Illicit drug toxicity is an “escalating public health emergency” in Canada that significantly affects adolescents, yet pediatricians are ill prepared to manage it, new research suggested.
A study of more than 1000 pediatricians in Canada who care for young people aged 12-18 years found that while close to 14% reported caring for at least one case of illicit drug toxicity, awareness of substance use–related services was “limited.”
“This study shows that despite [drug toxicity] being considered an adult health issue, many pediatricians are interfacing with young people at risk for an overdose event,” Matthew Carwana, MD, clinical assistant professor of pediatric hospital medicine at the University of British Columbia in Vancouver, told Medscape Medical News. “This suggests that we have an opportunity to empower pediatricians to provide safe, trauma-informed care to this population.”
The study was published online on April 1 in Paediatrics & Child Health.
Pediatricians Must Be Prepared
Researchers conducted a cross-sectional study from May to June 2022 with three primary aims. They sought to determine the proportion of pediatricians in Canada caring for young people aged 12-18 years who have managed cases of illicit drug toxicity, to identify the characteristics of pediatricians who provide this care, and to describe respondents’ awareness of substance use–oriented services for young people in their home communities.
Clinicians self-reported cases of illicit drug toxicity from opioids, stimulants, and sedatives for adolescents aged 12-18 years over the preceding 24-month period. They also self-reported their knowledge of substance use–focused services for children and adolescents in their communities.
A total of 1027 pediatricians completed the survey, yielding a response rate of 37%. Most respondents (91%) reported providing medical care to children and young people aged 12 years or older, and 13.7% reported caring for at least one patient with illicit drug toxicity.
Sedative overdoses were most common (8.1% of respondents), followed closely by stimulants (7.9%) and opioids (7%).
The provinces with the highest number of respondents reporting at least one case were Ontario (29.7%), British Columbia (20.3%), and Quebec (17.2%).
Many respondents were general pediatricians (43%); 84.4% worked in urban settings and 72.7% at academic centers. In addition, 19.5% were providers in pediatric emergency medicine, 13.3% in pediatric critical care, and 7% in adolescent medicine.
About one third (31.8%) of doctors gave a response about service awareness. For patients aged 12-15 years, most respondents (84.5%) had an awareness of outpatient mental health services. But for every other service included in the survey, less than 50% of respondents were aware of a related service in their community. This included low awareness (< 30%) of residential treatment programs (29.3%), outpatient medication treatment for substance use prescribers (28.3%), intensive outpatient programs (26.3%), and inpatient detoxification centers (24.9%). Patterns of awareness of services for 16- to 18-year-old patients were similar.
Of course, the study had certain limitations. Its results cannot be used to determine population-level estimated minimum toxicity incidence because more than one pediatrician may have reported the same case, and some cases may have presented to nonpediatricians. Although response rates were higher than average for this type of survey, participation rates were still under 50%, leading to the possibility of nonresponse bias and overestimation of the prevalence of illicit drug toxicity in pediatric practice.
In addition, more than two thirds of respondents did not answer questions on awareness of treatment resources, which may have led to an overestimation of participant knowledge of available services.
Nevertheless, the data highlight that “illicit drug toxicity and substance use are substantial pediatric issues and that pediatricians need to be prepared to provide medical care for youth presenting with these issues,” the authors wrote. “Pediatric substance use should be prioritized as a field of education and further study.”
“Solutions must be generated alongside youth,” Carwana added. “Our next steps will include codesigning an overdose prevention toolkit alongside youth with lived and living experience to help providers feel more comfortable providing care to these young people.”
‘Urgent Threat to Adolescents’
April Kam, MD, associate professor of pediatrics and director of Research and Quality for the Division of Pediatric Emergency Medicine at McMaster University in Hamilton, Ontario, commented on the study for Medscape Medical News.
“Illicit drug toxicity is no longer just an adult crisis and hasn’t been for a while. It’s an urgent and escalating threat to our adolescents,” she said. “This study confirms what many of us on the front lines have observed: Youth between the ages of 12 and 18 years are presenting with serious, and sometimes life-threatening, complications from illicit drug use.”
After receiving acute care, “there is a dearth of services available to support these youth, and that disconnect is troubling,” she continued. “It reflects broader systemic gaps in how we train, support, and equip pediatric providers to manage substance use as a chronic, relapsing condition — not just a one-time medical emergency.”
Like Carwana, Kam said that substance use among youth must be recognized as a pediatric issue. Medical education should be provided at all levels to prepare pediatricians for acute management and longitudinal support.
To ensure that young people and families aren’t navigating this crisis alone, she said, requires “expanding age-appropriate, youth-centered substance use services — accessible across urban, rural, and suburban communities — and strengthening intersectoral collaboration between health, education, social services, and justice.”
The Canadian Paediatric Surveillance Program and Public Health Agency of Canada provided in-kind support for survey development and distribution as well as for data collation. Carwana and Kam reported having no relevant financial relationships.
Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.