["Autism Research, EarlyView. ", "\nABSTRACT\nThe prevalence of substance use disorders (SUD) among autistic people is substantial and growing. This unaddressed public health challenge is particularly important given the lack of knowledge about SUD service needs among people on the spectrum. This paper presents the first national‐level study of SUD‐related clinical outcomes and service use among US‐based autistic Medicaid enrollees with SUD (N = 50,487) compared to matched neurotypical enrollees with SUD (N = 151,461). The analyses reveal that overdose, hospitalizations, and some polysubstance use risks are elevated among autistic people with SUD compared to neurotypical SUD patients. Analyses also suggest that autistic people with SUD use fewer SUD services compared to their neurotypical counterparts. Results highlight the need for integrative, evidence‐based autism‐tailored SUD service solutions.\n"]