Alberta urged to develop strategy, curriculum to curb youth opioid deaths

Child and Youth Advocate Del Graff has urged the Alberta government to develop a specific strategy to fight opioid deaths among young people and teach "non-fear-based" information about substance abuse in classrooms, starting in elementary school.

Graff issued the call to action Tuesday after reviewing the cases of 12 male and female youths who died from opioid poisoning between October 2015 and September 2017.

Graff said prevalence and lethal nature of opioids such as fentanyl means those lessons should be taught in the classroom as early as elementary school. Right now such lessons are one-time events, usually delivered by a guest speaker. 

"The issue of drug use today is somewhat different than what it was 20 years ago," Graff told reporters at a news conference Tuesday morning. "We don't believe synthetic drugs are going to decrease in terms of their proliferation and access." 

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Dr. Susan Christensen, a family physician on the Blood Reserve in southern Alberta, has dealt with hundreds of opioid poisoning cases in her practice. 

She said lessons should start in Grade 1. 

"I do have children as young as seven or eight years old come and share with me stories about watching family and friends crushing and snorting pills, using I.V. drugs," she said. 

Alberta Education Minister David Eggen said he accepts Graff's recommendation. He said children start learning about the dangers of opioids in Grade 5. 

"I think there's different ways we could strengthen and emphasize the lessons around opioid use, and I think that's the direction that we will take," he said. 

Eggen said new curriculum won't roll out until 2019. He said work will continue through the summer and the fall. 

Update PChAD law 

Education isn't the only recommendation contained in Graff's report. 

Alberta formed a commission last year to develop strategies to reduce opioid deaths but it doesn't focus on specific problems affecting youth. Graff wants the government to have something by the end of 2019 to prevent more deaths in that age group.

"Young people require special attention because they are developmentally unique from adults," said the report, titled Into Focus: Calling Attention to Youth Opioid Use in Alberta.

"Substance abuse often begins during adolescence, and young people from 15 to 24 years old are more likely to experience harm related to substance abuse than any other age group."

The unique challenges presented by opioid addiction and withdrawal mean the Protection of Children Abusing Drugs Act (PChAD) needs to be updated, according to the report.

The law, passed in 2006 and amended in 2012, allows guardians to get court orders placing their drug- or alcohol-addicted children in safe houses for 10 days. A judge can extend that period by five days.

However, the report found that time frame is insufficient to deal with opioids, which carry a higher risk of overdose.

In some of the cases reviewed, safe houses made the problem worse.

"Six of these 12 young people were confined in a PChAD protective safe house," the report states. "During their stays, some made harmful connections with peers that increased their risk-taking behaviours."

Once they left the safe houses, programs to help the teens with the next phase of treatment were not easily accessible.

Some were put on wait lists; others were told they didn't meet the criteria. Parents feared the stigma of asking for help. Child intervention staff were overworked and didn't always know where to send people.

Alberta has few programs that treat both substance abuse and mental illness. The resources to help drug or alcohol-addicted youth with cognitive or intellectual disabilities are even more limited, the report said. 

Health Minister Sarah Hoffman said she met with Graff Monday about his report and will review his recommendations. She said the idea of a strategy focusing on youth has merit.

As for changes to PChAD, Hoffman said she would need time to think about possible changes as there is a difference of opinion among parents about what could work.

Multiple court orders

Some of the teens written about in the report were Indigenous, while others were not. Their ages ranged from 15 to 19.

All had contact with Alberta's child intervention system. Eleven had contact with the justice system. Ten spent time in hospital for drug addictions or psychiatric illnesses. Most came from families experiencing parental break-ups and substance abuse issues.

The youth in Graff's report were given pseudonyms to protect the privacy of their families.

Emily, 16, was a Métis youth whose mother suffered from mental illness and addictions. Her family life involved exposure to violence and substance abuse. She spent time in foster care when her mother was in addictions treatment, but ran away from her temporary home.

Emily's mother had her confined under two PChAD orders. After the first term was done, the girl returned home where she may have witnessed substance abuse and violence and had limited access to supports.

Her mother obtained a second PChAD order a month later.  After the term expired, Emily wasn't allowed to return home until she had finished a treatment program. Instead, the teen lived with friends and continued to use drugs. She didn't work with her caseworker or use other supports.

Six weeks later she was found unresponsive. She died four days later in hospital from methamphetamine and fentanyl poisoning.

Eva, 18, also died of methamphetamine and fentanyl poisoning. Like Emily, she was confined to safe houses under two PChAD orders.

After the first order, Eva moved back home with her parents but ran away that same night. She was arrested a week later with someone she had met at the safe house.

Three months later, she was arrested for break and enter, stealing a truck and using stolen credit cards.

The second PChAD order kept her in confinement for 15 days.

Eva agreed to undergo addictions counselling upon her release, but her attendance was sporadic. After staying off intravenous drugs for a couple of weeks, Eva was found unconscious near her home and later died in hospital.