photos: Youth today are acutely aware that even one instance of experimentation with illicit substances could be fatal. Photos courtesy Rehab Center Vita (above) and Alexis Barrera (right)

Sobering statistics

Amid B.C.'s staggering number of overdose deaths is a grim figure: An average of two teens a month are dying from substance abuse.

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More support. Less shaming.

That’s what youth need when it comes to substance use, according to one 16-year-old teen who spoke to Megaphone anonymously about his drug and alcohol use.

After losing friends to fentanyl overdoses and experiencing his own struggles with substance use as a coping mechanism, “Ben” (not his real name) knows the steps to take to try mitigate harm. “With fentanyl lacing everything, the safest way to do any drugs is to not do them alone,” Ben says. “Be with a good friend who’s staying sober and has a naloxone kit on hand. Let someone you trust know your plan.”

These are the strategies Ben has learned within the context of the B.C.’s ongoing drug overdose epidemic—a provincial crisis that claimed the lives of 1,452 British Columbians—including 24 youth between the ages of 10 and 18—in 2017. In these incidents, heroin was the most frequently involved substance (22 per cent), followed by alcohol (21 per cent). Fentanyl was a close third at just under 20 per cent.

Figures are still being tallied for 2018, but as of last month, overdose statistics were keeping pace with the previous year. According to the BC Coroners Service, the provincial average of illicit drug overdose fatalities in B.C. for the month of November alone was a grim four deaths a day.

“Our parents, grandparents, and so on did the same things we are doing when they were our age,” Ben points out, but without the significant threat that hangs over today’s teens. “The substances were different, but the main difference [is] that  even using a drug one time now could mean death for you or your friends. Now, even in moderation, one time could end everything.”

Too many youth are overdosing

Youth and substance use is the focus of a report issued in November by B.C.’s Representative for Children and Youth (RCYBC). The report, Time to Listen: Youth Voices on Substance Use, recommends the provincial government develop a system of drug and alcohol services to address the diverse needs of young people aged 13-18. In forming the recommendations, the report gleaned information first-hand from 100 youth with lived experience across the province.

Of the youth surveyed, most had used alcohol, marijuana and/or cigarettes, and more than half had taken cocaine, ecstasy, mushrooms and prescription pills that were not prescribed to them. Fifteen per cent had injected a substance, with females more likely than males to have done so.

An average of two teens a month died as a result of a drug overdose in 2017.

“We must face the reality today that too  many youth in B.C. with significant substance use issues are overdosing and tragically, some are dying,” says Representative for Children and Youth Dr. Jennifer Charlesworth (below right).

According to her report, the third-highest proportion of substance-related injury and death among B.C. youth in 2017 occurred on Vancouver Island (23 per cent), ahead of Vancouver Coastal (13 per cent). The much larger Fraser and Interior regions of B.C. had substance-related injury and death rates of 29 and 28 per cent respectively.

The representative also emphasized Indigenous youth are disproportionately affected.

Charlesworth calls for a ramped-up support system for teens, including encouraging prevention and safer substance use; developing culturally relevant support for Indigenous youth and their families; and offering easy-to-access information about available resources.

Perhaps one of the more controversial recommendations from Charlesworth is the creation of supervised safe-consumption sites for youth.

The report—which is being used as a resource for a strategy currently being developed by the Ministry of Mental Health and Addictions—acknowledges not everyone  will agree with the idea of young people using drugs at a taxpayer-funded safe consumption site. But Charlesworth says the goal is preventing overdoses and fatalities.

The need is here

Heather Hobbs, manager of harm reduction at Victoria-based AIDS Vancouver Island, says youth currently seeking assistance must access the organization’s primarily adult services, including supervised consumption sites—a situation that is not ideal.

“It feels like our community could be doing more for youth who use substances,” she says.

Hobbs says AIDS Vancouver Island tries to be as welcoming as possible for the young people who come in search of support and often refer them to youth-focused organizations such as the Victoria Youth Clinic, run by Foundry B.C., an organization that provides health and wellness services to teens aged 12-24.

The clinic is a “one stop shop” model of holistic care for youth and is among several recently opened by Foundry B.C., offering drug and alcohol support, reproductive health services, housing help and counselling. Between January 2017 and March 2018, the initial six Foundry Centres provided services to nearly 5,000 youth, with almost 36,000 visits.

Still, Hobbs says teens as young as 14 visit AIDS Vancouver Island to use its adult safe consumption sites.

She estimates about 10 youth between the ages of 16 and 19 use the organization’s supervised injection site. Most youth, she says, inhale substances and would benefit from safe inhalation tents or spaces. In Victoria, these spaces are few and far between, especially for youth who are under the influence at the time of seeking support.

“There might be youth services, but [clients] have to access them when they’re sober or they have to be abstinent,” Hobbs explains. “So for youth who can’t or won’t change their substance use, at least in the immediate term, those services aren’t particularly accessible to them.”

While youth can access support at AIDS Vancouver Island while under the influence, it isn’t an age-appropriate space, says Hobbs.

