Navigating treatment in the shadow of the overdose crisis: Perspectives of youth experiencing street-involvement across British Columbia.

Objective: Youth experiencing street-involvement are particularly vulnerable to substance use-related harms. Since an overdose public health emergency was declared in British Columbia (BC) in 2016, there have been concerted efforts to expand youths' access to integrated mental health and substance use treatment across the province. The present study sought to explore how youth were navigating this rapidly evolving treatment landscape. Methods: Focus groups were conducted with youth experiencing street-involvement in three BC cities, followed by a summit event in Vancouver. Audio recordings were transcribed verbatim and coded thematically alongside observational field notes. All activities were undertaken in collaboration with a Youth Advisory Council. Results: Across BC, youth expressed desires to achieve aspects of what some called a "normal life" following treatment, which required having "somewhere to go next." In the absence of desirable housing and adequate income, youth were often left with the crushing sense that, despite their efforts, treatment would not ultimately help them to "get somewhere better." Negative experiences in treatment settings were also shaped by the files that "followed" youth across care settings, inappropriate information sharing between providers, and an overemphasis on pharmacotherapies (namely, opioid agonist therapies and psychotropic medications). Conclusion: Our findings point to the inability of existing services and systems to address entrenched marginalization and chronic instability, and underscore the importance of relationship-, trust-, and future-building to providing treatment and care to youth. Young people must be empowered with control over their treatment trajectories, including decision-making surrounding pharmacotherapies and information sharing.