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B.C. agency releases first guidelines on treating youth with opioid-use disorder

The agency that oversees treatment of substance use and addiction in British Columbia has released new guidelines for treating young people with opioid-use disorder, emphasizing a range of pharmaceutical and counselling options and cautioning against traditional approaches such as detox alone.

The comprehensive document released on Wednesday is the first of its kind to help physicians and the public navigate addiction treatment specifically for young people, and includes modern therapies for a group traditionally limited to short-term detoxification, a process that rids the body of drugs, and counselling.

The British Columbia Centre on Substance Use developed the guidelines with a provincial committee of health partners and representatives of community and family groups. They supplement broader provincial guidelines on treating opioid addiction released last summer.

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“This document will help guide physicians, but can also be used for self-advocacy, for patients and for loved ones of patients,” said Sharon Vipler, a general practitioner specializing in addiction medicine with Providence Health Care and the Fraser Health Authority and co-chair of the development committee.

“I think it will build the confidence of the general treatment community around treating youth with opiate-use disorder.”

People between the ages of 10 and 24 account for one-fifth of all overdose deaths from illicit opioids in B.C., but to date there has been a dearth of guidelines based on clinical studies involving young people, and youth-focused treatment resources.

The guidelines note the importance of tailoring youth-focused care to the individual. Unique factors to consider include a patient’s relationship with caregivers, schooling, maturity level and access to housing.

Young people with moderate to severe opioid-use disorder who could benefit from substitution therapy with safer drugs known as opioid agonists are advised to begin with buprenorphine-naloxone (Suboxone). Those who do not respond adequately to that can consider methadone.

Such medication-assisted therapies can be appropriate for people with severe opioid-use disorders as young as about 18, but physicians are advised to base clinical judgment on individual needs, Dr. Vipler said.

“An example would be that a number of us are seeing patients who started the use of opioids at the age of 12 or 13,” she said. “To say that someone has to wait until the age of 18 to receive evidence-based medication seems both cruel and unjust – and obviously potentially dangerous given the current environment.”

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Leslie McBain, whose son, Jordan Miller, died of an opioid overdose in Victoria in 2014, was pleased with the new guidelines. Mr. Miller, who became dependent on oxycodone after he was prescribed it for a workplace injury when he was 23, had researched buprenorphine-naloxone and was convinced he would benefit from it.

However, the family was not able to find a physician who would prescribe it. Mr. Miller went to detox but relapsed and fatally overdosed a few months later. He was 25.

“Everything in the guidelines around [opioid-agonist treatment] makes perfect sense to me,” Ms. McBain said. “That’s what we were trying to access when Jordan was addicted, but we had no resources to call on. I felt like I called every doctor that was available in Victoria.”

The guidelines also note that youth with opioid-use disorder should be routinely offered counselling and be screened for disorders that include other mental-health issues.

The transition to adult-oriented services should also be gradual, rather than abrupt.

“If you’re a provider that solely deals with youth, that means to recognize early on that there’s a transition coming up and ... really bridging between two service providers rather than that person dropping out of one service and having to find another one,” Dr. Vipler said.

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At least 1,449 people died of illicit drug overdoses in B.C. last year. Fentanyl, a powerful painkiller, was detected in about 84 per cent.

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