Clinical Takeaway
Cannabis was the most commonly used recreational drug among youth presenting to emergency departments with acute behavioral disturbance, reported by 25% of participants, with overall recreational drug use documented in one-third of the cohort. These findings highlight the intersection of adolescent cannabis use and acute psychiatric emergency presentations. Clinicians evaluating youth with behavioral disturbance in emergency settings should routinely assess for cannabis and stimulant use as contributing factors.
#8 Recreational Drug Use Amongst Children and Adolescents Presenting to Australian Emergency Departments With Acute Behavioural Disturbance: A Secondary Analysis of a Randomised Controlled Trial.
Citation: Bourke Elyssia M et al.. Recreational Drug Use Amongst Children and Adolescents Presenting to Australian Emergency Departments With Acute Behavioural Disturbance: A Secondary Analysis of a Randomised Controlled Trial.. Emergency medicine Australasia : EMA. 2026. PMID: 42206869.
Design: 5 Journal: 0 N: 0 Recency: 3 Pop: 3 Human: 1 Risk: 0
Abstract: OBJECTIVES: To describe the historical and current use of recreational drugs by a trial cohort of youth presenting to the emergency department (ED) whilst experiencing acute behavioural disturbance (ABD). METHODS: This was a secondary analysis of a randomised, controlled trial comparing medication management of ABD in children and adolescents aged nine to 17 years who were deemed to require oral sedative medication. RESULTS: Recreational drugs were used by 33% of participants any time prior to enrolment (115/348). Cannabis was the most commonly used (87/348, 25%), followed by amphetamines/methamphetamines (32/348, 9%) and benzodiazepines (26/348, 7%). CONCLUSION: Recreational drug use may be a contributing factor to ABD amongst children and adolescents presenting to EDs.
What This Study Teaches Us
Among youth presenting to emergency departments with acute behavioral disturbance, one in three had a history of recreational drug use, with cannabis being the most common (25%), followed by amphetamines (9%) and benzodiazepines (7%). This suggests drug use may be a contributing factor to behavioral crises in this population, though the study does not establish causation.
Why This Matters Clinically
Clinicians evaluating agitated or behaviorally disturbed children and adolescents should consider substance use in the differential diagnosis, not just primary psychiatric or medical causes. For parents and patients, this data underscores that recreational drug exposure in youth is common enough to warrant screening and education.
Study Snapshot
| Study Design | Secondary analysis of a randomized controlled trial examining medication management of acute behavioral disturbance in youth |
| Population | Children and adolescents aged 9 to 17 years (N=348) presenting to Australian emergency departments with acute behavioral disturbance |
| Intervention | Not applicable (secondary analysis; original trial compared medication management approaches) |
| Primary Outcome | Historical and current recreational drug use prevalence among the cohort |
| Key Result | 33% (115/348) reported any prior recreational drug use; cannabis 25%, amphetamines/methamphetamines 9%, benzodiazepines 7% |
Where This Paper Deserves Skepticism
This is a secondary analysis of a medication management trial, so substance use data collection methods and timing are not detailed in the abstract. The abstract does not clarify whether drug use occurred before the behavioral episode or was concurrent with it, which is critical for causation claims. The study is purely descriptive of prevalence and cannot distinguish between substance use as a cause of behavioral disturbance versus a consequence of underlying psychiatric illness. Generalizability to non-Australian populations or non-emergency settings is unclear.
Dr. Caplan’s Take
This Australian cohort tells us that recreational drug use, especially cannabis, is present in the histories of a meaningful minority of youth presenting with acute behavioral crises. As a clinician, I read this as a reminder to ask about substance exposure in the work-up of pediatric behavioral disturbance, not as proof that drugs caused the crisis. The temporal relationship between use and symptom onset matters enormously for interpretation, and the abstract doesn’t give us that detail. What this does do is nudge us toward a broader differential in these cases.
Clinical Bottom Line
Roughly one in three youth with acute behavioral disturbance presenting to the ED has a history of recreational drug use, most commonly cannabis. Clinicians should screen for substance exposure in this population, while recognizing this study shows association, not causation.
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