Lessons Learned From “A Day for Youth Voices on the Opioid Overdose Crisis” and Future Directions for Research on the Youth Polysubstance Use Emergency in Canada : Canadian Journal of Addiction

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ORIGINAL STUDY

Lessons Learned From “A Day for Youth Voices on the Opioid Overdose Crisis” and Future Directions for Research on the Youth Polysubstance Use Emergency in Canada

Nairn, Stephanie A. MA1,2,3; Isaacs, Jason Y.4; Stewart, Sherry H. PhD4,5; Hawke, Lisa D. PhD6; Thulien, Madison7; Fast, Danya PhD7; Knight, Rod PhD7; Conrod, Patricia PhD1,2; Henderson, Joanna PhD6; Khan, Faria6; Lam, Alice9; Haines-Saah, Rebecca J. PhD8

Author Information
The Canadian Journal of Addiction 13(2S):p S8-S17, June 2022. | DOI: 10.1097/CXA.0000000000000151

Abstract

INTRODUCTION

Nonmedical opioid use among youth has been a longstanding public health concern, and the current overdose crisis that has taken hold in North America since mid-2010 is also greatly impacting youth and young adults. Opioid-related morbidity and mortality among U.S. youth continues to rise1,2 and hospitalizations due to opioids have increased among young people in Canada.3 In 2017, 20% of the 3987 deaths due to opioids in Canada were among 20 to 29 year olds,4 with younger adults evidencing the fastest growing rate of opioid poisonings over the past 5 years. The COVID-19 pandemic has further exacerbated these trends in some provinces.5

There is a dire lack of knowledge regarding how diverse young people (ages 15–25) experience opioid use (OU), connect to opioid-related services, and navigate opioid use disorder (OUD). This knowledge is urgently needed to inform the development of effective and appropriate prevention and treatment interventions for youth.

For example, in our scoping review of clinical interventions for OUD6 we found that interventions specific to early stages of youth OU are rare, focused heavily on male youth, and show significant challenges with youth retention. Of particular concern, we found that youth-specific strategies and approaches are rarely integrated into treatment a priori, with treatments for adults ‘mapped onto’ young people, with no evidence that youth or young adults were meaningfully consulted or included in their development.

To address these gaps in knowledge and practice, this paper outlines the protocol and procedures for our pan-Canadian youth engagement summit that was held in January 2020 under the auspices of the Canadian Research Initiative in Substance Misuse (CRISM). CRISM was established in 2015 and is comprised of four regional nodes across Canada: British Columbia, the Prairie provinces, Ontario, and Quebec/Atlantic regions. The network was established to facilitate communication and collaboration among addiction service providers, researchers, and policy makers and their research focuses on knowledge translation and prevention of and treatment for substance use.

To better understand the needs and experiences of youth who use opioids or are navigating OU and OUD in the context of the current overdose crisis, the “At-Risk Youth/ Newer Users” research team was established and consists of youth substance use researchers from across Canada who are involved in the CRISM network. In the context of a grant to CRISM from the Canadian Institutes of Health Research’ Emerging Health Threats Research Fund (EHT), CRISM identified four guiding objectives: (1) Scaling up public health interventions; (2) Optimization of OUD treatments; (3) Improving the evidence base for withdrawal management, psychosocial, and recovery-based treatment; and (4) Collaborating to develop new intervention approaches to meet the needs of high-risk populations. Our youth-focused project was one of 12 collaborative projects carried out with EHT funding. The goal of the youth summit was to understand adolescents’ and emerging adults’ (those whom we collectively refer to as “youth”) experiences and perspectives with regards to OU/OUD and the overdose crisis.

We begin by outlining the theoretical lenses and methodological framing that guided the development of the summit and data collection, highlighting qualitative and participatory approaches that continue to be atypical in addiction research. We outline how the planning, recruitment, and youth engagement processes unfolded with diverse populations of youth at the sites across Canada. Reflecting on both our successes and challenges in mounting and carrying out the summit, we point to some next steps for researchers, healthcare professionals, and policy makers working with youth who use opioids.

