September 19, 2019 — A new Canadian Institute for Health Information (CIHI) analysis reveals that a substantial number of people age 10 to 24 are being hospitalized for harmful substance use and highlights the impacts of cannabis, alcohol, opioids and other substances on youth in Canada.
Dr. Joanna Henderson, director of The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health at the Centre for Addiction and Mental Health, said this report shows that there is a need for improvements to the health care systems, specifically around youth.
“At one level, I’m concerned for young people and their connection to substances and especially substance use that is leading to harm for them — particularly to the extent that hospitalization is required,” said Henderson.
“At another level, though, it really speaks to some systemic issues that concern me in terms of the availability of timely access to youth-friendly, substance-related services.”
The analysis builds on CIHI’s new indicator Hospital Stays for Harm Caused by Substance Use released in May 2019, and further explores patterns of hospital stays for children and youth — a priority population for CIHI and provincial and territorial stakeholders.
Dr. Charlotte Waddell, a child and adolescent psychiatrist and professor at Simon Fraser University, thinks that better community supports could help keep young people from needing hospitalization.
“For young people, many problems with substances are preventable,” Waddell said. “We know of prevention programs in the community that could be working, but we also know that those programs are not widely available. Kids should not have to be hospitalized.”
Here are some key findings from the new report:
In jurisdictions where full data was available, for every 1 hospital stay, there were about 5 emergency department visits as a result of substance use by youth in Canada in 2017–2018, and 59 youth hospitalized for harm caused by substance use died in hospital due to any cause.
“Both the inpatient stays and emergency department visits are the tip of the iceberg for young people who are experiencing difficulty with harmful substance use,” said Henderson.
CIHI’s Hospital Stays for Harm Caused by Substance Use indicator does not include visits to addiction centres, primary care clinics, emergency departments or fatal overdoses in the community.
Challenges in the availability of appropriate community services and supports can lead to frequent hospitalizations. Improvements to continuity of care, such as connecting youth to specialized community-based follow-up services soon after hospitalization, can help reduce the rate of return visits.
“If a youth comes in once, that should trigger a robust response by the hospital — communicating back with the community and with the care team and family surrounding that youth to say that we need to step up what we’re doing here,” said Waddell. “So repeat hospitalizations are a huge red flag that good coordination is not happening between the hospital sector and the community and vice versa. But again, prevention is crucial if we are going to reduce these problems.”
The rates of hospital stays for harm caused by substance use among those age 25 and older are significantly different, with cannabis associated with only 11% of these stays and alcohol with 58%.
“Harms associated with alcohol are quite significant among children and youth, and have been for a long time, and yet are not as prominent in the discourse around substance-related harms as cannabis right now in Canada, in part due to the recent legalization,” said Henderson. “We really need to be talking about both, as well as opiates and other substances.”
There is a documented link between unmanaged mental health problems and self-medication with substances. Substance use may cause or exacerbate mental health conditions.
The proportion of youth age 10 to 24 hospitalized with concurrent substance use and mental health problems was nearly double the proportion of adults age 25 years and older with the same conditions.
“This connection is not surprising,” said Henderson. “Hopefully it’s an indicator that the right young people are receiving the most intensive levels of service. On the other hand, it does flag a failure of our system to work in a more integrated way to prevent and intervene early when young people are experiencing mental health concerns.”