Medications for opioid use disorder among young people : evidence to improve treatment experiences and outcomes in Vancouver, Canada

Background: Adolescents and young adults (AYA) continue to be impacted by the toxic drug crisis. This dissertation sought to examine AYAs’ experiences with opioid agonist treatment (OAT) to inform treatment programming and improve health outcomes and well-being among AYA who use opioids. Methods: A systematic review of literature examining access to medications for opioid use disorder (MOUD), including prescription and non-prescription opioids, was conducted from electronic database inception until May 3, 2021. Quantitative analyses derived data from the At-Risk Youth Study, an open, prospective cohort of street-involved AYA who use drugs in Vancouver, Canada, to examine OAT access and outcomes, interest in buprenorphine-naloxone, and factors associated with methadone maintenance therapy (MMT) discontinuation between December 2005 and June 2018. Longitudinal qualitative exploration into experiences navigating OAT and barriers to engagement, retention, and completion were conducted with AYA between January 2018 and August 2020. Results: Systematic review findings suggest AYA are less likely to access MOUD versus adults, and that adolescents are more likely to be prescribed partial opioid agonists. In before and after analysis of OAT outcomes among 454 AYA, greater reductions in daily illicit opioid were observed among AYA retained in OAT versus AYA who did not initiate OAT (-1.83 vs. -0.63, p=0.015), but no other reductions were observed. Low levels of initial buprenorphine-naloxone interest were reported (n=60, 13.4%), which was negatively associated with self-reported Indigenous identity, and racial or ethnic identity, while later study follow-up period was negatively associated with buprenorphine-naloxone interest over time. A majority of 160 AYA who initiated MMT over the study period discontinued MMT (n=102, 63.8%), which was found to be positively associated with crystal methamphetamine use. Lastly, qualitative findings demonstrate barriers experienced by AYA navigating OAT and highlight ways to improve OAT access, engagement, and discontinuation. Conclusions: Findings from this dissertation suggest OAT alone is insufficient for helping AYA to meet their treatment goals. AYA require access to essential socioeconomic supports alongside culturally safe and patient-centered treatments and a broader range of OAT. Clinical treatment guidelines require updating to align with AYAs’ needs while recognizing the potential harms of overmedicalizing treatment.Graduate and Postdoctoral StudiesGraduat