THEORETICAL FRAMEWORK: FROM PATIENT ENGAGEMENT TO MEANINGFUL YOUTH ENGAGEMENT

The EHT Implementation Science Program on Opioid Interventions and Services led by CRISM7 is a part of larger policy, governmental, and research-related shifts that increasingly recognize the value of involving service users, people, and people who use drugs in health care, policy, and research. Researchers have argued that this shift is underpinned by a commitment to social inclusion, which requires both the active removal of barriers and investments to promote inclusiveness.8 The United Nations convention on the rights of the child, is the most ratified international human rights treaty in history, and emphasizes children's rights to ‘provision, protection and participation’, including freedom from poverty, discrimination, violence and other harmful social conditions that limit their ability to learn, thrive, and grow to their full potential.9

A focus on youth inclusion in health research has been rather recent. The World Health Organization10 and UNICEF11 have recently published guidelines on child and adolescent civic engagement in health-related issues. In 2020, the Wellcome Trust also published results of a rapid evidence review and stakeholder consultations about the role, benefits and potential of youth involvement in health research specifically.12 The results of the report indicated that, “There are too few opportunities for young people to get involved in health research” (Das et al, 2020: 4) and the authors also argued, “Researchers need to employ new ways of working with young people” (Das et al, 2020: 4). The report also showed that literature on young people's involvement in research is still emerging, with an increase in publications in the last 5 years. Most of the current research comes from high income countries (ie, 85% of the articles they found were from high income countries). The report hypothesized this was due to several factors including constrained funding in low-middle income countries.

Canadian governmental initiatives are aligned with the aforementioned guidelines and include the recent establishment of a federal youth advisory council13 and the continued policy and research-related endeavors of the Students Commission of Canada and the Centre of Excellence for Youth Engagement.14 In Canada specifically, youth inclusion in substance use research and policy has also been operationalized by governmental agencies, research organizations, and grassroots patient advocacy organizations, including the Canadian Association of People who Use Drugs and the Vancouver Area Network of Drug Users who argue that, “The relationship between the researcher and the researched is not in and of itself empowering or liberating. It only becomes so when organized movements of the oppressed group play an active [our emphasis] role in shaping and carrying out the research.”15 The Canadian Institutes of Health Research has also developed strategies to integrate and engage patients in clinical and scientific research.16

Frequently it is proposed that programs and policies for youth will be more efficient and effective if young people are engaged in the planning, delivery, and evaluation of services.17 The benefits for society and youth populations also emerge through the act of participation itself, as young people acquire skills, self-esteem, and self-development.17

Youth inclusion in research is operationalized via several different methodologies, including Participatory Action Research, Youth Participatory Action Research,18 and Community-Based Participatory Research. The goals of these methodologies are diverse, but a shared motif is the assertion that the involvement of youth should avoid “tokenistic”18 gestures. Participatory Action Research and Youth Participatory Action Research advocate for the active involvement of youth in the research process, including identifying and constructing solutions to social problems. Community-Based Participatory Research also emphasizes that individuals should be involved in all phases of a rigorous research process (for a comprehensive review of these approaches, see Ozer et al, 2020).19

Members of our team have published extensively on youth engagement in research, including guidelines for researchers on how to involve youth effectively and authentically in research projects where they are collaborating with and being mentored by adult researchers.20–29 The youth summit procedure (described following) represents a unique methodology for involving and collaborating with youth.

YOUTH SUMMIT STRUCTURE & PLANNING

To meet our research objectives (see Figure 1 in Appendix, https://links.lww.com/CJA/A20) we implemented a four-pronged methodological approach (see Figure 2 in Appendix, https://links.lww.com/CJA/A20). To understand the needs and perceptions of youth regarding the overdose crisis we held a pan-Canadian youth summit event entitled, “A Day for Youth Voices on the Opioid Overdose Crisis”, with 6 youth populations across Canada: (i) youth who were prescribed opioids for pain (Montreal), (ii) youth seeking substance use services (Toronto), (iii) youth experiencing street involvement (Vancouver, Prince George, and Kelowna), (iv) Northern youth (Thunder Bay), (v) siblings and family members of youth with OUD (Calgary), and (vi) university students who had experience with opioid, stimulant, or sedative/tranquilizer prescription drug use (Halifax).

A total of 8 summits were held in Halifax, Montreal, Toronto, Calgary, Vancouver, Prince George, Kelowna, and Thunder Bay. Four summits were held simultaneously in January 2020; the BC node held their summit in Vancouver in November 2019, a few weeks prior to the other summits, and then shared information about the structure and that helped to inform the subsequent summits. The Ontario team hosted a follow-up summit with Northern youth in February 2020 in Thunder Bay.

For the simultaneous summits, Montreal, Halifax, and Calgary were linked together via videoconference at the start of the summit to welcome participants and to identify common goals across the groups. The formats of the summits varied (see Table 1 for summit formats).

