Trends in substance use-related emergency department visits by youth, 2018-2023

We aimed to examine trends in substance use-related emergency department (ED) visits for youth from 2018 to 2023, compare the patient characteristics, types of substance involved, and ED disposition for these visits, and calculate revisit frequency.

Retrospective review of electronic health records (EHRs) from six EDs in an urban healthcare system to identify 12-21-year-old patients with substance use-related ED visits from 2018 to 2023. Visits were identified by International Classification of Diseases, 10th Revision Clinical Modification codes for substance use. Proportions of substance use-related visits each year were compared by age group (12-14y, 15-17y, 18-21y), sex, race/ethnicity, and substance type. Logistic regression was used to assess characteristics associated with substance use-related visits, hospital admissions, and ED revisits.

Of 151,764 ED visits for 12-21-year-olds, 3.0 % were for substance use. From 2018 to 2023, substance use-related ED visits increased from 2.8 % to 3.4 % of all ED visits (p < 0.001) and were most often by 18-21-year-olds (79.4 %), yet there were significant increases in visits by 12-14-year-olds and 15-17-year-olds. Visits for females increased from 43.4 % to 52.4 % from 2018 to 2023 (p < 0.001). Although visits for alcohol were most frequent (53.4 %), cannabis visits increased from 17.9 % to 35.3 %, with increases across all age groups (p < 0.001). Nineteen percent of visits involved patients that had an ED revisit for a substance use-related diagnosis within one year.

Substance use-related ED visits increased from 2018 to 2023, with an increase in visits for cannabis over time. These findings can inform targeted ED-based interventions for substance use in youth.