Substance Use-related Emergency Department Visits and Resource Utilization

Introduction: Substance use-related visits to the emergency department (ED) have been linked to higher service delivery costs, although little is known about the specific services used. Our goal In this study was to describe the recent trends of substance use-related ED visits and assess the association between substance use and specific ED resource utilization.  Methods: We performed a retrospective, cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2013–2018. All ED visits in the United States for patients ≥18 years of age were included. The primary exposure was having substance use included as a chief complaint or diagnosis, which we identified using the International Classification of Diseases, 9th and 10th revisions, codes. The primary outcome was the use of diagnostic services (including laboratory studies and cardiac monitoring) or imaging studies in the ED.  Results: The study sample included 95,506 visits in the US, extrapolating to over 619 million ED visits nationwide. The total number of ED visits remained stable during the study period, but substance use-related visits increased by 45%, with these visits making up 2.93% of total ED visits in 2013 and 4.25% in 2018. This increase was primarily driven by stimulant-, sedative- (opioids and benzodiazepines), and hallucinogen-related visits. Mental health-related visits rose in parallel by 66% during the same period. Compared to non-substance use-related visits, substance use-related visits were more likely to undergo any diagnostic study (adjusted odds ratio [aOR] 1.28; 95% confidence interval (CI): 1.11-1.47; P = 0.001), toxicology screening (aOR 10.15; 95% CI: 8.84-11.66), but less likely to have imaging studies (aOR 0.62; 95% CI: 0.56-0.68; P <0.0001). In stratified analyses, substance use-related visits with concurrent mental health disorders were more likely to undergo imaging studies (aOR 1.56; 95% CI: 1.09-2.22), while findings were opposite for those without concurrent mental health disorders (aOR 0.64; 95% CI: 0.51-0.71; P for interaction <0.0001).  Conclusion: Substance use- and mental health-related ED visits are rising, and they are associated with increased resource utilization. Further studies are needed to provide more guidance in the approach to acute services in this vulnerable population