Ottawa Pediatrician Dr. Shawn Kelly is calling for more focus on addressing youth opioid use. Kelly spoke with People First Radio to expand on the issues he raised in a recent editorial in the Canadian Medical Association Journal, co-authored by Shannon Charlebois.
“ I belong to a loose network of other people who do similar work. And there are a few child and adolescent psychiatrists, and there’s a few adolescent addiction medicine specialists like myself. And then there’s a few people who are adolescent medicine providers,” he said.
“We’re all seeing a very similar, and frightening picture, which is that there’s been a bit of a culture change… opioid use has come from the fringes and taken a few steps towards the mainstream.”
Kelly cites data from the Ontario Drug Use and Student Health Survey, which found in 2023 that more than 1 in 5 students sampled from grades 7 to 12 had used opioids in a non-medical way in the past year.
He says overall death rates across the population from opioids have declined slightly from a peak of 22 Canadians per day to 19, a number which he says still represents a crisis. Kelly says he thinks a perception of safety around pharmaceutical grade opioids has led to wider use among youth than in the past.
“I think one of the things that has been good from a public health perspective and perhaps why the overall opioid death rate has gone down is that the word is out on fentanyl. People are afraid of fentanyl to a certain extent, and youth have understood that that is a dangerous, scary, lethal substance,” he said.
“Unfortunately, there seems to be a perception of some safety around this medical grade or pharmaceutical quality opioid being Dilaudid or dillies, that has allowed it to take this step towards the mainstream. And to me it’s incredibly frightening.”
Kelly says there is data that backs up what he’s seeing in his practice, that youth are using higher levels of prescription opioids than the past.
“It’s the story now and it represents a real change in what’s been going on in our high schools and the risk that our youth are facing.”
Kelly is calling for access to treatment for substance use disorder, as well as treatment that can address underlying conditions that are leading youth to use in the first place.
“ When I make a diagnosis of substance use disorder in my clinic, I struggle to think of a time where there wasn’t another diagnosis that happened at the same time,” he said.
“It’s typically things like generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, major depressive disorder, ADHD, eating disorders of all kinds. And so they all have at least two things going on, and we need to treat them at the same time. And a lot of those things require skilled counseling. And here in Ontario, some of the counseling is not always accessible through our provincially funded systems.”
Kelly says some families are able to pay for timely access to counselling, while others cannot.
“Ability to pay becomes a barrier to care for youth suffering from potentially life-threatening conditions.”
He says people’s pathways into care depend on chance circumstances, like a positive experience during a visit to the ER, or having a primary care provider who is skilled at treating substance use.
“ The reality is you have to be lucky to be a youth, to get connected to the kind of care that you need at this time.”
“What we need to have is some kind of self or family referral situation where people who are at risk or are thinking they might be at risk, are much more easily connected to providers with some comfort in the area.”
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