TORONTO – Canada’s opioid crisis continues and grows: overdoses continue to be high, and a growing number of teenagers are using substances like heroin and fentanyl. But Canada’s healthcare system is unprepared, and not enough has been done to improve the situation in recent years. Or, at least, the right things weren’t done.

The alarm about opioids emerges, loud and clear, from a detailed article by Shannon Charlebois and Shawn Kelly published today in the Canadian Medical Association Journal (CMAJ), which emphasizes right from the headline that “Canada’s youth are part of the opioid crisis and need treatment” (here). As the article states, “more than 18 people in Canada still die every day from opioid toxicity, according to national statistics from April 2024 to March 2025”. And behind this number lies “an even more shocking crisis — many deaths from the illicit opioid supply occur in youth”.

The article cites the example of British Columbia, where opioid use became the leading cause of death among 15- to 18-year-olds in 2021. “Early-onset initiation and escalation of opioid use among youth – the article emphasizes – is being overlooked. If this crisis is not properly addressed now, Canada’s health systems will play a part in perpetuating the opioid crisis for decades to come…“.

The 2023 McCreary Adolescent Health Survey, conducted among 38,488 British Columbian youth aged 12 to 19, found that 14% reported using substances other than alcohol and cannabis, and 1% specifically used heroin, fentanyl, or other opioids (excluding prescription drugs used without a medical indication or prescribed to someone else), while 4% of youth had tried illicit opioids. Another study, the Ontario Student Drug Use and Health Survey, found that non-medical use of prescription opioid painkillers increased from 12.7% in 2021 to 21.8% in 2023, with students in grades 12 to 13 more likely to report use than those in grades 11 to 13. In 2021, 9% of all opioid-related emergency room visits and 8% of opioid-related deaths in Ontario occurred in people aged 15 to 24. Furthermore, the rate of emergency room visits for opioid toxicity among youth in Ontario was 67.7 per 100,000 people in 2023. And then, again: many young drug users begin using opioids at ages 10 to 12, as described in a 2022 article co-authored by those with direct experience. And “early substance use dramatically increases the risk of substance use disorders later in life” the article emphasizes.

There are, in fact, solutions. In Canada and the United States, new clinical guidelines from the Canadian Paediatric Society (CPS) and the American Society of Addiction Medicine (ASAM) provide a framework for treating opioid use disorder (OUD) in adolescents. For adolescents with moderate to severe OUD, combining OUD medications (MOUD) such as buprenorphine and methadone with community-based psychosocial therapy has proven most effective. Immediate access to lifesaving medications is crucial, especially when a young person suffers a non-fatal overdose. While integrating medical and psychological support leads to better outcomes, immediate access to these medications should be prioritized.

There is also strong evidence – we still read in CMAJ’s article –  for psychosocial interventions such as family therapy, motivational enhancement therapy, and cognitive behavioral therapy (CBT), which, when combined with mental health care, improve engagement and promote long-term recovery. But all this doesn’t seem possible in Canada… there are too many obstacles, such as long waiting lists, high costs, and the evident lack of training among Canadian doctors. Indeed, despite the effectiveness of medication-based therapy for opioid dependence (MOUD), prescriptions among young Canadians have decreased. Despite the fact that opioid-related deaths increased by 369.2%, from 2.6 to 12.2 per 100,000 inhabitants from 2013 to 2021, prescriptions for OUD drugs issued to young people reached their lowest level in 2024. Any doctor seeing young people in Canada can prescribe buprenorphine, but many lack the basic training to feel comfortable doing so.

According to the two authors of the article, therefore, it is necessary to ensure efficient and funded continuing medical education to advance the skills of primary care physicians and specialized nurses willing to provide specific care for adolescents with substance use disorders, including pharmacotherapy, which, however, should be funded by Canadian public health systems, as should family therapy. “Health systems’ inaction and lack of investment to provide evidence-based addictions services for youth is inexcusable, as the opioid crisis involves this population” the two authors conclude. And any lack of intervention would represent “complicity in the next decade of preventable deaths”.

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