The American Society of Addiction Medicine (ASAM) and American Academy of Pediatrics (AAP) does not recommend routine UDS by clinicians in the absence of suspicion for substance use (Jarvis et al., 2017Jarvis M. Williams J. Hurford M. Lindsay D. Lincoln P Giles L. Safarian T. Appropriate use of drug testing in clinical addiction medicine.; Levy et al., 2014Levy S. Siqueira L.M. Ammerman S.D. Gonzalez P.K. Ryan S.A. Smith V.C. Committee on Substance Abuse
Testing for drugs of abuse in children and adolescents.). Neither group supports home UDS by parents because of the risk of misinterpretation and limited evidence that home UDS reduces adolescent drug use (Jarvis et al., 2017Jarvis M. Williams J. Hurford M. Lindsay D. Lincoln P Giles L. Safarian T. Appropriate use of drug testing in clinical addiction medicine.; Levy et al., 2014Levy S. Siqueira L.M. Ammerman S.D. Gonzalez P.K. Ryan S.A. Smith V.C. Committee on Substance Abuse
Testing for drugs of abuse in children and adolescents.). The ASAM and AAP recommend screening children and adolescents for emergent clinical care, assessment of behavioral or mental health symptoms, in substance abuse programs, or as a deterrent for use in the juvenile probation system (Levy et al., 2014Levy S. Siqueira L.M. Ammerman S.D. Gonzalez P.K. Ryan S.A. Smith V.C. Committee on Substance Abuse
Testing for drugs of abuse in children and adolescents.). UDS is useful for clinicians to identify potential toxins in patients who present with altered mental status. The AAP recommends obtaining a UDS if there is a concern for accidental or intentional ingestion, unexplained seizures, syncope, arrhythmias, or the presence of toxidromes (Levy et al., 2014Levy S. Siqueira L.M. Ammerman S.D. Gonzalez P.K. Ryan S.A. Smith V.C. Committee on Substance Abuse
Testing for drugs of abuse in children and adolescents.). The ASAM identifies those with a known history of substance use or trauma, in treatment for mental health disorders, or declining academic performance as a high-risk population that may benefit from early detection of substance use (Levy et al., 2014Levy S. Siqueira L.M. Ammerman S.D. Gonzalez P.K. Ryan S.A. Smith V.C. Committee on Substance Abuse
Testing for drugs of abuse in children and adolescents.). High-risk patients suspected of having recent or ongoing drug use (by parent or clinician) should be screened by clinicians, particularly if the patient also presents with fatigue, moodiness, or school failure (Levy et al., 2014Levy S. Siqueira L.M. Ammerman S.D. Gonzalez P.K. Ryan S.A. Smith V.C. Committee on Substance Abuse
Testing for drugs of abuse in children and adolescents.). Screening may not be necessary if a patient is honest about substance use history, though it may provide added value. If a child or adolescent denies substance use but shows concerning signs/symptoms of substance use, screening should still be performed.