Grant: Operating Grant: SickKids-CIHR-IHDCYH New Investigator Grants

Canadian youth who use drugs are vulnerable to severe health and social harms. Recently, the emergence of fentanyl and other opioid analogues in the illicit drug market has led to dramatic increases in overdoses across Canada. In British Columbia, young people ages 20 to 29 comprise approximately one quarter of overdose fatalities, while youth ages 15 to 24 represent the fastest growing age demographic for hospitalizations due to opioid poisoning in Canada. Street-involved youth (defined as those temporarily or absolutely without housing or accessing street youth services) are particularly vulnerable to overdose and other drug-related harms. The overdose crisis underscores the urgent need to intervene early to address substance use among vulnerable youth ages 14 to 18. As a setting that has been badly affected by the opioid overdose crisis, efforts are currently underway in Greater Vancouver to improve youth’s engagement with addiction services, including harm reduction services, residential detoxification and treatment, psychosocial programs, and opioid agonist treatment. However, given the well documented systemic gaps and barriers to addiction services experienced by Canadian youth, and in particular street-involved youth, many important questions remain regarding how to effectively implement, adapt, and scale up services in this and other affected settings. In particular, we lack an understanding of how to best integrate services across the multiple systems that vulnerable youth interface with, including pediatric care, mental health care, foster care, criminal justice and frontline service (e.g., shelter) systems. The proposed ethno-epidemiological study will integrate qualitative methods, including longitudinal interviewing and ethnographic fieldwork, with quantitative behavioral and clinical data to delineate the individual, social, structural and environmental contexts that influence the effectiveness of different youth-focused addiction services, and to identify how they can best be adapted to meet the unique needs of youth as they move across multiple systems of care and supervision.