Los Angeles County experts call for better substance-use screening and cautious use of psychotropic drugs for youth in care

On the Talk to Me podcast, Los Angeles County child-welfare and clinical experts said efforts to identify and engage youth in the foster care and juvenile justice systems who are using substances need to improve, and they urged caution and close monitoring when psychotropic medications are prescribed.

The discussion matters because system-involved young people are often subject to both clinical and judicial oversight; Michael Nash, executive director of the Los Angeles County Office of Child Protection, noted that in California “by a quirk of law, judges here in California have the obligation to approve or disapprove the use of psychotropic medications for system involved children.” That judicial role, the guests said, heightens the need for careful clinical practice and oversight.

Dr. Scott Hunter, a child and adolescent addiction psychiatrist who runs a co-occurring disorders clinic treating youth in carceral settings in Los Angeles County, said clinicians face two linked challenges: identifying substance use accurately and making treatment accessible. “We need to do a better job of identifying those young people who have an issue with the use of various substances,” Nash said. He added that engagement is as important as identification: services must reach youth in ways that allow effective treatment rather than simply documenting use.

On psychotropic medications, Nash said they should be reserved for treatment purposes rather than as behavior-control tools. “The psychotropic medication should be used, as a last resort when other treatment modalities don't work,” he said, and emphasized ongoing monitoring: “the keyword is vigilance. When a child is being administered psychotropic medications, we need to watch them like a hawk.”

Hunter echoed the need to distinguish underlying substance use from behavioral symptoms and described trust-building as essential in juvenile settings. “It takes a while to gain the trust and also, let them know that this is a nonjudgmental environment where they can tell me what's going on,” he said, adding that accurate reporting is often limited by youth fear of consequences.

The guests also discussed medications for substance-use disorders. Hunter argued that, for true addictions, medications can be life-saving and should be considered earlier in care: “we wanna be thinking about medications for substance use disorders honestly as a first resort, or earlier on.” He said access remains limited because many prescribers in primary care and psychiatry do not yet feel comfortable providing those treatments.

Both speakers highlighted changes in the opioid supply that affect youth treatment: “we're now in the third wave of the opioid epidemic with the advent of fentanyl, and other synthetic opioids that are kind of really now dominating the supply of the drugs that are on the street,” Hunter said, noting that higher-risk compounds increase the urgency of accurate screening and timely treatment.

The conversation on the episode did not record policy changes or formal actions; the guests described clinical and system-level challenges and urged better screening, engagement, and clinician training to expand safe access to medications for substance-use disorders while reserving psychotropic medications for appropriate clinical indications and monitoring.

The podcast episode included other materials such as a land acknowledgment and guest introductions; no formal policy decisions were announced during the discussion.