“The system always undermined what I was trying to do as an individual”: identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada

Abstract

Background Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. Methods This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers’ (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. Results Three overarching themes were identified, reflecting service providers’ goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers’ priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. Conclusion These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths’ needs (micro-level).

Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers

“…The developed innovations directly responded to the needs of youth (virtual OAT guide) and caregivers (caregiver handbook), which were expressed during the Phase 1 workshops [ 24 , 53 , 54 ] and supported by the literature. For example, although OAT is a first-line evidence-based intervention to treat OUD among youth and adults, youth have described being dissuaded by family members and service providers about accessing OAT or being denied certain OAT options (e.g., full opioid agonists such as methadone) [ 31 , 33 ].…”

“…The findings from Phase 1 have been published elsewhere [ 24 , 53 , 54 ]. Briefly, Phase 1 began by developing a partnership between the Canadian Centre on Substance Use and Addiction (CCSA), a national organization providing leadership on addressing substance use related harms, and Foundry Central Office, a central hub for a provincial network of integrated youth services in BC.…”

“…Applying CBPR and co-design can help researchers and healthcare providers bridge the gap between research and practice by improving their understanding of service user experiences and needs within the healthcare system and developing patient-centered innovations that are acceptable and responsive to local contexts. These approaches may improve the experiences and outcomes of community-based opioid use treatments/services for youth, as current organizational- and system-level policies often hinder service providers’ ability to meet the individual needs of youth, which are closely related to their local context [ 24 ]. For instance, British Columbia (BC) guidelines on opioid agonist treatment (OAT) best practices require people to access a pharmacy daily to acquire their OAT, which does not consider the barriers of living in rural and remote communities (e.g., transportation, travel distance, pharmacy hours) [ 24 ].…”

“…These approaches may improve the experiences and outcomes of community-based opioid use treatments/services for youth, as current organizational- and system-level policies often hinder service providers’ ability to meet the individual needs of youth, which are closely related to their local context [ 24 ]. For instance, British Columbia (BC) guidelines on opioid agonist treatment (OAT) best practices require people to access a pharmacy daily to acquire their OAT, which does not consider the barriers of living in rural and remote communities (e.g., transportation, travel distance, pharmacy hours) [ 24 ]. Although CBRP and co-design methods can limit the generalizability of findings to a specific community or region, these investigations are crucial for developing solutions that work in practice.…”

“…Improving youths' access to opioid use treatments/services is particularly important given the ongoing opioid toxicity crisis in Canada, which accounted for 32,632 deaths between January 2016 and December 2022 [25]. Youth (ages [15][16][17][18][19][20][21][22][23][24] represent 21% of these deaths and have the fastest growing rates of opioid-related toxicity hospitalizations [26]. Using substances early in life can have detrimental effects on youths' substance use trajectories and is predictive of developing health and psychosocial problems later in life [27][28][29].…”