Opioid-related deaths are increasing among youths aged 15 to 24 years in the province of Ontario, Canada, while the use of opioid agonist treatment (OAT) is declining, according to new research.
In a cross-sectional study in which investigators analyzed public health data for the years 2013 to 2021, opioid-related deaths among youths in Ontario increased by almost 370%, but the rate of OAT use among youths decreased by 56%.
Dr Tea Rosic
“We don’t know what is causing this, but it signals that we need more studies in this population of adolescents and youth to understand why we are seeing deaths increasing, while treatment is decreasing,” lead author Tea Rosic, MD, PhD, child and adolescent psychiatrist at Children’s Hospital of Eastern Ontario in Ottawa, Canada, told Medscape Medical News. “There may be different explanations for this, but we can only hypothesize at this point until more research is done.”
The findings were published July 6 in JAMA Network Open.
Contributing Factors Unknown
Despite efforts by public health officials and society in general, the opioid crisis is not abating. Young people between the ages of 15 and 24 years have generally been understudied, said Rosic. They are experiencing great suffering but aren’t necessarily receiving the scientific attention that may be warranted, she added.
This age group is important, because youths are still developing neurobiologically, socially, educationally, and emotionally. “It is a time point in one’s life where I believe we can meaningfully intervene to change trajectories. This is not necessarily the case with adults. But we need resources, we need research that is specific to this population, because it can be very difficult to make conclusions or to apply things from adult literature that may or may not fit for children,” she said.
The investigators used data from the Ontario Drug Policy Research Network, Public Health Ontario, and Statistics Canada to analyze rates of OAT and opioid-related deaths among individuals aged 15 to 44 years. The cohort was stratified into two groups: youth (aged 15 to 24 years) and adults (aged 25 to 44 years). Rates of OAT (including methadone, buprenorphine, and slow-release oral morphine) and opioid-related deaths were calculated for both groups.
From 2013 to 2021, 1021 youths died of opioid toxicity. Most (710, 69.5%) were male. In the final year of the study period, 225 youths (146 male, 64.9%) died of opioid toxicity, and 2717 (1494 male, 55.0%) received OAT.
During the study period, the rate of opioid-related deaths among youths increased by 369.2%, from 2.6 per 100,000 population to 12.2 per 100,000 population. In total, there were 48 opioid-related deaths in 2013 and 225 deaths in 2021. Despite this huge rise in deaths in this population, the use of OAT declined by 55.9%, from 3.4 per 1000 population to 1.5 per 1000 population (6236 to 2717 individuals).
A similar trend for opioid-related deaths was observed among adults aged 25 to 44 years. Over the study period, deaths in that population increased by 371.8%, from 7.8 per 100,000 to 36.8 per 100,000. The totals increased from 283 deaths in 2013 to 1502 deaths in 2021. But unlike among youths, the rate of OAT increased by 27.8%, from 7.9 per 1000 population to 10.1 per 1000 population (28,667 to 41,200 patients).
Trends in rates of OAT and deaths were similar for males and females.
“Public health data give us a big-picture snapshot of what is going on but don’t give us answers about what is contributing to these alarming results,” said Rosic. “Why are so few youths getting OAT treatment? Is it because there are fewer young people with the diagnosis of opioid use disorder? Are there barriers to treatment for young people? Is there something else that we don’t know about? These are very troubling findings.”
Barriers to Treatment?
Commenting on the study for Medscape, Naomi Steenhof, PhD, assistant professor of pharmacy at the University of Toronto, said that much more research is needed in this vulnerable group of individuals. “This study raises a lot of questions and uncovers a lot that we do not know,” she added. Steenhof did not participate in the research.
Dr Naomi Steenhof
“I was talking with some colleagues about this paper, and we all felt that the results are extraordinarily concerning. For me, the biggest concern is the increase in opioid-related deaths in that younger age group. It’s very scary,” she said.
Steenhoff noted that the reduction in OAT therapy among youths could mean that this age group is less likely to be diagnosed with opioid use disorder and, as a result, is less likely to get treatment.
“There is more recreational use at that age, either with experimentation or just trying one time and then perhaps taking something laced with fentanyl. That is a huge problem in Canada, as well as the United States. In Ontario, we have a very contaminated drug supply. Close to 90% of the opioid-related deaths that occurred in 2021 were directly related to fentanyl contamination,” said Steenhoff.
“We need more information to find whether the youths who are dying do indeed have opioid use disorder or whether they are at very high risk of dying because of the fentanyl. Are they trying to access treatment without success? We need answers to these questions.”
The study was funded by ICES, the Ontario Ministry of Health, and the Canadian Institutes of Health Research. Rosic and Steenhof reported no relevant financial relationships.
JAMA Netw Open. Published July 6, 2023. Full text
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