The vast majority of Canadian youth being hospitalized for drug-related injuries or overdoses also have a mental-health condition, according to new numbers that show the most common substance behind those hospital stays is cannabis, not alcohol.
The statistics, a one-year snapshot analyzed by the Canadian Institute for Health Information, also reveal a system struggling to manage these cases, particularly with early interventions and follow-up care. According to the data released on Thursday, 65 Canadians aged 10 to 24 were hospitalized each day for harm related to drug use, totalling 23,580 hospital stays, between April, 2017, and March, 2018.
But 17 per cent of these young people were hospitalized more than once over the year. And even more are turning up in emergency departments, where the numbers record five visits for every one hospital stay.
What’s more, these are complex cases: seven out of 10 of the youths hospitalized because of drug use are also dealing with a mental-health issue. Among those, 18 per cent had a psychosis-related disorder such as schizophrenia. This was the second-most-common diagnosis, after mood disorders, such as depression, at 24 per cent.
The report builds on CIHI data released earlier this year that showed the number of children and youth being hospitalized or visiting emergency departments for mental-health reasons has risen significantly across Canada in the past decade – a trend that is no surprise to clinicians working to treat an increasing load of young patients.
Pediatric specialist Nicholas Chadi opened his substance-abuse clinic at Montreal’s Sainte-Justine University Hospital in August, and already has a crowded roster. This includes a 13-year-old hospitalized for an opioid overdose, but also three young people with chronic vomiting brought on by long-term marijuana use. Given the strength of new marijuana on the market, and the fact that many teens use it in edibles and oil concentrates, he said many such cases are likely happening across the country.
While the study predates legalization, cannabis was identified in nearly 40 per cent of the hospitalizations, with alcohol at 26 per cent. This is a reversal of the pattern among older Canadians, the study notes; among those over 25, alcohol is the cause of 58 per cent of hospitalizations related to drug use – six times more than cannabis. Opioids were identified in 10 per cent of youth cases. In one quarter, more than one drug was identified. In 27 per cent of cases, the substance was not identified.
hospital stays for harm
caused by substance use
Percentage among youth involving care for a
concurrent mental health condition, by sex,
Canada, 2017–2018
Both
sexes
Mental health condition
Females
Males
69%
72%
66%
All mental health disorders
Schizophrenia, delusional and
non-organic psychotic disorders
18%
9%
26%
Mood/affective disorders
24%
28%
20%
Anxiety disorders
12%
14%
10%
Selected disorders of adult
personality and behaviour
16%
21%
12%
11%
9%
13%
Neurodevelopmental disorders
13%
17%
9%
Trauma/stressor-related disorders
12%
17%
7%
Other disorders
john sopinski/the globe and mail
source: canadian institute for health
information
hospital stays for harm
caused by substance use
Percentage among youth involving care for a concurrent
mental health condition, by sex, Canada, 2017–2018
Both
sexes
Mental health condition
Females
Males
69%
72%
66%
All mental health disorders
Schizophrenia, delusional and
non-organic psychotic disorders
18%
9%
26%
Mood/affective disorders
24%
28%
20%
Anxiety disorders
12%
14%
10%
Selected disorders of adult
personality and behaviour
16%
21%
12%
11%
9%
13%
Neurodevelopmental disorders
13%
17%
9%
Trauma/stressor-related disorders
12%
17%
7%
Other disorders
john sopinski/the globe and mail, source: canadian
institute for health information
hospital stays for harm caused by substance use
Percentage among youth involving care for a concurrent mental health condition,
by sex, Canada, 2017–2018
Mental health condition
Both sexes
Females
Males
69%
72%
66%
All mental health disorders
Schizophrenia, delusional and
non-organic psychotic disorders
18%
9%
26%
Mood/affective disorders
24%
28%
20%
Anxiety disorders
12%
14%
10%
Selected disorders of adult
personality and behaviour
16%
21%
12%
11%
9%
13%
Neurodevelopmental disorders
13%
17%
9%
Trauma-and stressor-related disorders
12%
17%
7%
Other disorders
john sopinski/the globe and mail, source: canadian institute for health information
The majority of his patients are also struggling with mental illness, Dr. Chadi said. Their care is complicated by a lack of training in this area among emergency-department physicians, limited access to therapy and a shortage of youth-friendly follow-up care in the community. “There is a big gap between being in hospital and going home,” Dr. Chadi said, especially for young patients with more than one diagnosis who need more support to stay in treatment.
This is especially complicated for many older teenagers, who are moving into the adult health-care system and losing the care they received as pediatric patients, pointed out Peter Szatmari, the chief of the Child and Youth Mental Health Collaborative, an initiative of the Centre for Addiction and Mental Health, The Hospital for Sick Children and the University of Toronto.
The CIHI study found that the rate of hospitalization related to drug use was the highest for young Canadians between the ages of 18 and 24. As well, rates of hospitalizations were higher among rural and low-income youth, and those living in Canada’s North, areas where resources to help with those transitions may be even more scarce. The Northwest Territories had the highest rate of hospitalization, at nearly five times the national average.
Dr. Szatmari said the system needs to provide timely mental-health treatment that includes help for substance use, and easier, one-stop access for teenagers that would help them get well before they end up in a hospital. He said it also needs to ensure “a warm hand-off for chronic cases,” so that patients moving between parts of the health care system remain in treatment, and families aren’t isolated.
“Our system isn’t built for that."
For instance, he said, doctors receive “zero training” to work with youth at the high-risk transition age – those too young to navigate the adult system alone, and too old for hospitals with cartoon stickers in the exam rooms. As a result, “the most vulnerable are the least well served,” he said. “There is a fault line in the way services are put together."
Tracy Masters lost her 30-year-old daughter last spring to an intentional overdose after 15 years of emergency-department visits, hospitalizations and rehab. Now a community advocate in Campbell River, B.C., she started her own substance support group, and she says the longer young people go without supportive treatment, the more hopeless they become – a despair she saw firsthand in her daughter. The challenge for an overwhelmed system, she says, is “connecting with people so they are not left alone,” especially when they leave hospital. “Someone who can sit down and say, ‘Let’s talk.’ ” And perhaps offer young people another door to use for help that doesn’t involve waiting in an emergency room.
Erin Anderssen