As the world marks International Youth Day today, the United Nations Office on Drugs and Crime calls on the youth to take charge of their health and future. Drug use among young adults has been linked to negative health and social outcomes in later years.
In order to achieve the Sustainable Development Goals (SDGs), it will require that state parties take appropriate measures to protect this age group from the illicit use of drugs. However, the war on drug use often trumps young people’s rights.
Harm reduction, or minimization, refers to a philosophy and set of practices that acknowledge that substance use – be it alcohol, drugs, or cigarettes – is a part of life. It aims to reduce the negative harmful effects of substance use, rather than simply ignoring or condemning it. Decades of evidence have revealed that many harm reduction strategies are highly effective in decreasing tobacco use, preventing overdose, and reducing other sources of morbidity and mortality among people who use substances, including young adults who use illicit drugs.
Most young adults feel that existing harm reduction programs are too narrow in scope and do not address the full spectrum of concerns that affect their substance use, such as mental health issues, family and peer relationships.
Drug use programs for the youth and educational strategies are frequently informed by prevention approaches that emphasize abstinence, which often does not resonate with youth in their lack of acknowledgment of young people’s social context and how young people perceive the positive effects of substance use. Further, approaches to drug use prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing drug use in the context of population variation and inequities. Harm reduction services, such as syringe services programs, overdose education, naloxone distribution, fentanyl test strips and electronic cigarettes, help reduce poor health outcomes and deaths from substance use in adults. Yet few of these programs are designed around young people's needs, and most exclude them altogether.
Successful harm reduction models which provide overdose services and HIV prevention to adolescents and young adults exist. Electronic cigarettes serve as a safer alternative that reduces health-associated risks. While some critics have argued that electronic cigarette use is a gateway to smoking, the opposite is true. E-cigarettes provide a gateway from smoking and have been used by millions of smokers to reduce the health risks associated with tobacco consumption.
A recent analysis of trends in nicotine use in England suggests that the so-called gateway theory of vaping is not the explanation. The real reason for the link could be that young adults who start vaping are the same ones who are likely to try smoking, regardless of whether they ever have an e-cigarette. Clinicians risk limiting engagement opportunities and losing young patients' trust by focusing on abstinence-based messaging. Harm reduction programs that are available, too often exclude young people, even though there's no evidence-based or scientific reason for those age limits.
But even when legally available services are provided, many youths stay away from programs that primarily serve adults. Barriers include avoidance of law enforcement, mistrust of adults in authority, and a fear of being around older adults who use substances. There is a need for legal and policy frameworks relating to drug use and service delivery to be reviewed and amended to remove barriers so that young adults can realize their right to health and easily access available products and services. While removing age limits on harm reduction services is a good start, what's needed is programming designed to meet the needs of youth from the ground up and is sensitive to young people's intersecting identities.
By creating more youth-centred programs and offering harm reduction services, policymakers and care providers can save lives and create more entry points into treatment and healthcare for young people who use drugs. Failing to find solutions represents a missed opportunity to protect and improve the health of the next generation of youth across the world.