Emergency Department Visits by Patients With Substance Use Disorder in the United States

Xingyu Zhang, PhD; Ningyuan Wang, MS; Fengsu Hou, PhD; Yaseen Ali, BS; Aaron Dora-Laskey, MD; Chin Hwa Dahlem, PhD; Sean Esteban McCabe, PhD


Western J Emerg Med. 2021;22(5):1076-1085. 

In This Article

Abstract and Introduction


Introduction: We aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons.

Methods: Using 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD.

Results: Of all adult ED visits (N = 27,609) in the US in 2016–2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66–1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09–1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14–1.43) and intensive care unit (aOR 1.40, CI, 1.05–1.85).

Conclusion: Patients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD.


Studies have shown people with substance use disorders (SUD) are more likely to experience trauma, report lower quality of life, and be diagnosed with mental illness, cancer, and heart disease.[1–3] According to the 2017 National Survey on Drug Use and Health,[4] almost 74% of adults with a SUD had an alcohol use disorder and approximately 38% of adults with a SUD had an illicit drug use disorder. Substance use, misuse, and SUD cost American society more than $740 billion annually in lost workplace productivity, healthcare expenses, and crime-related costs.[5–10]

Substance-related injuries, soft tissue infections, and overdoses often result in admissions to the emergency department (ED), and therefore provide a window of opportunity to identify and connect people with SUD for treatment and referral services.[11,12] Previous studies found that socioeconomic status influenced a person's substance use.[13–16] However, there is limited research using nationally representative samples to examine the association between patients with SUD and the characteristics of their ED visits.[17] Through better understanding the medical care needs of people with SUDs, EDs can be the bridge to connect patients to evidence-based interventions to the community upon discharge.[18]

To better understand the relationship between SUDs and ED visits, we conducted a secondary analysis of a large nationally representative dataset. In particular, the current study aimed to do the following: 1) estimate ED use by patients with SUD; 2) characterize the clinical presentation of ED patients with SUD; and 3) examine factors associated with clinical outcome and resource utilization for ED patients with SUD. The goal of the study was to provide information that could potentially improve quality of ED care delivered to patients with SUD.