Table 1 - Youth Summit Demographic Data.
All Sites(n = 131) Total (%)
Age
 14 and under 2 2
 15–16 7 5
 17–18 19 15
 19–22 43 33
 23–26 40 31
 27–29 5 4
 No response 15 11
Gender
 Woman/girl 71 54
 Man/boy 36 27
 Transgender/gender diverse 1 10 8
 No response 14 11
Location 2
 Rural 7 7
 Suburban 12 13
 Urban 64 67
 No response 13 14
Ethnic origin
 White 52 40
 Black/African Descent 8 6
 Indigenous 28 21
 Asian 6 5
 Middle Eastern 5 4
 Mixed/Biracial 11 8
 Other 7 5
 No response 14 11
1Transgender/gender diverse include transgender, non-binary, two-spirit, another gender, no gender.
2Data on participants’ location was not collected at ON site.

The lead researchers and research assistants met in June 2019 to plan the objectives and structure for the youth summit. The planning meetings consisted of firstly identifying goals and objectives that would guide the activities. The first goal identified was to familiarize youth with the current evidence on interventions and treatments for youth and opioid use. We decided that each site would work with youth leaders to support them in presenting this evidence to their peers at the summit.

The second goal was to solicit information about how to make interventions and treatments more youth-friendly and or youth-focused. We sought to support youth to present sample intervention vignettes to their peers, and then facilitate discussion to identify strategies that might make those interventions more responsive to youth needs. Research assistants alongside youth and investigators paraphrased, condensed, and simplified data from the published articles into vignettes for youth, with a focus on outlining the characteristics of the treatments (see Figure 3 in Appendix, https://links.lww.com/CJA/A20).

Lastly, we developed the goal of creating youth-generated guiding principles, core values, or “philosophies” for addressing the opioid overdose crisis among youth, with a focus on identifying practical definitions of what these principles look like in service settings. The core values and principles were intended to be communicated to relevant stakeholders, including policy makers and service providers.

At the conclusion of the meeting, it was agreed that while the team would have the same objectives, the formats of each event would be flexible. This allowed each site to work collaboratively with youth leaders to ensure that summits were tailored to the unique needs of the youth demographic that was the focus of their event.

With regards to structure, team leaders decided that the summit should be long enough to achieve its goals and short enough to maintain attention and energy from youth. As such, team leaders reached a consensus on a 4-hour summit. It was further agreed that the provision of snacks and beverages as well as lunch would help engage participants throughout this period of time.

YOUTH SUMMIT RECRUITMENT

Previous research has found that recruitment and engagement with youth (especially younger youth) can be difficult.30 Researchers working with youth who use opioids have noted that it is sometimes difficult to access youth because they are “hidden” and potentially fearful or ambivalent about consulting with professionals and researchers.31 Efforts to combat stigma associated with discussing substance use are ongoing among Canadian organizations.32

Despite these challenges, the teams were successful in recruiting a total of 169 youth across Canada. Each site engaged in various methods of recruitment depending on previously established professional relationships, including through existing Youth Advisory Councils (Vancouver, Calgary) (see Table 1).

YOUTH SUMMIT PROCESSES

All sites acquired informed consent or assent from participants and their guardians (if ethics boards indicated that guardian consent was required) either prior to the summit or prior to the initiation of the event. Youth were invited to complete a demographic survey prior to the event at each site (see Appendix, https://links.lww.com/CJA/A20 for demographic data for N = 131 participants).

The final formats of the summit varied at each site and each site revised the summit agenda consistent with local needs in consultation with youth advisors. For example, it was not realistic within the timeframe for some sites to present results from our scoping review to youth, so they opted out of this activity.

Each site supported youth facilitators to present site-relevant treatment vignettes. Each site's lead researchers selected the treatment vignettes based on the results of the scoping review (see Figure 3, https://links.lww.com/CJA/A20, for example). Lists of open-ended questions were developed at each site regarding the vignettes and guided youth discussions on how to improve the interventions. This activity was modified in Vancouver and discussion topics and principles were identified beforehand in consultation with a Youth Advisory Council (see Table 1).

Each site then facilitated discussions with youth about the overarching values that could inform treatment and intervention services for youth. This included identification of actionable levers (ie, persons and/or organizations) to facilitate changes or improvements in opioid-related services and policies. Open-ended questions were also developed in advance by researchers in collaboration with youth, which allowed youth to expand on any topic they thought was relevant to the issues.

