit drug overdose

Greater Toronto Area deaths due to opiate intoxication have doubled among racialized populations in the last five years.This stark finding, and other data were presented by Dr. Amy Gajaria, an Ontario psychiatrist at the Centre for Addiction and Mental Health (CAMH), at the Black Physicians’ Association of Ontario’s mental health professional development day in May. Compiling data from a 2022 coroners report and other sources, Dr. Gajara said there were higher rates of opioid-related deaths in “ethnically diverse” neighbourhoods in Ontario during the COVID-19 pandemic; overdose deaths were higher in Indigenous populations; and 50% of Indigenous youth in conflict with the law in Canada have a history of substance abuse disorder.Despite this, Dr. Gajaria said there is minimal ready information on racialized populations, immigrants and refugees dealing with substance abuse disorders in Canada.“What we do know is that the rates of substance use are quite comparable between Black and white populations, but what’s not comparable is access to care,” said Dr. Gajaria, who works on the problem through the Substance Abuse Program for African Canadian Youth (SAPACCY) at CAMH. She shared some tips for her fellow clinicians on tackling these issues “I always encourage other physicians to ask ‘why?’” Dr. Gajaria told the Medical Post. Expressing that sense of genuine curiosity—as well as reinforcing that you understand and acknowledge their lived reality—is important for physicians seeking to connect with these patients. Mental-health and substance-use care through voluntary pathways is often less available for Black and other racialized youth, compared to their white counterparts, said Dr. Gajaria. “So we’re seeing youth over-represented in the criminal justice system, versus actually getting the care they need.” How youth are taking drugsYouth are less likely to use safe injection sites (where available), and racialized youth even more so. There is a higher risk associated with using drugs with peers in places like parks or alone in their rooms. Youth also often consume drugs together and are therefore exposed to trauma through deaths by overdose of their friends. Dr. Gajaria noted this can, in turn, increase substance use, making recovery all the more difficult.When prescribing/managing substance-use disorders, physicians should remember that opiate agonist treatment (OAT) is life saving, says Dr. Gajaria, adding that suboxone microinduction protocol can be very helpful if a young patient wants to start OAT right away but isn’t in withdrawal yet. “Suboxone microinduction can be helpful for young patients that aren’t willing to use a Rapid Access Addiction Medicine Clinic or day-detox clinic,” she added. Further, youth particularly benefit from sublocade injection if a physician can get them to a high enough dose of suboxone (8-milligrams). But physicians should keep in mind that youth may need lower doses than adults, depending on their drug of choice. “Fentanyl users will likely need higher doses like in adults,” Dr. Gajaria noted.This is especially important since Xanax has become a popular street drug for youth, but in her presentation, Dr. Gajaria said most of what is labelled as “Xanax” (commonly referred to as “xans” or “xanies” on the street) is often a synthetic benzodiazepine, also called etizolam, which are also often cut with fentanyl or other synthetic opiates that can lead to respiratory arrest and death.“This is not reversible with Narcan/naloxone and requires hospital management,” she emphasized.Making overdose prevention youth friendlyDr. Gajaria says overdose prevention starts with physicians understanding how youth take drugs. She recommends telling youth not to use alone and to stagger the onset of use between friends in case they all have a bad batch. “It could be as simple as waiting 30 minutes between friends taking the drug, so that there is someone sober enough to get help if they need it,” she said. At home, Dr. Gajaria also says she doesn’t tell youth they have to tell their parents they are taking drugs while they’re locked in their rooms—but does suggest they go downstairs, in the living room, or in public, about an hour later so that someone will see them if they don’t react well to the drug.She says physicians should also use a municipal drug-checking service in a session with youth to talk about contaminants in drug supply, encourage them to not combine substances and to always have a naloxone kit. According to Dr. Gajaria, some youth will also express a fear of being referred to psychotherapy or to seeing a therapist or social worker.“At that point it might be your job as a physician to engage them and support them using supportive psychotherapy if they are engaging around medication,” said Dr. Gajaria.Ultimately, she encourages physicians to leverage their relationship to try and teach a few skills in session with their young patients or to support a young person to develop a sense of safety and then try to refer them to a therapist or group. A study published in CMAJ in April this year found more than 1 in 4 deaths among young people in Canada were opioid-related in 2021. The study also found that the overall number of opioid-overdose deaths also jumped from 3,007 to 6,222 between 2019 and the end of 2021, nationally. For physicians working with Black youth, Dr. Gajaria recommends getting some formal training (such as that offered at CAMH) to be more aware of their biases, to better understand how stereotypes affect the accuracy of their diagnosis, the efficacy of their treatment plan, and to better understand their patients. “Most physicians want to do a good job, training just helps you be a better physician,” she said.

How to be more effective at helping youth prevent illicit drug overdose

Register for free access or login.

Related Topics