Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

English version

Autoři: Cayley Russell ^aff001; Maria Neufeld ^aff001; Pamela Sabioni ^aff001; Thepikaa Varatharajan ^aff001; Farihah Ali ^aff001; Sarah Miles ^aff004; Joanna Henderson ^aff005; Benedikt Fischer ^aff001; Jürgen Rehm ^aff001
Působiště autorů: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada ^aff001; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany ^aff002; Translational Addiction Research Lab, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada ^aff003; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada ^aff004; Department of Psychiatry, University of Toronto, Toronto, ON, Canada ^aff005; The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada ^aff006; Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada ^aff007; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ^aff008; Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil ^aff009; Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada ^aff010; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada ^aff011; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation ^aff012
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225548

Souhrn

Background

Illicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study.

Methods

This study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14–25) who live in Northern Ontario and use illicit drugs. Interviews with ‘key informants’ who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures.

Results

A total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported ‘fair’ mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling.

Conclusions

Although each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.

Klíčová slova:

Drug therapy – Drug research and development – Mental health and psychiatry – Addiction – Opioids – Recreational drug use – Drug administration – Ontario

Zdroje

1. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2018. Vienna, Austria: United Nations Office on Drugs and Crime (UNODC); 2019.

2. Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI, et al. Why young people's substance use matters for global health. The Lancet Psychiatry 2016, 3(3):265–279. doi: 10.1016/S2215-0366(16)00013-4 26905482

3. Erskine HE, Moffitt TE, Copeland WE, Costello EJ, Ferrari AJ, Patton G, et al. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2014, 45(7):1551–1563. doi: 10.1017/S0033291714002888 25534496

4. Health Canada. Canadian Tobacco, Alcohol and Drugs Survey (CTADS): Summary of results for 2017. Ottawa, ON: Health Canada; 2019.

5. Canadian Centre for Substance Abuse (CCSA). A Drug Prevention Strategy for Canada's Youth. Ottawa, ON: Canadian Centre for Substance Abuse (CCSA); 2007.

6. Canadian Centre on Substance Abuse (CCSA). Substance Abuse in Canada: Youth in Focus. Ottawa, ON: Canadian Centre on Substance Abuse (CCSA); 2007.

7. Canadian Centre on Substance Abuse (CCSA). Cross-Canada Report on Student Alcohol and Drug Use: Technical Report Ottawa, ON: Canadian Centre for Substane Abuse (CCSA); 2011.

8. Boak A, Hamilton HA, Adlaf EM, Mann RE. Drug Use Among Ontario Students, 1977–2017: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) CAMH Research Document Series. Toronto, ON: Centre for Addiction and Mental Health (CAMH); 2017.

9. Ialomiteanu AR, Hamilton HA, Adlaf E, M., Mann RE. CAMH Monitor E-Report: Substance Use, Mental Health and Well-Being Among Ontario Adults, 1977–2017. Toronto, ON: Centre for Addiction and Mental Health (CAMH); 2018.

10. Gomes T, Khuu W, Martins D, Tadrous M, Mamdani MM, Paterson JM, et al. Contributions of prescribed and non-prescribed opioids to opioid related deaths: population based cohort study in Ontario, Canada. BMJ 2018, 362:k3207. doi: 10.1136/bmj.k3207 30158106

11. Russell C, Firestone M, Kelly L, Mushquash C, Fischer B. Prescription opioid prescribing, use/misuse, harms and treatment among Aboriginal people in Canada: a narrative review of available data and indicators. Rural Remote Health 2016, 16(4).

12. Rush B, Kirkby C, Furlong A. North East Local Health Integration Network Addiction Services Review. North Bay, ON: North East Local Health Integration Network 2016.

13. Kurdyak P, Binu J, Zaheer J, Fischer B. Patterns of Methadone Maintenance Treatment Provision in Ontario: Policy Success or Pendulum Excess?. Canadian Family Physician 2018, 64(2):95–103.

