Cannabis was the third most common substance in emergency department visits, with sex differences in patterns

What the researchers found

Researchers analyzed 10,511 emergency department visits across three Pennsylvania hospitals over 18 months where the final diagnosis involved substance use. Alcohol dominated at 54.3%, followed by opioids at 19.2%, and cannabis at 14.4%.

The overall population was predominantly male (65.6%) with a mean age of 43.6 years. However, sex-specific patterns emerged for different substances. Males with cannabis-related ED visits were older than females with cannabis visits, mirroring the alcohol pattern. For opioids, the relationship reversed: females were older (41.3 years) than males (38.9 years) at opioid-related visits.

Females tended to be younger overall and were more likely to be discharged after their ED visit (36.1% vs 32.3%), while males were more likely to be admitted.

Why it matters

Emergency departments are often the frontline for managing substance-related crises. Understanding that cannabis accounts for nearly 1 in 7 substance-related ED visits, and that patterns differ by sex and age, can inform resource allocation, screening protocols, and targeted intervention strategies.

The numbers in context

10,511 substance-related ED visits. Mean age 43.6 years. 65.6% male. Alcohol: 54.3%. Opioids: 19.2%. Cannabis: 14.4%. Females younger overall (42.4 vs 44.3 years, p < 0.001). Females more likely discharged (36.1% vs 32.3%, p < 0.001). Males older for cannabis and alcohol visits; females older for opioid visits (41.3 vs 38.9 years, p < 0.001).

How the study worked

Retrospective electronic data analysis of ED visits at 3 hospitals in northeastern Pennsylvania from January 2016 through July 2017. All visits with substance use diagnosis codes (F10-F19, excluding nicotine) were included. Data captured primary substance, sex, age, date, and disposition. Time series analysis assessed trends by sex.

What this study cannot tell us

The study was limited to three hospitals in one region of Pennsylvania and may not represent national patterns. Only visits coded with substance use diagnoses were captured, potentially missing cases where substance use was not documented. The study could not distinguish between primary cannabis toxicity and cannabis as a secondary finding. Retrospective data abstraction depends on coding accuracy.

How to read the evidence

This is a moderate-sized retrospective analysis from a regional hospital system, providing moderate evidence of substance use patterns in the ED setting.

When this study was published

Published in 2018 with 2016-2017 data from Pennsylvania.

The bigger picture

This study provides a snapshot of the substance use crisis from the emergency department perspective, where cannabis sits as the third most common substance. While less acutely dangerous than opioids, the volume of cannabis-related ED visits underscores that cannabis use does generate acute clinical presentations requiring medical attention.

Questions still open

• What specific presentations bring cannabis users to the emergency department most frequently? Has legalization in other states changed the proportion of cannabis-related ED visits? How do cannabis-related ED visits compare in severity and cost to alcohol and opioid visits?

Common questions

Read the original research

Sex Differences in Prevalence of Emergency Department Patient Substance Use.

Clinical therapeutics, 40(2), 197-203

Citation

Cannon, Robert D; Beauchamp, Gillian A; Roth, Paige; Stephens, Jennifer; Burmeister, David B; Richardson, David M; Balbi, Alanna M; Park, Tennessee D; Dusza, Stephen W; Greenberg, Marna Rayl. (2018). Sex Differences in Prevalence of Emergency Department Patient Substance Use.. Clinical therapeutics, 40(2), 197-203. https://doi.org/10.1016/j.clinthera.2017.12.013

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