Centering Young People’s Perspectives, Needs, and Preferences in Researching Barriers to Medications for Opioid Use Disorder-Reply

In Reply

We thank Marchand et al for their commentary on the importance of including young people’s perspectives in designing and providing substance use treatment services, including medication for opioid use disorder (MOUD) programs. While our systematic review provided insight into some of the factors associated with MOUD access among young people,¹ we agree that centering their voices is critical to ensuring treatment willingness, access, and engagement. Indeed, the evidence suggests that agency in decision-making and the provision of additional health and social supports are. essential components of youth-centered substance use and mental health treatments.²

Similarly, including young people’s voices in identifying their own treatment goals and outcomes is essential to supporting engagement in services and favorable outcomes.³ For example, complete abstinence from opioids may not be a desired or realistic aim for some young people who report frequent polysubstance use; instead, reducing illicit substance use may be seen as a more attainable goal and available supports and services should correspond with young people’s immediate needs to reduce potential harms and risks. Alternatively, young people who have ceased illicit opioid use and have been taking MOUD could be provided with tapering options and subsequent supports to transition away from MOUD, but only if and when they are prepared to do so.

Although these considerations are clinically important, they are also relevant in substance use treatment research.⁴ This could include expanding the metrics of success beyond conventional and standardized measures (eg, abstinence only) and assessing outcomes identified and validated by young people. For example, reduction of risky injection practices or changes in the frequency of illicit opioid use should be viewed as favorable outcomes and indicative of an intervention’s success as opposed to its failure.

In addition to reenvisioning substance use treatment outcomes and measurements, our review also demonstrated the concerning absence of voices of young people who identify as lesbian, gay, bisexual, transgender, queer (or questioning), asexual (or allied), intersex, or two-spirit; those who have been racially minoritized; and those with disabilities in conversations around treatment design and provision. This requires acknowledging the ongoing harms of colonial and carceral approaches to substance use treatment that have damaged trust in treatment services, researchers, and clinicians as well as providing nonmandatory, person-centered treatments that respect young people’s autonomy. For this reason, policy makers and clinicians must work with young people to expand harm reduction services and the range of available treatments while avoiding punitive and coercive approaches to care.⁵

We concur with Marchand et al that emphasizing young people’s voices in substance use treatment is essential to building trustful and meaningful relationships. Nevertheless, we acknowledge that structural violence and the ongoing threat of the syndemic of COVID-19 and the toxic drug crisis pose considerable challenges. Urgent action is needed to reduce the harms and risks to young people who use illicit drugs, and we are confident that increasing their autonomy in treatment decision-making, goal setting, and outcomes measurement can facilitate improvements in their health and well-being.