TY - JOUR
AU - S. Sandelich
AU - S. Amanullah
AU - I. Barata
AU - K. Berg
AU - K. Brown
AU - T. Cheng
AU - C. Chimptazi
AU - I. Claudius
AU - A. M. Dietrich
AU - S. Lin
AU - T. Ruttan
AU - M. Stoner
AU - C. Sulton
AU - M. Waseem
A1 - 
AB - Adolescent substance use remains a major public health concern, and the emergency department (ED) represents a critical point of contact for identification and early intervention. Many adolescents rely on the ED as their primary or sole source of health care, making missed opportunities for screening particularly consequential. Although overall substance use rates among youth have stabilized or declined in recent years, drug-related mortality, especially from illicitly manufactured fentanyl, has risen sharply, highlighting the need for proactive detection and intervention. Professional organizations recommend universal, validated screening for substance use in adolescents, yet implementation in ED settings remains inconsistent due to workflow constraints, confidentiality concerns, and limited provider training. Validated tools, such as the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) questionnaire, the screening to brief intervention (S2BI) tool, and the brief screener for tobacco, alcohol, and other drugs (BSTAD) tool, allow rapid, developmentally appropriate screening. They can be integrated into electronic health records (EHRs) or self-administered digital formats. Evidence suggests that electronic or kiosk-based screening increases disclosure and detection without adversely affecting throughput. Screening alone is insufficient; pairing detection with brief motivational interventions and facilitated referral to treatment improves short-term outcomes and linkage to care. However, follow-up rates remain suboptimal, underscoring the need for structured referral pathways, behavioral health integration, and technology-enabled supports such as text-based reminders or telehealth. Universal, developmentally tailored screening in the ED, combined with brief intervention and active linkage to outpatient care, offers a practical strategy to reduce substance-related morbidity and improve long-term outcomes for adolescents.
AD - Department of Emergency Medicine and Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.; Department of Emergency Medicine, Pediatrics, and Health Services, Policy and Practice, Alpert Medical School of Brown University and Brown School of Public Health, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island, USA.; Department of Pediatrics and Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA.; Department of Pediatrics, University of Texas at Austin-- Dell Medical School, Austin, Texas, USA.; Department of Pediatrics and Emergency Medicine, the George Washington University (GWU) School of Medicine, Washington, District of Columbia, USA.; Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Harbor-UCLA Medical Center, Department of Emergency Medicine, Los Angeles, California, USA.; Division of Emergency Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Department of Emergency Medicine, Torrance, California, USA.; Department of Emergency Medicine, Prisma Health, Greenville, South Carolina, USA.; Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA.; Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.; Department of Pediatric Emergency Medicine, Nemours Children's Hospital, Orlando, Florida, USA.; Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York, USA.
AN - 42382160
BT - J Am Coll Emerg Physicians Open
C5 - Opioids & Substance Use; Healthcare Disparities
CP - 4
DA - 08/2026
DO - 10.1016/j.acepjo.2026.100447
DP - NLM
ET - 20260622
IS - 4
JF - J Am Coll Emerg Physicians Open
LA - eng
N2 - Adolescent substance use remains a major public health concern, and the emergency department (ED) represents a critical point of contact for identification and early intervention. Many adolescents rely on the ED as their primary or sole source of health care, making missed opportunities for screening particularly consequential. Although overall substance use rates among youth have stabilized or declined in recent years, drug-related mortality, especially from illicitly manufactured fentanyl, has risen sharply, highlighting the need for proactive detection and intervention. Professional organizations recommend universal, validated screening for substance use in adolescents, yet implementation in ED settings remains inconsistent due to workflow constraints, confidentiality concerns, and limited provider training. Validated tools, such as the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) questionnaire, the screening to brief intervention (S2BI) tool, and the brief screener for tobacco, alcohol, and other drugs (BSTAD) tool, allow rapid, developmentally appropriate screening. They can be integrated into electronic health records (EHRs) or self-administered digital formats. Evidence suggests that electronic or kiosk-based screening increases disclosure and detection without adversely affecting throughput. Screening alone is insufficient; pairing detection with brief motivational interventions and facilitated referral to treatment improves short-term outcomes and linkage to care. However, follow-up rates remain suboptimal, underscoring the need for structured referral pathways, behavioral health integration, and technology-enabled supports such as text-based reminders or telehealth. Universal, developmentally tailored screening in the ED, combined with brief intervention and active linkage to outpatient care, offers a practical strategy to reduce substance-related morbidity and improve long-term outcomes for adolescents.
PY - 2026
SN - 2688-1152
SP - 100447
ST - Adolescent Substance Use Screening in the Emergency Department
T1 - Adolescent Substance Use Screening in the Emergency Department
T2 - J Am Coll Emerg Physicians Open
TI - Adolescent Substance Use Screening in the Emergency Department
U1 - Opioids & Substance Use; Healthcare Disparities
U3 - 10.1016/j.acepjo.2026.100447
VL - 7
VO - 2688-1152
Y1 - 2026
ER -