New CPSP study aims to close data gaps on substance use and overdose trends in youth

In 2022, a one-time CPSP survey exposed an increasing rate of exposure to opioids, sedatives, and stimulants in youth 12-18 years old. The same team—led by Drs. Matthew Carwana, Nicholas Chadi, and Eva Moore—has recently launched a multi-year study to better understand the trends of this crisis and to identify knowledge gaps for the health care providers treating these young people. We sat down with co-Principal Investigator Dr. Nicholas Chadi, for more information.

[This interview has been edited for clarity and brevity]

CPS: This 3-year study follows from a one-time survey. What were the most striking results from that survey and what led to this longer-term study?

NC: We've seen a worrisome trend over the past few years. Since 2022, overdose deaths are the main cause of mortality among adolescents in Western Canada. And this is a phenomenon that evolved quickly, just from the beginning of the pandemic. This led to the first cross-sectional survey. The most striking finding to me was that 14 per cent of respondents reported having seen at least one young person with a severe and acute event related to the use of an opioid, sedative, or stimulant substance in the past two years.

That seemed quite high and meant that paediatricians do intersect frequently with young people with these issues. It also correlates with the national data that we are seeing: an increase in overdose deaths related to illicit drugs. Given these findings, our group was interested in continuing the investigations and learning more about the characteristics of young people who present in situations related to the use of sedatives, stimulants, and opioids, as well as what treatment they received.

CPS: You mentioned that overdose deaths are the leading cause of youth mortality in Western Canada. Is this an issue that paediatricians across the country need to be on the lookout for?

NC: Absolutely. When we look at general trends in substance use over the past few decades, there's some good news and there's some less good news. We are seeing positive trends, such as cigarette smoking rates in young people really trending downwards, and use of substances like alcohol also trending downwards more generally. In recent years, we've seen misuse of prescription opioids go down, actually, among adolescents. However, some other trends have emerged. Increased rates of nicotine vaping, use of certain high potency cannabis products, and also the use of very high potency, synthetic, opioids or sedative substances like benzodiazepines. Given the potency of different prescription medications or illicit substances that young people may be misusing, there has been a trend toward more opioid, sedative, and stimulant overdose deaths in young people. And that's a trend that is seen across Canada. Specifically in Western Canada, but other provinces are also seeing increased rates of overdose deaths or severe substance use related events when it comes to opioids, sedatives, and stimulants.

CPS: In general, do you feel that paediatricians are well equipped to handle overdose and substance use disorder?

NC: There is very limited training and exposure to substance use issues during paediatric training. There have been some improved resources through the past few years, but many paediatricians still feel they don't necessarily have the right training to address severe substance use in young people. There's a need to develop more awareness about the issue; but also, better guidelines, practice aids, and materials to support paediatricians caring for young people with substance use-related problems. And this can start in medical schools and residency programs, as well as through continuing medical education.

 [Dr. Chadi recently published a clinical report with the American Academy of Pediatrics, providing guidance for paediatricians on recognizing, screening for, and addressing non-medical use of controlled or prescription opioids, stimulants, and sedatives.]

CPS: Can you give your elevator pitch for why paediatric care providers should report cases to the CPSP?

NC: The fact that so many young people are having acute, life-threatening events related to the use of substances in the opioid, sedative, and stimulant category make it a true paediatric health issue. Given that it's the first cause of mortality in Western Canada—and there's a risk that this may become true for the entire country—paediatricians need to know how best to prevent, recognize, and treat these cases. We need to know more about individual cases, and this is specifically what this study is trying to do. As investigators, we are trying to understand why these young people are having these events related to these three categories of substances. What are some of the risk factors that might have led to these events? What are the treatments they are currently receiving, and are those aligned with current treatment recommendations? If there is a gap—if there are ways to improve this care—then this will certainly help generate more educational resources and can help shape targeted advocacy efforts to make sure that the right resources are available in the right settings all across Canada for all young people who may be exposed to the harms and sometimes deadly consequences of misuse of opioids, stimulants, and sedatives.

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For this study, respondents are asked to report any patient less than 18 years of age who requires ED care, hospitalization, or admission to an ICU, or who requires resuscitation (e.g., naloxone) outside of hospital, due to:

• use of an illicit/non-prescription opioid, stimulant, or sedative substance, or
• the non-medical use of a prescription opiate (e.g., codeine, hydromorphone, oxycodone), stimulant (e.g., psychostimulants), or sedative drug (e.g., benzodiazepines, barbiturates).

Please email CPSP@cps.ca if you have seen a case.

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