“It is a predominantly adult environment so it does cause me to have some concern that youth are seeing behaviours or relationships that aren’t necessarily positive influences for them and that there may be some concern around vulnerability,” she says.

Adult users are often uncomfortable around youth as well, she explains, and are troubled to see young people using the services.

“I think youth need to be able to access spaces where they don’t have to deal with that dynamic of other people projecting their own pain or their own experiences of perhaps being a youth themselves who didn’t have the support and care they needed,” she says.

At the core of harm reduction, Hobbs says, are relationships.

“It’s a way of being in a relationship with another human being that aims to come from a place, as much as possible, of non-judgement and of care—and really of love.”

Hobbs says in her experience, what works is having support workers meet people where they are on their journey of substance use while keeping them safe without fear-based messaging—a philosophy she has seen work especially well with teens.

“Youth are often trying to find out who they are and where they fit in the world and that’s a time when people are exploring their own independence, so really respecting that and coming to where they’re at works really well,” she says.

Alan Rycoft (right), community relations manager for the Victoria Cool Aid Society, a housing organization, agrees harm reduction options—including supervised consumption sites—are vital to keeping young people safe.

“There’s been a war on drugs forever, it’s been a total failure. People are going to consume their drugs whether we like it or not,” he says. “The current supply on the street can be extremely dangerous, in fact lethal, and so it’s very important that we recognize we have a health emergency and that we need to respond to every member of the community.”

Marnie Goldenberg, director of youth services for Family Services of Greater Vancouver and for Directions Youth Services, a Vancouver-based resource for at-risk and homeless youth,
says harm reduction is a critical tool for assisting youth.

“An abstinence-based approach is not a model of care that is most inclusive,” she says. “We see the value of offering care based around harm reduction every day.” Goldenberg recalls a “clarifying” moment relayed to her by a staff member, involving an interaction with a youth staying at a safe house being offered a clean needle.

“This young person said, ‘I never realized I was worth clean needles’,” she says. “When you think of that individual and what they’ve learned about their self-worth, stating that ‘you are of course worth clean needles’ is the baby step that might allow a person to then hear a message of ‘you’re worth so many things’.”

Goldenberg also points out that substance use is entwined with many other social issues, noting some youth experiencing homelessness use drugs to stay awake all night to stay alert and safe, and that almost all of the youth who access Directions Youth Services are coping with some form of trauma.

According to Time to Listen: Youth Voices on Substance Use, 86 per cent of youth who had a critical injury or died had experienced at least one traumatic incident in their lifetime. These include neglect, assault, domestic violence and/or sexual violence. What’s more, most of the youth (73 per cent) had a confirmed or suspected mental health diagnosis.

“It’s so easy to judge, but in some cases they’re making the choice [to use] because the alternative feels more dangerous,” Goldenberg says. “If you are experiencing pain, you look for ways to manage it. Until we as a society do a better job at addressing pain and having more holistic, long-term methods of supporting people through pain, I think we’re not going to see an end to illicit drug use.”

Help designed for youth, with youth

No matter what the reason for young people using drugs or alcohol, frontline workers agree: More support of every type is needed.

“We need more youth-centred services across the range—harm reduction, detox, treatments, recovery... that’s designed with youth and for youth, and we need far more long-term supports for youth relating to mental health challenges,” Goldenberg says.

Ben echoes those sentiments, particularly the part about youth involvement.

“I’m not going to walk into an addictions anonymous as the only teenager. I’d feel even worse about myself, resulting in wanting to do more of whatever,” he says. “ We need youth support groups, run by recovered young adults.”

He also says honest dialogue and information would be the most effective means of curbing substance use and saving lives.

“Education-wise, schools barely speak about substances,” he says, and when they do, the tendency is to paint drugs as “evil.”

Youth quoted in the RCYBC report suggest information be delivered by a nurse or other “unbiased” health professional, and stressed service providers avoid “scare tactics.”

One other teen Megaphone spoke with, “Carol,” notes while drugs and alcohol are everywhere, when it comes to seeking support or education, the path is hard to find.

“I can most definitely say that every time a friend passes from an overdose, some youths will forever quit drugs, while others find doing more drugs helps cope,” Carol says. “I think the root of our battle with addictions is the lack of emotional support.”

Youth cited in the RCYBC report say the top barriers to getting help are they didn’t know where to go; there was no one they felt comfortable talking to; and they didn’t think it would help.

Ben suggest that schools have counsellors dedicated to addiction and substance use, “or at least an assembly every so often reminding students never to do anything alone and at least be smart if you choose to do any substances.”

The main thing, Ben says, is that “asking for help must be seen as less of a failure and more of a new beginning.”

Fast facts:

Substance(s) youth reportedly used at the time of injury or death (in order of prevalence):

- Heroin
- Alcohol
- Fentanyl
- Methamphetamine
- Xanax
- Cocaine
- Marijuana
- Amphetamine
- Carfentanil
- Codeine
Average age of substance use-related critical injury:
- 16.5 years old
Barriers to accessing services:
- Didn’t know where to go
- There was no one youth felt comfortable talking to
- Didn’t think it would help
—Time to Listen: Youth Voices on Substance Use

Read the full report at:


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