Addiction treatment trajectories among street-involved young people who use opioids: Responding to a public health emergency in Vancouver (Addiction Rx Trajectories Study)

(2017-2020; CIHR)

Principal Investigator(s): Jean Shoveller and Danya Fast

Co-Investigators and Knowledge Users: Nadia Fairbairn, Kanna Hayashi, Tania Culham, Kora Debeck, Thomas Kerr, Rodney Knight, Ryan McNeil, William Small

In Canada and internationally, there are serious concerns regarding opioid use among street-involved young people under 30 years of age. Recently, fentanyl use among youth has generated unprecedented alarm. In 2016, the British Columbia Provincial Health Officer declared a public health emergency due to dramatic increases in fentanyl related overdose deaths in the province, including among youth. Addiction treatment is a cornerstone of addressing the fentanyl overdose crisis, and Vancouver is in the process of rapidly expanding its efforts to create a comprehensive addiction treatment system for adolescents and young adults. Notably, in 2015 the Vancouver Coastal Health Authority (VCH) issued new clinical addiction treatment guidelines that make Suboxone® a recommended first line pharmacotherapy for opioid use disorder among youth. In addition, VCH anticipates the addition of 17 youth dedicated residential addiction treatment beds over the next year. Vancouver is also in the midst of scaling up efforts to coordinate healthcare service delivery for vulnerable, drug using populations through the Downtown Eastside Second Generation Strategy. With these changes, young people’s access to Suboxone®, residential addiction treatment beds, and continuity of addiction care promises to reach unprecedented levels. However, many urgent questions remain regarding how to most effectively implement, adapt, and scale up these interventions, in ways that are congruent with the complex, everyday lived experiences of street-involved youth who use opioids, as well as those who provide treatment and care to this population. The proposed three year study will address this knowledge gap by describing and prospectively monitoring street-involved youth’s addiction treatment trajectories and outcomes in the context of Vancouver’s expanding efforts to address the opioid overdose crisis. Through annual in-depth, semi-structured interviews and ethnographic fieldwork conducted across the study period, we will document the evolving experiences of street-involved youth and their addiction treatment providers in relation to a transforming system of services in this setting. Bringing together an interdisciplinary team of researchers, knowledge users, trainees, and collaborators (e.g., VCH, BC Ministry of Health), our goal is to create new knowledge that will directly inform ongoing efforts to implement, adapt, and scale up innovative addiction treatment services for adolescents and young adults in Vancouver. The objectives of the study are to:

  1. Document the evolving experiences of street-involved youth and service providers as they
    access/provide Suboxone® as a first line pharmacotherapy for opioid use disorder;
  2. Describe and prospectively monitor street-involved youth’s addiction treatment trajectories and
    outcomes within Vancouver’s expanding and increasingly coordinated efforts to address the opioid overdose
    crisis; and
  3. Identify the knowledge gaps that could impede the implementation and scale up of addiction treatment services for street-involved youth in Vancouver.

The findings of this study will be disseminated via a range of policy, community, and scholarly oriented outputs, including peer reviewed publications, synthesis reports, plain language summaries, press releases, media interviews, social media and website postings, email newsletters, and an end of study multi-media event that seeks to engage diverse publics.


Total: $317,476