Sunday, October 26, 2025

Canada is failing the rising numbers of youth who use opioids


Canadian Medical Association Journal




Youth opioid use is increasing in Canada, as are related emergency department visits and deaths, yet governments are not providing adequate support to address this public health crisis, argue the authors of a CMAJ (Canadian Medical Association Journal) editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251682.

“If this crisis is not properly addressed now, Canada’s health systems will play a part in perpetuating the opioid crisis for decades to come,” write Dr. Shannon Charlebois, medical editor, CMAJ, and Dr. Shawn Kelly, a pediatrician and addictions medicine specialist, CHEO and the University of Ottawa, Ottawa, Ontario.

In Ontario, students’ use of prescription opioid pain relievers for nonmedical reasons increased significantly from 12.7% in 2021 to 21.8% in 2023. Students in younger grades (7 to 9) were more likely to report use than older high school students (grades 10 to 12). Youth aged 15 to 24 made up 9% of emergency department visits in Ontario for opioid use, and opioid-related deaths increased 369.2% from 2.6 to 12.2 per 100 000 population from 2013 to 2021.

Paradoxically, youth struggle to access opioid agonist therapy, with evidence showing that fewer prescriptions are written even as the need increases. Other effective treatments, such psychological therapy and substance use disorder programs, are sparse, have long wait-lists, and are often privately funded, making them inaccessible to those most at risk.

“Health systems’ inaction and lack of investment to provide evidence-based addictions services for youth is inexcusable, as the opioid crisis involves this population. Physicians who treat youth need support to be able to care for their patients with OUD [opioid use disorder]. Anything less represents complicity in the next decade of preventable deaths,” they conclude.

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Can inpatient care help address overdose crisis?



Canadian Medical Association Journal





Is expanding hospital inpatient, or bed-based, care a way to help address the overdose crisis? An analysis article in CMAJ (Canadian Medical Association Journalhttps://www.cmaj.ca/lookup/doi/10.1503/cmaj.240955  describes the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), which can help provinces determine whether bed-cased care is effective.

British Columbia and Alberta, the two provinces with the highest rate of overdose deaths, are focusing more on bed-based care. British Columbia is considering expanding capacity, and Alberta is planning to build 11 new inpatient facilities to help people with substance use disorder (SUD).

Inpatient care offers a range of supports, from reducing drug use to abstinence, with a range of medications and psychological treatments. However, access to care is challenging, with long wait-lists because of a lack of beds and specialized health workers.

“The RE-AIM framework is flexible enough to incorporate evaluation of the effectiveness of component services, as well as the extent to which they meet the needs of the eligible client base and how facilities expand, adapt, and are sustained over the long term,” writes Dr. Bohdan Nosyk, a professor at Simon Fraser University, Burnaby, BC, and a scientist at the Centre for Advancing Health Outcomes, Vancouver, BC, with coauthors.

“Bed-based models of care for people with SUD offer multifaceted, complex interventions that are resource intensive. Effectiveness is therefore difficult to evaluate. Using the RE-AIM framework helps to highlight suboptimal evidence of effectiveness of bed-based care and likely limited capacity relative to the size of the populations with SUD.”

The authors suggest that the RE-AIM framework can help provinces evaluate whether bed-based care for SUD can meet the needs of their populations and whether it is effective for improving outcomes for people with SUD.

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