Teenage use of some of the most accessible drugs – e-cigarettes, cannabis, and prescription opioids – can too easily evade notice by practitioners and parents, a fact that has led to an undertreated population at a critical time in their development, according to a new study by a team of researchers.

The study, published in the November issue of the Lancet: Child and Adolescent Health, outlines practical identification and intervention tools for providers to combat substance use in this age group.

“There are concrete approaches for providers to screen for substance use in adolescents even in the absence of overt physical or behavioral symptoms,” say the authors. “We hope to empower adolescent health providers to effectively screen for and intercept adolescent e-cigarette, cannabis, and prescription opioid use, to reduce harm and redirect young people away from these substances.”

Laura Holt
Laura Holt, Charles A. Dana Research Associate Professor of Psychology at Trinity College.

The study is a collaboration between Laura Holt, Charles A. Dana Research Associate Professor of Psychology at Trinity College; Genevieve F. Dash, at the University of Missouri; Emily A. Kenyon, Emily K. Carter, Diana Ho, Karen A. Hudson, and Sarah W. Feldstein Ewing, Prochaska Endowed Professor and Director of the Adolescent Neuroscience Center for Health Resilience (ANCHoR), at University of Rhode Island.

The team performed a comprehensive review of the peer-reviewed literature about teenage substance use published within the past five years and developed a set of recommendations for clinicians, practitioners, and parents of youth.

The difficulty of identifying substance use in youth is reflected in treatment numbers. Among adolescents ages 13-18 engaged in hazardous substance use, only about six percent seek and/or receive any form of treatment to change their behaviors, note the authors.

The literature indicates the degree to which caring providers who communicate early and often with their adolescent patients makes a difference in substance use initiation and trajectories. Even if adolescents do not report use when first queried, with trusted providers, young people are more likely to share that behavior in subsequent visits.

Hurdles still exist. In the review, authors note that among 250 pediatricians in the United States 88 percent conducted substance use screening annually, but only 26 percent had easy access to validated screening tools to evaluate teen substance use. As part of their work, the study authors identify several free screening tools available to clinicians working with this age group.

“Simultaneously attending to building ongoing rapport with young people and integrating … screening into annual and any other interim visits could be the most effective avenue,” the authors note.

Part of laying that groundwork is encouraging teens to delay the initiation and exploration of substance use. The data are clear that the brain is not completely developed until 25 years, and scientists still do not yet fully understand how the introduction of e-cigarette, cannabis, and prescription opioids might affect the structure and function of the developing brain, according to the review.

The authors also highlight avenues parents can take to protect young people. Among the strongest protective factors for adolescent use are parental supervision and knowledge of young people’s whereabouts and activities, according to the authors.

Although active use of these three substances is difficult to detect in adolescents, there are some signs that may help in identification, especially when tracked over time. Those include increased fluid intake to counteract dry mouth, dental symptoms (inflammation or dry socket), and fruit or sweet-like smells for e-cigarettes; dry or red eyes, dry mouth, increased appetite, and potential cognitive or motor impairment for vaped or edible cannabis use; and constricted pupils in the eyes, drowsiness, slowed breathing, nausea, and itchiness for hazardous prescription opioid use.

Compounding the difficulty of identifying teen substance use for providers and parents, is the difficulty of identifying negative consequences. The authors found that addressing potential misconceptions that youth may have is an effective approach to discuss consequences. For example, many adolescents believe that e-cigarettes do not contain nicotine, that the vapor contains only water, and that legal  substances are safe with minimal health hazards.

The research in the Lancet Child & Adolescent Health was supported by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.