Integrate Universal Screening for Substance Use Into Routine Care

By Ruth McDonald, MD
Vice President, Medical Affairs
Seattle Children’s

The rising rates of opioid deaths coupled with changes in young people’s beliefs about marijuana in the wake of its legalization for adults underscore the need for primary care providers to actively incorporate universal screening for substance use into routine care.

Pediatricians and primary care providers are uniquely positioned to influence adolescent patients’ knowledge of health issues, and they have a crucial role to play in preventing and reducing the use of intoxicating substances and their associated harm.

In July 2016, the AAP published an updated policy on Substance Use Screening, Brief Intervention, and Referral to Treatment (a.k.a. SBIRT ) that provides clinical guidance for screening and intervening as necessary.

Two key messages for adolescents (and their parents) are that teenage substance use is not a rite of passage, and that kids’ health is best served by not using any alcohol, tobacco, marijuana or other drugs.

 You can encourage parents to:

  1. Start talking to their kids early! Teens who use often start by age 14. Have ongoing conversations about drugs by the 4th or 5th grade.
  2. Keep communication open with their tweens and teens. Tips for this include: eating dinner together, having family activities, using the same communication methods as the teens (text, social media, etc.).
  3. Know the friends and families of their kids.
  4. Adopt a ‘no use is normal’ attitude. Teens who believe their parents are OK with them using are more likely to use by middle school.
  5. Be consistent with expectations and consequences for substance use.

 When talking with teens, consider:

  1. Taking time to meet with adolescents alone. Introduce this to the parents in a way that normalizes the action. For example: “at age 12, I ask all parents to step out for a moment so I can speak to your tween/teen.”
  2. Not assuming anything. When your patients are in middle school, start asking straightforward, open-ended questions, including if their friends or peers have used drugs and if they’ve ever tried any.
  3. Following up when a teen responds ‘yes’ to using. Assess for safety and ask what the pros and cons are of using. They wouldn’t be using if there wasn’t a benefit to them – whether it is social acceptance, a decrease in anxiety, a calming effect, etc.

Substance use can have long-term consequences for adolescents. Integrating universal screening into routine care has the potential to shape one of the most important modifiable behaviors that contributes to poor health outcomes for adolescents.