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Confronting the disparity in non medical prescription opioid use among rural and urban youth:

A call for broader recognition in the era of clandestine fentanyl

Perry Tompkins1 Citation: UBCMJ. 2018: 9.2 (36-37

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Nonmedical prescription opioid use (NMPOU) among Canada’s rural youth is a public health problem largely overshadowed by the opioid crisis in metropolitan centres. In this commentary, the author explores the unique socioeconomic factors that underpin NMPOU among rural youth and draws attention to its potential to prime and promote exposure to increasingly prevalent clandestine fentanyl, often disseminated and disguised as common prescription opioids. In turn, the author argues for mitigating strategies to curb NMPOU, informed by greater awareness of the unique vulnerabilities of rural youth.

In 2017, the Canadian Institute for Health Information identified youth aged 15-24 as one of the fastest growing cohorts in terms of opioid-related hospitalization,1 driven in part by the increasing prevalence of clandestine fentanyl, particularly in British Columbia and Alberta.2,3 While the urban impact of this phenomenon has been widely covered, the threat to Canada’s rural communities has received less attention. This is concerning not only because of the relative undersupply of rural mental health and addictions treatment services compared to urban communities, but also owing to the higher prevalence of nonmedical prescription opioid use (NMPOU) among rural youth.4 As its name implies, NMPOU involves taking prescription opioids in any manner inconsistent with how they were prescribed or by a person for whom they were not prescribed; it can involve borrowing from friends or family, using higher–than–recommended doses, or pure recreational use.5 Apart from serving as a gateway to heroin,6 greater NMPOU may be priming Canadian rural youth to the threat posed by the spread of potent clandestine fentanyl, often masquerading as prescription pain medicine.7 Averting the attendant morbidity and mortality in rural communities will require broader recognition of the geographic disparity in NMPOU, which is also a prerequisite to developing viable public health responses. Despite its potential impact, lack of awareness of greater NMPOU among rural youth is unsurprising given the recently emergent literature on geographic differences in prescription drug misuse. While rural