Youth in the N.W.T. and Nunavut are more likely to be hospitalized from harm caused by substance use than youth anywhere else in the country, and cannabis is the most likely substance to send youth to hospital across the country.

This is according to a study released this week by the Canadian Institute for Health Information (CIHI) that looked at hospitalization rates for youth between 10 and 24 years old in 2017-18.

"Youth, we know, are developing still until they reach the age of about 25," said Geoff Hynes, who manages the team at CIHI who put together the analysis.

"And because of their developing brains, they are very susceptible to substance use and substance harms."

Last year, more than 23,500 youth were hospitalized for harm caused by substance use, or 65 cases per day, the study finds.

During that time, N.W.T. youth were hospitalized for harm caused by substance use at a rate almost five times the national average. Meanwhile, the rate for young Nunavummiut was about three times the national average, while the rate in the Yukon was 22 per cent higher than the average.

The Northwest Territories leads the nation in hospitalization rates for harm caused by substance youth per 100,000 population. It is worth noting that all three territories have populations well below 100,000 residents. The study uses this ratio as a way to show how the rates compare across the country. (Infographic submitted by the Canadian Institute for Health Information)

Limited services and supports in rural and northern areas may factor into why the northern territories lead the pack in terms of substance-use hospitalization among youth, said Hynes.

"Yes, we do see that due to a lack of GPs [general practice doctors] and even mental health clinicians, that the only source for care for people is visiting a hospital," he said.

"We know that there are lots of barriers to care in the North, whether it be transportation costs ... costs for accessing care — a lot of these services may require psychological services which are not covered under health plans — family support, housing. All of these factors can make life more challenging for individuals in these areas."

Alcohol contributed to the most hospital stays by youth in the N.W.T., at a rate of 1,283 per 100,000. Alcohol was also the most harmful substance for youth in the Yukon, with the second-highest rate in the country of 295 per 100,000.

The N.W.T. also leads the nation in per-capita rate of youth hospitalizations involving cannabis, at 701 per 100,000. Cannabis was found to be the most harmful substance in Nunavut, which had the second-highest rate in the country at 630 out of 100,000.

"The cannabis today is much different from the cannabis from yester-year," Hynes said. "THC levels in cannabis are very, very high and that also helps increase the risk for problems."

'Hospitalization is a reaction'

More than two-thirds of the substance-use related hospital stays among youth also involved mental health crises, the study found.

This is reflected by the reality on the ground among at-risk youth in Yellowknife, according to SideDoor youth centre executive director Iris Notley.

"I can't name one youth ... that we work with where they're not plagued with mental health and addictions concerns," she said.

"Because, you know, of trauma. Whether it's intergenerational trauma caused by the effects of residential schools, whether it's being apprehended from your family, disconnected from your culture, I mean, all of those things are trauma.

"How youth choose to deal with that trauma is to not deal with it and partake in drugs and alcohol to kind of mask the problem."

Cannabis was the most common cause of hospitalization for harm caused by substance use among youth in Canada last year. While alcohol contributed to the most youth hospitalizations in the N.W.T., the territory also led the nation in its rate of cannabis-related hospitalizations. (Tijana Martin/The Canadian Press)

When asked about what she has noticed since the legalization of marijuana in Canada, Notley says use among the youth she works with has, if anything, increased. However, they most often buy cannabis from street sources, not government stores, and so there have been instances of youth she knows consuming tainted cannabis.

"Hospitalization is a reaction," she said.

"But there needs to be a lot of work and effort on the front end to prevent these instances from happening."

As an organization that serves at-risk youth and youth who are experiencing homelessness, the SideDoor needs to provide mental health and addictions services, she said. But, while they do have an un-funded counsellor position, they have been struggling to secure government support to have a health-care professional provide services at the shelter.

"We're not funded to provide those services because there are those services at the government," she said. "But a lot of youth we work with won't go to the government."

"It's a systemic problem that needs a systemic solution. If we're going to draft a strategy on what to do about this, youth have to be involved. Without youths' voice, it's you know, useless."