In addition to these activities, each site hired a graphic recording artist(s) to illustrate the process of the youth summit (see Appendix for designs, https://links.lww.com/CJA/A20). Each site consulted with the artists prior to the summit and discussed the topic with them. The sites varied with regards to how youth participated in the graphic design process. For example, in Montreal, youth were invited to place their thoughts on the design at the end, but this approach did not work for every site. In Vancouver and Halifax, youth opted to either share their thoughts with the graphic recording artist directly or with the group more generally (while the graphic artist recorded discussion points alongside the group). Some youth preferred to write their thoughts on paper and leave them behind, to be included in the drawing afterwards anonymously.

Each site used either audio recording or note taking to document discussions, with some sites utilizing a combination of both methods. For example, the Halifax site included two live note takers for each discussion; the two sets of notes were confirmed after the summit to confirm accuracy of the information obtained. Verbatim or almost verbatim note taking is a commonly used ethnographic method when it is not desired, permitted, or practical to have an audio recorder present; this was the case at the Toronto, Thunder Bay, and Halifax events.

The sites that did audio record the youth summit, transcribed the recordings in full. The youth summits were coded using a master codebook. The coding scheme was developed together with the research team members who shared their tentative coding schemes. Together, they refined their codebooks across the sites based on similarities to create a master codebook, resolving differing opinions via consensus. Researchers then coded all transcripts using the master codebook, creating new site-specific codes for any content that did not fit the master scheme. The results of these analyses are presented in other publications from our project team.

YOUTH SUMMIT SUCCESSES

Youth were encouraged to fill out a feedback survey at the end of the summit that consisted of approximately 14 to 19 questions and was premised on the Public and Patient Engagement Evaluation Tool (PPEET). The PPEET tool has been used to evaluate patient and public engagement in health systems and research and some have recently argued tools like PPEET can be useful for evaluation of youth engagement activities when it may not be feasible to develop new tools with youth.33 We modified the language of the PPEET tool to encompass references to the ‘summit’ event, rather than the ‘engagement’ event. The questions were closed-ended and asked youth to rate their level of agreement with statements with response options ranging from “strongly disagree” to “strongly agree.” The survey also included open-ended questions about general feedback and thoughts on the event. Some sites incorporated additional site-specific questions that pertained to site-specific material.

The following discussion of summit successes and challenges is derived from analysis of the data from the feedback surveys and feedback provided informally to summit teams.

Most of the youth at each site rated the event highly. About 82.5% of the N = 126 respondents who filled out the survey, indicated they either agreed or strongly agreed with the statement that they were (overall) satisfied with the event and 78.6% agreed or strongly agreed that the summit was a good use of their time. About 83% agreed or strongly agreed that they understood the purpose of the summit and 76% agreed or strongly agreed that the support they needed to participate was available. About 84% agreed they were able to express their views freely and 78.5% agreed or strongly agreed they felt their views were heard.

With the exception of the Calgary site, feedback was more mixed with regards to the possible impacts the summit would have. For example, 65% agreed or strongly agreed that the results of the summit would be used by people who were involved in providing substance use services to youth and 57% agreed or strongly agreed that the results of the summit would make a difference in youth substance use services. Participants at all sites highlighted the difficulties of catalyzing changes in policy or practice at federal, provincial, and regional levels.

Engagement

Through a combination of connections with youth via focus groups, previous professional connections, Youth Advisory Councils, recruitment posters, and social media posting, different youth demographics participated in the event. It should be noted that youth with diverse experiences with opioids were represented at each site. As mentioned previously, 6 youth populations with various experiences with opioid use participated in the summit and interestingly, a large proportion (>50%) of participating young people identified as young women. This is notable, because as we have discussed elsewhere, most OUD treatment for youth focuses on men.

Each site offered training to support youth leaders in presenting evidence-based and peer-reviewed material, as well as to facilitate the discussion activities among their peers. Training and facilitation preparation before the event involved meetings wherein youth facilitators could ask questions about the material and contribute to design of the activities, as well as offer their feedback about the vignettes or guiding principles and philosophies that might be discussed at the summit. The team's experience working with and consulting youth prior to the summit, particularly with regards to the vignette-based activity, resonated with literature that demonstrates youth (ages 15 and up) can understand scientific literature on substance use and make sense of the content.34

All sites documented positive feedback and engagement with the graphic recording process. The accessible, visually-pleasing, and informative nature of these artistic renderings meant that they were circulated widely beyond the actual youth summit event. The graphic recordings have been presented at the United Nations Commission on Narcotic Drugs in Vienna in March of 2020, the Canadian Society of Addiction Medicine conference and to the Controlled Substances Directorate at the Public Health Agency of Canada.

