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.