Complexities of treating opioid addicted B.C. youth prompt new guidelines
Prescription pill bottle containing oxycodone and acetaminophen are shown on June 20, 2012. (Graeme Roy / THE CANADIAN PRESS)
VANCOUVER -- New guidelines aimed at improving treatment for opioid-addicted young people have been released by the British Columbia Centre on Substance Use, which says a lack of youth-focused treatment programs has created challenges in the province with the highest number of fatal overdoses.
Rachel Staples, whose 15-year-old son Elliot Eurchuk died in April from an accidental overdose, said that while the guidelines are a good start, insufficient treatment beds and a law prohibiting parental involvement in care without a youth's consent are big problems that must be addressed.
Dr. Sharon Vipler, who was on the committee that developed the guidelines, said they call on doctors to prescribe treatment drugs such as suboxone before methadone is tried, as well as counselling to support youth dealing with addiction.
The guidelines say short-term detox programs alone are not recommended because they tend to increase rates of relapse, HIV infection and overdose death but that patients should be referred to ongoing treatment, including in residential facilities.
Doctors are encouraged to screen all youth for substance use disorders and mental health disorders and to refer patients to addiction physicians with experience treating youth with opioid use disorder.
Physicians should also work to ensure their young patients are provided continuing treatment as they enter adulthood, with future caregivers identified early to prevent scrambling to get them into another program, said Vipler, an addictions specialist who works at a detox centre in Surrey, which has six beds for youth.
"What we're saying is that if you are a clinician providing care for an individual who is going to age out imminently or even in the foreseeable year or so, that process should start as soon as that thought comes into mind," she said.
The guidelines also call for involvement of family so youth have the emotional support they need. However, the Infants Act in B.C. says children under 19 may consent to a medical treatment on their own if the health-care provider is sure the treatment is in the child's best interest and if the child understands its potential risks and benefits.
"Parental participation in the treatment of youth should be actively encouraged, and family members should be supported with sufficient information and training," say the new guidelines.
Staples, whose son was found dead from an overdose at the family's home in April, said she and her husband, Brock Eurchuk, couldn't legally get involved in his care without his consent after he was hospitalized for a bone infection related to drug use.
"To have guidelines, great. But there also has to be a time and place where adults can intervene for the child's welfare. Because if their brain is soaked in opioids like Elliot's was, they cannot make a rational decision to accept treatment."
Staples said her son initially overdosed in hospital and was revived when a nurse administered naloxone but she and her husband weren't given any information indicating the seriousness of his addiction because he insisted he was OK and didn't want them involved.
"Nobody told us he came into hospital having opioids on board," she said of his hospitalization for a bone infection related to drug use.
She said he got illicit drugs on the street when he was given a day pass from the hospital after becoming addicted to prescribed opioids following four surgeries -- two for a jaw that was fractured on a soccer field and two for shoulder reconstruction from wrestling.
When he was discharged from hospital, she and her husband mentioned taking him to a nature-based treatment program in Oregon because of a lack of facilities near their home, but a social worker at the hospital told them they would be reported for kidnapping, Staples said.
She is advocating for the Safe Care Act, which the Opposition Liberals have introduced as a way to allow parents to force their drug-addicted children into treatment.
Staples said the family was financially able to pay for treatment, but many people are not in that position so subsidies should be provided for people willing to pay part of the cost in light of a lack of treatment beds.
The B.C. Coroner's Service reported there were 1,449 illicit drug over deaths in 2017, an increase from 992 deaths from a year earlier.
The service said 23 people between the ages of 18 and 23 died in 2017, and 270 of them were aged 19 to 29.