Results indicate that 3 in 10 ED visits made by underage drinkers involved other primarily illicit drugs. Findings point to the importance of monitoring drug-related ED visits among underage drinkers. Differences based on gender, age, and race/ethnicity was minimal which suggests that a general prevention approach may be as effective as a targeted approach to address this problem among adolescents and young adults. From a public health perspective, the lack of evidence of follow-up care for underage drinkers who made an ED visit, whether they were involved with other drugs or not, suggests that ED health care providers may be missing an opportunity to intervene with underage drinkers to prevent or reduce their use of alcohol and drugs. This report suggests that ED staff conduct brief interventions to immediately address the concurrent use of alcohol and drugs. ED health providers may be especially well-placed to identify youth who may be in need of further substance abuse assessment or treatment and to provide subsequent referrals. Continued surveillance and reporting of ED data can be a first step in raising awareness, particularly among youths and parents about the dangers posed by and the physical harm that may result from the concurrent use of alcohol and drugs. 2 tables and 6 notes