Synopsis
Identify alcohol, drug, medicine, nicotine and behavioural risk accurately and without stigma, treat intoxication, overdose or withdrawal promptly, assess development, mental health, exploitation and safeguarding, use proportionate harm reduction and brief intervention, and connect young people to specialist support.
- Ask every young person privately and neutrally about alcohol, cannabis, stimulants, opioids, sedatives, ketamine, inhalants, nicotine, prescribed medicines, supplements and unknown pills or powders.
- Clarify substance, formulation, amount, route, frequency, last use, setting, combinations, source, desired effect, adverse effects, tolerance, withdrawal, spending and attempts to cut down.
- During acute illness use ABCDE, glucose, temperature, ECG and substance-specific toxicology advice; do not accept a single reported drug when adulteration or co-ingestion is plausible.
- Give naloxone for suspected opioid respiratory depression while supporting ventilation, remembering that its effect may wear off before the opioid and repeat dosing or infusion may be needed.
- Assess self-harm intent, driving or water risk, sexual consent, assault, pregnancy, mental state, home safety, school, debt, carrying activity and exploitation in every concerning presentation.
- Use a brief collaborative intervention linking use to the young person's own goals, offer practical harm reduction and refer dependence, repeated harm or complex need to specialist young-people's services.
- Do not advise abrupt unsupervised cessation when alcohol, benzodiazepine or another sedative dependence may exist; arrange medical withdrawal assessment.
- Provide overdose-response education, naloxone access where opioid exposure is possible, never-use-alone advice, safer transport, contraception and infection prevention without implying that use is safe.
- Follow missed contacts actively when risk or exploitation is present and coordinate health, mental-health, school, youth, social-care and substance services around one plan.
Key red flags
Slow or absent breathing, cyanosis, pinpoint pupils or reduced consciousness suggests opioid toxicity and requires airway support and naloxone under the emergency pathway.
Hyperthermia, rigidity, severe agitation, chest pain, seizure or arrhythmia after stimulants or unknown tablets requires urgent monitored care.
A young person who carries drugs, money or weapons for adults, stays in unfamiliar addresses, has unexplained travel or debt, or fears retaliation may be criminally exploited.
Substance use with suicidal intent, psychosis, severe mood change, violence, unsafe driving, pregnancy or repeated unexplained injury increases immediate and longer-term harm.
Abrupt cessation after sustained heavy alcohol or sedative use can cause dangerous withdrawal and should not be managed by unsupported advice to stop suddenly.
Investigation priorities
Identify immediately reversible physiological danger during suspected intoxication.
Management branches
There is reduced consciousness, respiratory depression, seizure, hyperthermia, chest pain, severe agitation or abnormal physiology.
- Use ABCDE, support airway and ventilation, check glucose and temperature and summon emergency and poisons expertise.
- Give naloxone for suspected opioid respiratory depression and use exposure-specific management for seizures, agitation or arrhythmia.
- Look for trauma, infection, pregnancy, self-harm and co-ingestion while maintaining proportionate observation and staff safety.
- Continue monitoring through the expected toxicity interval and ensure the handover includes safeguarding and mental-health concerns.
The young person is medically able to participate after an acute event or in routine care.
- Map substances, routes, combinations, timing, desired effects, harms, dependence features and previous attempts to change.
- Assess suicide, psychosis, mood, neurodevelopment, pain, sleep, sexual risk, driving, school, housing and family context.
- Ask privately about debt, carrying, threats, assault, spiking, online supply and criminal or sexual exploitation.
- Identify one or two priorities the young person accepts while documenting any protection that cannot wait for consent.