Navigating Consent and Confidentiality in Adolescent Substance Use Treatment.

Consent and confidentiality are central to adolescent substance use care, functioning not only as legal and ethical frameworks but as early preventive interventions during a critical developmental window. This urgency is highlighted by rising rates of substance use disorders and overdose deaths driven by illicit fentanyl and polysubstance exposure. Expanded harm reduction efforts have intensified tensions between adolescent autonomy, parental involvement, legal requirements, and the clinician's duty to protect safety. This article provides a clinically grounded framework for navigating consent and confidentiality across outpatient, emergency, and inpatient settings, emphasizing harm reduction, documentation, family engagement, and high-risk clinical contexts.