The COVID‐19 impact and characterization on substance use‐related emergency department visits for adolescents and young adults in Canada: Practical implications

Abstract

Rationale Coronavirus (COVID‐19)‐related stressors precipitated the mental health crisis and increased substance use in Canada and worldwide. As the pandemic continues to evolve, monitoring and updating substance use‐related ED visit trends is essential to ensure the stability and quality of ED services under the prolonged pandemic timeline. Aims and Objectives This study examined the trends and characterization of substance use‐related ED visits during the pandemic among adolescents and young adults (aged 13–25 years) in Ontario, Canada. Methods Descriptive statistics and binary logistic regression analyses were conducted using population‐based, repeated cross‐sectional data. The volume, patient characteristics (age and sex) and hospital/ED visit features (triage to end time, timing of the visit, triage level and referral source) were compared before (2019) and during COVID‐19 (2020 and 2021) by each substance type (alcohol, opioid, cannabis, sedatives, cocaine, stimulants and multiple psychoactive substances). Results Substance use‐related ED visits decreased by 1.5 times during the pandemic compared to the prepandemic level. However, opioid‐related ED visits continued to show an increasing trend and did not recover to the prepandemic level in 2021. Moreover, a significant increase in emergent/life‐threatening triage levels (Canadian Triage and Acuity Scales 1 and 2) in substance‐related ED visits is alarming (2019 = 36.8%, 2020 = 38.7% and 2021 = 38.4%). We also found a general decrease in weekend visits, overnight visits and visits on statutory holidays, and substance use‐related ED patients tended to stay longer (over 6 h) in the ED during the pandemic. Conclusion Our findings indicate unmet substance use treatment needs due to the limited accessibility and heightened threshold for ED visits during the pandemic. Providing access to substance treatment/programs outside ED is critical to reducing substance use‐related complications presenting in the ED. Also, policies addressing the pandemic‐related complexities in the ED and Health Human Resource challenges are warranted.

Understanding youth and young adult cannabis use in Canada post-legalization: a scoping review on a public health issue

“…A Québec study found increases in hospitalizations post-legalization among boys aged 10–14 years, with 70% of substance-related hospitalizations after legalization involving cannabis, compared with 39.3% pre-legalization [ 87 ]. Kim et al [ 81 ] studied ED visits in Ontario and found that cannabis-related visits increased in 2020 compared to 2019 among young adults 18–25 years more than among youth 10–17 years. Additionally, young adults with cannabis-related ED visits had triage to end times longer than six hours with higher rates of emergent or life threatening triage levels.…”

“…Two studies included data from both Canada and the United States [74,75] and one included data from Canada, the United States, and England [76]. The remaining studies gathered data from a single province, with eleven studies in Ontario [77][78][79][80][81][82][83][84][85][86]95], four in Québec [4,15,20,87], two in Manitoba [88,89], two in British Columbia [90,91], and one each in Saskatchewan [92], Alberta [93], and Newfoundland and Labrador [94].…”

“…The second category encompassed twelve studies examining cannabis-related injuries and emergency department (ED) visits attributable to cannabis [53,62,64,72,74,77,81,83,84,86,87,93]. While most studies in this category examined the rates of ED visits since legalization, two examined trends related to vaping [53,62], and one study examined traffic injury presentations related to cannabis in EDs [72].…”

Trends in Opioid Toxicity–Related Deaths in the US Before and After the Start of the COVID-19 Pandemic, 2011-2021

“…Furthermore, the absolute number of unintentional deaths due to opioid toxicity and the associated YLL among those younger than 40 years far exceeded those attributable to COVID-19 in both 2020 and 2021, indicating the distinct impact of drug toxicity-related deaths among younger individuals. This aligns with previous observations of accelerating substance-related harm among adolescents 10 and warrants further attention and expansion of harm reduction and treatment programs tailored to this demographic population.…”

Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia

“…Across Canada, mental health and substance use service utilization during the pandemic has mostly suggested a decline in emergency department and hospital visits ( 18 , 19 ) with hospitalization rates returning to pre-pandemic levels by March 2021 ( 20 ). Evidence from Ontario, Canada using population-level administrative data found psychiatric-related hospital admissions did not return to pre-restriction rates ( 21 ) and while overall volumes may have decreased, monthly increases were observed for specific mental disorders post pandemic ( 22 , 23 ).…”