Youth were supported at each site through the provision of honoraria for the half-day, the provision of food, and the coverage of travel and accommodation expenses in some instances. Youth identified that having reminders about the event were helpful prior to the summit.

Education and information

Of the 126 participants who filled out the survey, most youth indicated that they felt more informed about the youth opioid overdose crisis and the current state of available services and treatments. About 76.6% agreed or strongly agreed that after the event they knew more about topics related to substance use services. Youth also felt that there were different perspectives and views shared throughout. About 83% agreed or strongly agreed that people participating represented a broad range of viewpoints on topics related to youth and youth substance use. This success is particularly salient as it has been suggested by youth that there has been very little basic information about opioids and prevalence of use among young people or about the treatment and intervention options available.

It should be noted that while many youths felt more informed about interventions and treatments for opioid use and opioids in general, other youth already came to the summit with awareness and/or experience with opioid treatment services and were involved in advocacy-related initiatives regarding the opioid overdose crisis. For example, in Montreal, there was a range of experience with opioids and with treatment services; while the exchanges between youth were revealing, some youth with prior awareness and information about opioids and the overdose crisis felt as though they did not learn as much as others.

Social-psychological support, normalization, and validation

Each summit was structured to provide a safe space separate from authority members, while simultaneously keeping resources and supports available (if needed). For example, certain summits were attended by a psychotherapist who could support youth during the event as needed. In some instances, other relevant supports were present. For example, in Vancouver, a nurse who works with youth experiencing street-involvement and a harm reduction leader from the local health authority were present. In Halifax, a student-services leader with knowledge of opioid-related services for students attended the beginning of the event.

Chill spaces and/or ‘breakout rooms’ were provided at all sites to make participants feel more comfortable. Depending on the site, these spaces offered opportunities such as consulting with a counselor, relaxing, and/or safely consuming substances. The provision of safe injection equipment and substance use professionals was not possible at every site but was necessary at the Vancouver site. While each ‘chill space’ looked different, all sites incorporated more relaxed seating and lighting, and in some instances, music was provided. In Montreal, the breakout space was in the same room as the group discussion, and it was discovered through lack of youth use of the space, that perhaps it would have been preferable to have the space outside of the main discussion hall. For example, in Halifax, the breakout room was accessible in a separate level of the event building where food and drinks were provided, and where one of the group events took place in the afternoon.

The interactive nature of the summit promoted sharing of different stories among youth and provided youth not only with information about interventions and treatments but sensitized youth to other perspectives and experiences that were like and also different from their own. The sharing of different stories and experiences promoted feelings of validation and normalization of youth experiences in some cases.

YOUTH SUMMIT CHALLENGES

Time and structure

A recurrent challenge experienced at each site was related to time and timing of the event. Our team experienced initial difficulty settling on whether a weekend or a weekday would be ideal for young people who are in school during the week and also potentially working or taking leisure time on weekend. We determined that youth were potentially more able to attend a weekend event, although hosting the event on a weekend could also have caused the loss of participants due to their desire for leisure time and work commitments.

Some participants suggested the event could have been shorter as it was difficult to engage youth and maintain momentum for a 4-hour period. Some sites asserted that the event could have also been longer. For example, 15 minutes for each intervention vignette was considered not long enough and it was suggested that this could be extended to 30 minutes. There was a need for activities to maintain youth engagement over longer periods of time.

Content

Even though youth generally felt more informed post-summit, it was argued that there could have been less “information sharing” and more time allotted for discussions. Approximately 45 minutes were allotted for information sharing and it may be beneficial for future events to eliminate or modify the presentation of the evidence to include more discussion-focused activities. For example, a rotating group discussion, a method utilized by the Vancouver site, may have been more ideal for youth who prefer to participate in less didactic activities.

Interaction(s)

Since there were varied discussion group sizes (11–36 people) at each site there were challenges managing the contributions to group discussions. As with the focus group methodology, a challenge was that some individuals tended to dominate discussions. It was evident that some individuals felt more confident sharing and speaking in larger groups. It was suggested that smaller breakout groups (eg, of 4 or 5 youth) might be preferable to ensure that individuals felt more comfortable sharing and that all views would be sufficiently noted and acknowledged. It was suggested that building relationships among youth, facilitators, and researchers prior to the summit could be a helpful strategy to allow for a richer and more in-depth interaction and discussion.

