Developing evidence-based practice guidelines for delivering and monitoring youth-centred opioid agonist treatment

Background: Opioid use disorder (OUD) is a chronic health condition that impacts over 26 million people worldwide and is one of the largest contributor of global disease burden (e.g., blood-borne infections, unintentional injuries, overdose deaths, suicide). Opioid agonist treatment (OAT) is widely recognized as the safest and most effective treatment for people with OUD. Yet, youth encounter substantial structural barriers to engage with OAT (e.g., age-based eligibility criteria, misinformation, and stigma). Further, youths’ treatment goals, preferences, and needs often do not align with how OAT is currently delivered (e.g., daily dispensation). Thus, this life-saving treatment remains underutilized among youth, further exacerbating opioid-related harms (e.g., mental and physical morbidity, social exclusion, mortality) in North America and many nations globally. Objective: This project aims to develop evidence-based practice guidelines for the delivery and monitoring of youth-centred OAT. These guidelines will help service providers deliver OAT and measure outcomes that are relevant and informed by youth. Methods: In the first phase of this study (completed), we conducted a scoping review to identify and summarize peer-reviewed literature published between 2015 and 2023 on the full range of evidence-based interventions and health-related services for youth (ages 12-25) who use unregulated opioids in North America. In the second phase (December 2023 – January 2024), we will conduct semi-structured interviews with four expert groups (youth, caregivers, service providers, and policy makers) who have experience receiving, delivering, or making decisions on the implementation and monitoring of OAT for youth. Interviews will collect data on their perspectives of the optimal principles, characteristics, settings, and outcomes of a youth-centred OAT model of care, as well as their recommendations for implementing a best practice across diverse healthcare settings. The interviews will be audio-recorded, transcribed, and analyzed using a directed content analysis approach. We will share the findings from the analysis at the conference and use them to inform the implementation of youth-centred OAT across Foundry, a network of integrated youth services in British Columbia. Results/Implications: Twenty-five articles were included in the scoping review. The findings show that OAT leads to improved substance use outcomes among youth, however treatment effects were not as strong as in adults. Few studies in the scoping review were conducted in healthcare settings that were tailored to youth or in integrated care settings where youth could engage with comprehensive and individualized care. The results of the review support the need for developing youth-centred OAT practice guidelines. The practice guidelines will improve the quality and monitoring of OAT for youth, and thus, reduce the adverse harms associated with opioid use. While these guidelines will be developed from the perspective of experts in British Columbia, they can provide direction for pan-Canadian and international guidelines.