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

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 street-involved young people. Addiction treatment is a cornerstone of addressing the 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. In 2015, the Vancouver Coastal Health Authority (VCH) issued new clinical guidelines that make Suboxone a recommended first line treatment for opioid use disorders among young people. 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, street-involved young people's access to Suboxone, residential treatment beds, and continuity of addiction care promises to reach unprecedented levels. However, many urgent questions remain regarding how to most effectively deliver these interventions, in ways that are congruent with the complex, everyday lived experiences of these young people, as well as those who provide addiction treatment and care to this population. The proposed study will address this knowledge gap by describing street-involved youth's addiction treatment trajectories and outcomes in the context of Vancouver's expanding efforts to address the overdose crisis. Through interviews and ethnographic fieldwork, we will document the evolving experiences of these young people and their service providers, in relation to a transforming system of services in this setting. Our goal is to create new knowledge that will directly inform ongoing efforts to deliver innovative youth addiction treatment services in Vancouver.