Sandelich S, Amanullah S, Barata I, et al. Adolescent Substance Use Screening in the Emergency Department. J Am Coll Emerg Physicians Open. 2026;7(4):100447. doi:10.1016/j.acepjo.2026.100447
This review examines current approaches to screening and managing the detection of adolescent substance use disorders (SUDs), with a particular focus on emergency departments (EDs). It covers clinical presentation, validated screening tools, including screening and brief interventions, tested implementation strategies for those tools, ideal post-screening workflows, brief motivational interviewing tactics, substance-specific management, and links to cost, care, and implementation. The authors also describe how confidentiality and equity affect the use of digital screening tools, especially for adolescent users. The American Academy of Pediatrics (AAP) recommends universal screening with validated tools for all adolescents at every well visit. Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends screening, brief intervention, and referral to treatment (SBIRT) as part of routine health care. However, Centers for Disease Control and Prevention (CDC) research has revealed gaps in current practice. The review identifies universal, validated electronic screening as a practical approach that can be completed within minutes, detect otherwise hidden substance use, and address longstanding inequities in identification. The authors report that combining screening with structured follow-up, brief motivational intervention, substance-specific management, harm reduction, and active referral can improve linkage to care and produce measurable short-term reductions in alcohol-and cannabis-related harms. The authors also emphasize the importance of following standard adult practice for other age groups and initiating buprenorphine in emergency departments for adolescents. Standing protocols should support its use in pediatric emergency settings. Future research should focus on adolescent-specific cost-effectiveness analyses, outcomes beyond 12 months, validation of tools for emerging substances, and integration of artificial intelligence and natural language processing for real-time risk assessment and care coordination.