Canadian Youth Experience Low Rates of Outpatient Physician Follow-up After Substance Use-related Emergency Department Visits

Emergency departments (EDs) across the US and Canada have seen an increase in substance use-related visits among youth. Researchers used population-level data in the province of Ontario, Canada to investigate the proportion and predictors of outpatient physician follow-up visits 60 days after a substance use-related ED encounter in youth aged 10–24, both before and during the COVID-19 pandemic (April 2017–May 2021).

• During the study period, 64,236 youth had at least one ED visit related to substance use.
• Visits for alcohol (49 percent) and cannabis (32 percent) use were the most common. Visits for sedatives were the least common (9 percent); sedatives were the only substance for which there were more visits among females than males.
• Compared with prior to the pandemic, there was a higher prevalence of ED visits for all substances except alcohol during the pandemic. However, alcohol-related ED visits were associated with the greatest increase in the relative risk (RR) of having repeat ED visits or hospitalizations (RR, 1.65), and follow-up with a mental health or addiction treatment provider (RR, 1.42), compared with visits for other substance use.
• Rates of follow-up physician care for any substance use was 33 percent pre-pandemic versus 42 percent during the pandemic (adjusted odds ratio [aOR], 1.34). Sedative presentations had the highest rates of follow-up care (65 percent).
• Receipt of mental health services in the year before the substance use-related ED visit was most strongly associated with follow-up physician care for substance use within 60 days (aOR, 6.86).

Comments: Despite improvements made during the COVID-19 pandemic, continuity of substance use-related care from the ED to outpatient physician follow-up in Canadian youth is poor. The authors propose that increased utilization of virtual care may account for the increased rates of follow-up during the pandemic. Future studies should focus on identifying barriers to substance use care within the health system. Until such obstacles are further elucidated and remedied, substance use interventions for youth in the ED setting should be maximized.

Emily Nields, DO

Reference: Rosic T, Cloutier P, Myran D, et al. Physician follow-up of pediatric and young adult emergency department visits for substance use in Ontario, Canada. J Adolesc Health. 2024;75(5):757–765.