Optimizing the quality of opioid agonist treatment for youth: experts’ recommendations for youth-centred models of care

Background Opioid agonist treatment (OAT) remains the standard of care for people with opioid use disorder in Canada and the United States. Despite rising rates of overdose among youth (aged 16–24), OAT continues to be underutilized in this population. To reduce these gaps, we gathered experts’ recommendations on the development and implementation of youth-centred models of care for OAT. Methods This qualitative research study was conducted between March 2024 and March 2025 in British Columbia (BC, Canada), where overdose is one of the leading causes of accidental death among youth. The study involved semi-structured expert interviews, conducted with four participant groups with expertise on the development and implementation of OAT for youth, including youth (aged 16–24) with experience accessing OAT, caregivers of youth with such experience, service providers, and decision-makers. Participants were recruited purposefully through youth mental health and substance use services across BC. A directed content analysis was performed on transcribed interviews to synthesize and describe experts’ recommendations for improving the delivery of OAT to youth. Results A total of 17 experts participated, including n = 6 youth, n = 4 caregivers, n = 5 service providers, and n = 2 decision-makers. The analysis led to the identification of eight recommendations: (1) establishing and maintaining trusting relationships with youth; (2) regularly checking in with youth about their goals, benefits, and challenges with OAT; (3) presenting all medication options and their benefits and challenges; (4) collaboratively developing OAT induction plans; (5) delivering OAT as part of a comprehensive approach; (6) delivering OAT in low barrier and non-judgmental settings; (7) collaboratively developing tapering processes; and (8) empowering and supporting caregivers. Recommendations were grounded in four foundational pillars, which emphasized positive youth–service provider relationships, flexible treatment plans, and service delivery settings that are low-barrier and holistic. Conclusions This study outlines experts’ recommendations for youth-centred models of care for OAT. Future research is needed to examine the implementation of youth-centred models of care for OAT, with specific attention to how these models address the diverse needs of youth across different communities, age ranges, genders, and clinical, social, and cultural contexts.