Background: Emergency departments (EDs) are a promising location for initiating substance use interventions for youth. Our objective was to determine trends in substance use-related ED visits for youth from 2018-2023, and investigate the patient characteristics, types of substance involved, and ED visit disposition and revisits. Methods: We conducted a retrospective review of electronic health records (EHRs) from six EDs in an urban healthcare system to identify 12-21-year-old patients with a substance use-related ED visit from 2018 through 2023. Visits were identified by International Classification of Diseases, 10th Revision Clinical Modification codes for substance use involving alcohol, cannabis, sedative/hypnotics, opioids, cocaine/stimulants, and psychoactive substances. The proportion of substance use-related visits each year was calculated by age group (12-14y, 15-17y, and 18-21y), sex, race/ethnicity, and substance type. We used 2-sample tests of binomial proportion to compare proportions. Logistic regression was used to assess characteristics associated with substance use-related visits, hospital admissions, and ED revisits. Results: Of 151,764 ED visits for 12-21-year-olds, 4,556 (3.0%) were for substance use. From 2018-2023, 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 younger age groups (12-14y and 15-17y). Visits for females increased from 43.4% in 2018 to 52.4% in 2023 (p< 0.001). Although visits for alcohol were most frequent (53.1%), 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. Conclusion: 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.

The authors have declared no competing interest.

Roland C. Merchant was supported by a National Institute on Drug Abuse career mentoring award (K24DA044858).

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