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UBC Theses and Dissertations

A paradigm shift in the treatment of high-risk substance use and overdose among youth Westenberg, Jean Nicolas


Mental and substance use disorders are the leading cause of disability and overall burden of disease in children and youth worldwide. Further, overdose and suicide are the leading contributors to mortality among youth in North America. The need for effective healthcare systems for youth will only become more substantial, especially in the context of the opioid overdose crisis and the COVID-19 pandemic. This research investigated the current paradigm surrounding substance use disorder treatment among youth and aimed to contribute a more innovative and effective response to high-risk substance use and overdose among youth. Firstly, a narrative review assessed the current reality of treatment approaches for high-risk opioid use among youth by means of narrative review. Findings revealed a dearth of academic effort and clinical research on interventions for youth with high-risk substance use, which demonstrates the many gaps within the field of addiction psychiatry and adolescent medicine. Secondly, a rapid review evaluated the clinical guidance in place for youth with high-risk opioid use. The clinical practice guidelines available, or lack thereof, reaffirms the systematic failure in addressing the mental health and substance use needs of youth. Lastly, to inform service development and ameliorate the standard of care for youth, a multidisciplinary panel of clinicians and researchers in the field of youth substance use disorder developed 60 recognized statements through Delphi process. This international collaborative project provides a basis for education and establishes an infrastructure for research by outlining clinical risks, determining target populations, defining intervention goals, recognizing evidence-based strategies, and identifying appropriate treatment settings and expertise. Comprehensively, this research identifies critical problems in the current systems of care for adolescents and young adults internationally and provides a framework for the improved prevention, treatment, and management of high-risk substance use and overdose among this vulnerable group. Healthcare systems must strive to support youth through their development with tailored and stigma-free evidence-based approaches. High-quality studies are needed to further determine the safety and effectiveness of treatment options for youth.

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