14. Rowan M, Poole N, Shea B, Gone JP, Mykota D, Farag M, et al. Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy 2014, 9(1):34.

15. Brownlie EB, Chaim G, Heffernan O, Herzog T, Henderson J. Youth Services System Review: Moving From Knowledge Gathering to Implementation Through Collaboration, Youth Engagement, and Exploring Local Community Needs. Can J Commun Ment Health 2017, 36(2):133–149.

16. Mental Health and Addictions Leadership Advisory Council. Better Mental Health Means Better Health: Annual Report of Ontario’s Mental Health & Addictions Leadership Advisory Council Toronto, ON: Mental Health and Addictions Leadership Advisory Council,; 2015.

17. Winters KC, Botzet AM, Fahnhorst T. Advances in Adolescent Substance Abuse Treatment. Curr Psychiatry Rep 2011, 13(5):416–421. doi: 10.1007/s11920-011-0214-2 21701838

18. Chiefs of Ontario. Ontario Region first nations Addiction Service Needs Assessment: Final Report. Ottawa, Ontario: First Nations and Inuit Health Branch of Health Canada & Chiefs of Ontario; 2009.

19. North East Local Health Integration Network (LHIN). 2016/2017 Annual Report. North Bay, ON: North East Local Health Integration Network; 2018.

20. North West Local Health Integration Network (LHIN). 2015–2016 North West Local Health Integration Network (LHIN) Annual Business Plan Thunder Bay, ON: North West Local Health Integration Network (LHIN); 2017.

21. Luce J, Strike C. A Cross-Canada Scan of Methadone Maintenance Treatment Policy Developments. Toronto, ON: Canadian Executive Council on Addictions; 2011.

22. Anderson TJ, Saman DM, Lipsky MS, Lutfiyya MN. A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings. BMC Health Serv Res 2015, 15(1):441.

23. Strasser R. Rural health around the world: challenges and solutions. Fam Pract 2003, 20(4):457–463. doi: 10.1093/fampra/cmg422 12876121

24. Weaver KE, Geiger AM, Lu Lingyi, Case LD. Rural-urban disparities in health status among US cancer survivors. Cancer 2013, 119(5):1050–1057. doi: 10.1002/cncr.27840 23096263

25. Sibley LM, Weiner JP. An evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Serv Res 2011, 11(1):20.

26. Ryan-Nicholls KD, Haggarty JM. Collaborative mental health care in rural and isolated Canada: Stakeholder feedback. J Psychosoc Nurs Ment Health Serv 2007, 45(12):37–45. 18246862

27. Calloway M, Fried B, Johnsen M, Morrissey J. Characterization of rural mental health service systems. The Journal of Rural Health 1999, 15(3):296–307. doi: 10.1111/j.1748-0361.1999.tb00751.x 11942562

28. Rost K, Fortney J, Fischer E, Smith J. Use, quality, and outcomes of care for mental health: The rural perspective. Med Care Res Rev 2002, 59(3):231–265. doi: 10.1177/1077558702059003001 12205828

29. Borders TF, Booth BM, Stewart KE, Cheney AM, Curran GM. Rural/Urban Residence, Access, and Perceived Need for Treatment Among African American Cocaine Users. The Journal of Rural Health 2015, 31(1):98–107. doi: 10.1111/jrh.12092 25213603

30. Hsia R, Shen Y-C. Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural CommunitiesTrauma Center Access for Vulnerable Patients. JAMA Surgery 2011, 146(1):46–52.

31. Smalley KB, Yancey CT, Warren JC, Naufel K, Ryan R, Pugh JL. Rural mental health and psychological treatment: A review for practitioners. Journal of clinical psychology 2010, 66(5):479–489. doi: 10.1002/jclp.20688 20222125

32. Regan S, Wong ST. Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural Remote Health 2009, 9(1):1142. 19298094

33. Amartey A, Chium M, Gatov EJ, Guttmann A, Lebenbaum M, Kurdyak P, et al. The Mental Health of Children and Youth in Ontario: 2017 Scorecard. Toronto, ON: Mental Health and Addictions Scorecard and Evaluation Framework (MHASEF), Institute of Clinical Evaluative Sciences (ICES); 2017.

