The multidimensional needs and integrated service utilization patterns of youth using non-medical prescription opioids
Background: Non-medical opioid use, including prescription opioids and illicit heroin/fentanyl, is one of today’s most complex health services and policy challenges. Youth (aged 12-24) are an important sub-group requiring tailored responses, and yet, there is a dearth of research on potential innovative models. This study aimed to characterize the multidimensional needs of youth using prescription opioids and their service utilization patterns in a novel provincial Integrated Youth Services (IYS) program.
Methods: The cohort included youth who completed a comprehensive demographic and health survey (n=6181) on their first visit to a community-based IYS center in British Columbia (Canada), which integrates five core service streams – primary care, mental health, substance use, and social and peer support. Analyses were conducted on youth-reported socio-demographic, substance use, and health data and clinician-reported service utilization records. Multivariable logistic regression determined the social-ecological factors associated with past 30-day non-medical prescription opioid use and multivariable Poisson regression tested the relationship between non-medical prescription opioid use and rates of service utilization over time.
Results: A total of 248 (4%) youth reported non-medical prescription opioid use in the past 30 days; of whom, 56% were aged 19-24 (44% aged 12-18), 60% were women (32% man, 7% gender diverse), and 66% were White (28% visible minority). From the social-ecological model, poor vs. excellent/very good self-rated physical health (adjusted odds ratio (aOR) = 2.71, 95% Confidence Interval (95%CI)= 1.43, 5.11), high vs. low probability of externalizing mental health disorders (aOR = 1.69, 95% CI = 1.01, 2.82), past 30-day polysubstance use vs. none (aOR = 7.93, 95% CI= 4.64, 13.56), and past 3-month exposure to violence vs. none (aOR = 1.91, 95% CI = 1.42, 2.59) were independently associated with a higher odds of past 30-day non-medical prescription opioid use. Regarding service utilization patterns, youth reporting past 30-day non-medical prescription opioid use did not have significantly higher rates of visits (adjusted relative rate (aRR) =1.11, 95%CI =0.95, 1.30), however, they did engage in a higher number of services streams (aRR =1.09, 95%CI = 1.02, 1.17) relative to youth not reporting non-medical prescription opioid use.
Conclusions: Youth using non-medical prescription opioids presented to IYS with needs that corresponded to all five core service streams. Although youth with non-medical prescription opioid use did not visit IYS more frequently than youth without prescription opioid use, they did engage in a higher number of service streams. These findings support the importance of innovative interventions and policies that can target youths’ multidimensional needs and reinforce the benefits of integrated health and social services for youth who may benefit.