CONCLUDING DISCUSSION

The EHT At-Risk/Newer Users project can be conceived as a pastiche of the models, frameworks, and guidelines of engagement previously discussed, including training, youth-led planning, participatory arts, consultations, and collaborations with youth advisory committees. This paper also contributes to the dearth of empirical research regarding youth engagement and participation activities. Previously cited reports including the Wellcome Trust report12 on the role, benefits, and potential of youth involvement in research, noted that the vast majority of studies do not report on the backgrounds of youth (eg, gender, socio-economic status, etc.) and that the benefits of participation of youth in health-related research frequently go under or unreported. Some Canadian federal initiatives have sought to address this gap13,14 and a report was published in 2019 about the first Canadian (federal) youth summit.35 We have also sought to address this gap and have thus documented youth feedback about the benefits of the summit and specified the characteristics of diverse youth participants from across the country representing different youth populations and experiences with opioid use.

In summary, youth contended there is a lack of information about opioids available to them and the summit was successful in informing youth populations about the contemporary state of the opioid overdose crisis and interventions that are (or are not) available to young people. Our process was premised on collaboration with youth leaders and their input not only informed but altered the activities in some instances. The open-ended question format meant that interactions went in various directions, determined by the flow of conversation among youth. Despite this success, future summit planners could consider the continuum of youth awareness about substance use issues, and then aim to find a balance between engaging youth who may have little awareness and simultaneously engaging youth who are already more informed or involved in advocacy.

Youth training and support promoted youth engagement through expressions of youth-specific needs and the opportunity to hone various skills development, including communication, presentation, and relational skills. One of the primary youth summit successes was education and information sharing. As shown through analyses of the PPEET surveys from each site, the majority of youth agreed or strongly agreed that they knew more about topics related to substance use services after the events, that different views were shared throughout and that the people participating represented a broad range of viewpoints related to youth substance use. Most youth indicated the supports they needed were in place to participate in the summit events. Youth felt in some instances both normalized and validated through the youth summit activities. Youth also participated in the development of a unique graphic illustration. This is significant because previous research has identified arts-based research as a potential transformative (participatory) qualitative research process.36

In this article we noted several challenges to the development and management of youth summits, which provide insight into how similar events could be improved in the future. Recruitment of youth is a time-consuming process, but we believe that it was vital to the success of the events. We acknowledge that despite the diversity of youth participants’ experiences with opioid use represented at the summit, concerted efforts for future events could be made to recruit youth from varied socio-demographic groups, including ethnic, gender, and regional groups. Relatedly, we acknowledge that better categories or labels for gender diverse youth could be integrated into analyses of youth summit engagement processes. The challenges regarding the time and timing, means that future planners consider being flexible with regards to different dimensions of the activities. For example, it may be beneficial to offer different methods for youth to express their views beyond face-to-face focus group-style interactions. This challenge could also be addressed through the on-going cultivation of rapport with youth participants before the actual event and the involvement of youth in earlier stages of youth summit planning rather than in the latter stages. While this is a time-consuming process, it could also promote more in-depth interactions that authentically value and comprehend youth experiences and values.

It is not surprising that youth were generally less confident, as indicated via assessments of the responses to the PPEET questionnaires, about whether their feedback about treatments and their values and guiding principles would be taken up by relevant stakeholders (eg, substance use professionals/organizations) and by policy makers. Policy analysts from Health Canada attended three summits (Halifax, Montreal, and Toronto) however, their involvement was observational as the event was intended to be solely youth-directed and informed. Consistent with the systematic review of literature on involvements of stakeholders in research,19 more frequent and meaningful engagement with youth by key decision-makers and health professionals are needed. Our team continues to share the results of the event and project through forums such as the United Nations Commission on Narcotic Drugs annual meetings, as well as several academic and governmental platforms and these continue to be key opportunities to connect youth with decision-makers and healthcare professionals.

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PPEET was assessed in 7 health systems organizations and was updated in 2018.

The results did not include data from Prince George or Kelowna.

A potential reason for this discrepant finding from Alberta was that youth were recruited from a provincial youth council, where they were engaged in activities designed to inform program development and had previous discussions with addiction and mental health policy stakeholders.

Keywords:

opioids; participatory research; protocol; youth; youth engagement; youth summit; jeunes; sommet jeunesse; participation des jeunes; recherche participative; protocole

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