Editorial: Parsing Youth Substance Use Trends in a Dynamic Milieu.

Substance use is highly heterogeneous in adolescence, ranging from non-use to experimentation to more serious involvement associated with morbidity and mortality. Recent developments in illicit drug supply, including contamination of products with fentanyl, have increased the risks of harm associated with use, including lethal overdose.1 Although longitudinally tracking overall substance use and related attitudes is critical to informing public health measures, the emergence of large electronic health record datasets creates novel opportunities to elucidate trends in substance involvement warranting serious clinical attention. The COVID-19 pandemic upended many aspects of young people's lives, such as schooling, socialization, and interactions with family, with a wide array of potential implications for substance use and use-related consequences; to date, surveillance findings regarding youth substance use during the pandemic have been mixed.2-4 In "A Nationwide Analysis of Pediatric Substance Use Trends Before, During, and Following the COVID-19 Pandemic," Kelly et al. leveraged Epic's Cosmos database to quantify emergency room and inpatient clinical encounters associated with substance use and involving patients between ages 6 and 17 years.5 This approach offered the chance to retrospectively assess pandemic-era changes in the proportion of substance-related clinical presentations, potentially informing future tailored programming to mitigate substance-related harms.