Dear Editor:
The Executive of the Canadian Paediatric Society (CPS) wishes to respond to the recently published Commentary by Drs. Warshawski and Warf (“It is time for an ethical, evidence-based approach to youth presenting to the ED with and opioid overdose”, Paediatrics and Child Health 2019:1–3).
In the context of the growing crisis due to fatal or potentially fatal opioid overdoses, a small proportion of which affect youth < 19 years of age, the authors denounce the absence of ‘standard of care’ for youth in Canada presenting to the Emergency Department with an illicit drug overdose. They describe the neurodevelopmental and situational factors that may inhibit youth from be able to make a truly informed decision about consent for or refusing of treatment, including hospitalization, and notification of their parents or legal guardians. Based on these factors, they express their belief that immediate notification of the youth’s legal guardian, admission to hospital, even involuntarily, are the means by which to keep patients safe and allow them to undergo a thorough assessment and discussion of potential options for substance use intervention, or harm reduction. They conclude by calling upon the Canadian Paediatric Society to ‘review this issue’ and ‘issue a statement advising caregivers accordingly’.
We acknowledge the overarching desire to ensure the safety and wellness of Canadian youth, and can assure the authors that this is a problem that resonates not just with the CPS Executive, but more broadly within its membership. The issues are complex, going well beyond the immediate stabilization of the patient with an opioid overdose, to the concepts of capacity and consent, with legal and bioethical ramifications. As well, the nature and availability of suitable resources for youth with struggling with addiction are a major concern.
In order to provide caregivers with appropriate, evidence-based guidance, a working group will be struck with participation from the CPS Acute Care, Adolescent Health, Bioethics, Drug Therapy and Hazardous Substances Committees, as well as experts in Addiction and Public Health. We wish to assure Drs. Warshawski and Warf that their call for action has been heard, and we will apply the appropriate resources to review the literature, analyze the issues, formulate recommendations, and determine which knowledge translation and advocacy strategies are required in order to make the most positive impact.