34. Statistics Canada. Census Profile, 2016 Census: Ontario Ottawa, ON: Statistics Canada; 2016.

35. Varatharajan T, Sabioni P, Russell C, Henderson J, Fischer B, Miles S, et al. Assessing service and treatment needs of young people who use illicit and non-medical prescription drugs living in Northern Ontario, Canada [version 1; peer review: 1 approved with reservations]. F1000Research 2018, 7(1644).

36. Creswell JW, Creswell JD: Research design: Qualitative, quantitative, and mixed methods approaches: Sage publications; 2017.

37. Satcher D: Methods in community-based participatory research for health: John Wiley & Sons; 2005.

38. Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract 2006, 7(3):312–323. doi: 10.1177/1524839906289376 16760238

39. Israel BA, Schulz AJ, Coombe CM, Parker EA, Reyes AG, Rowe Z, et al. Community-based participatory research. Urban Health 2019:272.

40. Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R, et al. Community-Based Participatory Research: A Capacity-Building Approach for Policy Advocacy Aimed at Eliminating Health Disparities. Am J Public Health 2010, 100(11):2094–2102. doi: 10.2105/AJPH.2009.170506 20864728

41. Motulsky H: Analyzing data with GraphPad prism: GraphPad Software Incorporated; 1999.

42. GraphPad Prism. 7.02 GraphPad Software. 2017.

43. Gibbs GR: Qualitative Data Analysis: Explorations with NVivo. Buckingham: Open University; 2002.

44. QSR International Pty Ltd. NVivo qualitative data analysis software: Version 12. 2018.

45. Holkup PA, Tripp-Reimer T, Salois EM, Weinert C. Community-based participatory research: an approach to intervention research with a Native American community. ANS Adv Nurs Sci 2004, 27(3):162–175. doi: 10.1097/00012272-200407000-00002 15455579

46. Public Health Ontario. Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy. Toronto, ON: Public Health Ontario; 2011.

47. Durbin J, Lin E, Zaslavska N. Impact Study, Final Report: A study of hospital emergency service use, crisis service delivery and police response after mental health system enhancements Toronto, Ontario, Canada: Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health; 2010.

48. Brundisini F, Giacomini M, DeJean D, Vanstone M, Winsor S, Smith A. Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis. Ontario health technology assessment series 2013, 13(15):1–33. 24228078

49. Chaim G, Henderson JL, Brownlie EB. Youth services system review. Toronto, ON; 2013.

50. Chaim G, Henderson J. Youth System Services Review Phase 2 Report: A review of the continuum of Ontario services addressing substance use available to youth age 12–24. Toronto, ON; 2014.

51. Wisdom JP, Cavaleri M, Gogel L, Nacht M. Barriers and facilitators to adolescent drug treatment: Youth, family, and staff reports. Addict Res Theory 2011, 19(2):179–188.

52. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010, 10(1):113.

53. Yap MBH, Wright A, Jorm AF. The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help. Soc Psychiatry Psychiatr Epidemiol 2011, 46(12):1257–1265. doi: 10.1007/s00127-010-0300-5 20938638

54. O'Connor PJ, Martin B, Weeks CS, Ong L. Factors that influence young people's mental health help-seeking behaviour: a study based on the Health Belief Model. J Adv Nurs 2014, 70(11):2577–2587. doi: 10.1111/jan.12423 24720449

55. Peterson PL, Baer JS, Wells EA, Ginzler JA, Garrett SB. Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychology of Addictive Behaviors 2006, 20(3):254–264. doi: 10.1037/0893-164X.20.3.254 16938063

