Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada

BackgroundIllicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study.MethodsThis study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14–25) who live in Northern Ontario and use illicit drugs. Interviews with ‘key informants’ who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures.ResultsA total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported ‘fair’ mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling.ConclusionsAlthough each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.

研究背景
加拿大青年的非法药物使用比例居高不下，在安大略省北部地区尤为突出。亟需提供有效且可及的药物使用相关治疗与服务以应对该问题，对于北部偏远乡村社区而言尤为如此。为评估安大略省北部地区非法药物使用青年群体的具体服务与治疗需求，以及其在获取和使用相关服务与治疗过程中面临的障碍与阻碍因素，本研究就此展开。

研究方法
本研究采用混合研究设计，并融入了基于社区的参与式研究（community-based participatory research）方法。研究针对居住在安大略省北部且存在非法药物使用行为的14至25岁青年群体，采用问卷调查结合音频录制的半结构化访谈及/或焦点小组讨论的方式开展数据收集；同时，研究还对各社区中与该青年群体对接的“关键知情人”开展了访谈。2017年8月至12月期间，研究团队前往安大略省北部各社区完成了全部数据收集流程。

研究结果
最终共访谈了来自安大略省北部11个不同社区的102名青年及35名关键知情人。最常使用的药物为处方阿片类药物、可卡因及快克可卡因（crack-cocaine）。多数受访者存在与药物使用相关的健康问题，且自述健康状况为“一般”水平。质性分析结果显示，整体服务供给严重不足；获取治疗与服务的障碍主要包括动机缺失、污名化现象、漫长的等候队列以及交通/出行不便等问题。受访者明确提出的需求围绕以下几方面：基于减害（harm reduction）理念的服务、低门槛项目、专业化服务项目以及同伴咨询服务。

研究结论
尽管各社区在药物使用行为及现有服务供给方面存在差异，但整体而言，针对青年群体的低门槛专属服务仍存在显著缺口。本研究收集的相关数据可为偏远乡村社区改进药物使用治疗与服务体系的运行效率及服务供给提供参考依据。