Today, over 75% of all drug overdose deaths are a result of opioid use, and more youth are dying as a result of drug overdoses. However, the problem of drug misuse among youth is often overlooked, likely due to a greater focus, and significantly more data, on adult drug misuse and overdose deaths. This is also often coupled with conventional wisdom and social stereotypes of what a “drug addict” (a derogatory term) looks like. Regardless of the reasons why there has been little focus on younger populations, failure to screen, diagnose, and treat youth with substance use disorder can be deadly.
In an article being early released this week in Pediatrics, Dr. Mary Grenier from Cincinnati Children’s Hospital and colleagues present data demonstrating that youth in foster care have double the incidence of substance use and substance use disorder—40% of youth in foster care versus 21% among youth not in foster care (10.1542/peds.2023-065057).
The authors’ goal was to determine whether a self-administered electronic version of the CRAFFT 2.1 Questionnaire, which is commonly used as a screening tool for substance use, is as good as a confidential interview at gleaning such information from a population of 373 10-20-year-old youth in foster care who were evaluated for mandatory health examinations in the foster care clinic between February 2022 and March of 2023.
While extant data suggests that youth prefer self-administered questionnaires, a notable percentage of youth in this study who denied substance use on the electronic screen later endorsed such use when interviewed by a provider. It is also notable that older youth were more likely to have such false negative results on the initial electronic screen.
This article provides a cautionary note to the conventional wisdom that youth (given their facility with and relative more time spent using technology) gravitate and respond better to electronic interfaces than a traditional face-to-face interview. However, the authors do not dismiss the use and utility of an electronic screen, reminding us that a screen is just the initial method to capture data about a given disease process. Given the data both in this and prior studies demonstrating higher use of substances among youth in foster care, it is imperative that providers couple any screening tool with appropriate disease surveillance to elicit health information to provide the best care we can to our patients. And while the authors admit that there was no objective confirmatory testing of substance use in their study, it is not the standard of practice to perform routine urine/serum toxicology on our patients coming in for annual exams, and the authors should not be faulted for this limitation.
The first step of addressing any problem is to acknowledge it. To that end, improving the fidelity of screening youth for substance use disorders is a worthy undertaking, and the authors’ contribution adds to our collective knowledge on this often-ignored problem.