56. Schroder R, Sellman D, Frampton C, Deering D. Youth retention: Factors associated with treatment drop-out from youth alcohol and other drug treatment. Drug and Alcohol Review 2009, 28(6):663–668. doi: 10.1111/j.1465-3362.2009.00076.x 19930021

57. Battjes RJ, Gordon MS, O'Grady KE, Kinlock TW, Carswell MA. Factors that predict adolescent motivation for substance abuse treatment. Journal of Substance Abuse Treatment 2003, 24(3):221–232. doi: 10.1016/s0740-5472(03)00022-9 12810143

58. DiClemente CC, Schlundt D, Gemmell L. Readiness and Stages of Change in Addiction Treatment. The American Journal on Addictions 2004, 13(2):103–119. doi: 10.1080/10550490490435777 15204662

59. Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. The Lancet Psychiatry 2016, 3(3):251–264. doi: 10.1016/S2215-0366(15)00508-8 26905480

60. Perlmutter AS, Bauman M, Mantha S, Segura LE, Ghandour L, Martins SS. Nonmedical prescription drug use among adolescents: global epidemiological evidence for prevention, assessment, diagnosis, and treatment. Curr Addict Rep 2018:1–8.

61. Adlaf EM, Hamilton HA, Wu F, Noh S. Adolescent stigma towards drug addiction: Effects of age and drug use behaviour. Addict Behav 2009, 34(4):360–364. doi: 10.1016/j.addbeh.2008.11.012 19097707

62. Corrigan P. How stigma interferes with mental health care. Am Psychol 2004, 59(7):614–625. doi: 10.1037/0003-066X.59.7.614 15491256

63. Gale F: Tackling the stigma of mental health in vulnerable children and young people. In: Mental health interventions and services for vulnerable children and young people. edn. Edited by Vostanis P. London, UK: Jessica Kingsley Publishers; 2007: 58–80.

64. Halsall T, Manion I, Iyer SN, Mathias S, Purcell R, Henderson J: Trends in mental health system transformation: Integrating youth services within the Canadian context. In: Healthcare management forum: 2019: SAGE Publications Sage CA: Los Angeles, CA; 2019: 51–55.

65. Barton J, Henderson J. Peer support and youth recovery: a brief review of the theoretical underpinnings and evidence. Canadian Journal of Family and Youth/Le Journal Canadien de Famille et de la Jeunesse 2016, 8(1):1–17.

66. Mofizul Islam M, Topp L, Conigrave KM, Day CA. Defining a service for people who use drugs as ‘low-threshold’: What should be the criteria? Int J Drug Policy 2013, 24(3):220–222. doi: 10.1016/j.drugpo.2013.03.005 23567101

67. Mitra S, Rachlis B, Krysowaty B, Marshall Z, Olsen C, Rourke S, et al. Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting. BMC Public Health 2019, 19(1):284. doi: 10.1186/s12889-019-6606-7 30849946

68. Sawula E, Greenaway J, Olsen C, Jaun A, Flanagan Q, Leiterman A, et al. Opioid Use and Impacts in Thunder Bay District. Thunder Bay, ON: Thunder Bay District Health Unit; 2018.

69. Kerr T, Mitra S, Krysowaty B, Marshall Z, Olsen C, Rachlis B, et al. Ontario Integrated Supervised Injection Services Feasibility Study (OISIS). Thunder Bay, ON: Thunder Bay Drug Strategy 2017.

70. Berryman A. The Merits of Supervised Injection Facilities: A Case for Sudbury and Northern Ontario Thunder Bay, ON: Northern Policy Institute 2016.

71. Diaczuk D. Overdose Prevention Site now open 2018. TB Newswatch Available from https://www.tbnewswatch.com/local-news/overdose-prevention-site-now-open-4-photos-1138000. Cited 17 June 2019

72. Rutherford K. Underground supervised injection site in Sudbury pops up in Louis st. neighborhood 2019. CBC News Available from https://www.cbc.ca/news/canada/sudbury/stigma-opioid-injection-underground-supervised-1.5158321. Cited 17 June 2019.