Health Policy and Health Services Research
Background: Drug and alcohol-related Emergency Department (ED) visits are common. The objective of this study was to assess the trend of ED visits related to the utilization of marijuana, alcohol, opiates and cocaine.
Methods: This was a retrospective multicenter longitudinal cohort study of hospital ED visits from all licensed acute care hospitals serving the state of California from 2008 to 2016 using a non-public statewide database. Visits for patients under the age of 18 years were excluded. Drug-related visits were classified by primary and secondary diagnoses codes (ICD-9-CM or ICD-10-CM). The proportion of ED visits attributed to marijuana, alcohol, opiate or cocaine use was assessed yearly from 2008 to 2016. Rates and differences (diff) with 95% confidence intervals (CIs) are reported.
Results: Overall, patient census increased from 8.30 to 11.58 million from 2008 to 2016. Between 2008 and 2016, the rate per 10,000 ED visits for marijuana-related visits dramatically increased by 236.2% from 45.5 to 153.0 (diff = 107.5, 95% CI = 106.6, 108.3). The rates of opiate and alcohol-related visits per 10,000 ED visits also increased during the same time period by 67.8% from 64.2 to 107.7 (diff = 43.5, 95% CI = 42.7, 44.3) and by 4.9% from 385.2 to 404.1 (diff = 18.9, 95% CI = 17.2, 20.6), respectively. Cocaine-related visits per 10,000 ED visits decreased from 2008 to 2016 by 9.7% from 42.3 to 38.2 (diff = -4.1, 95% CI = -4.7, -3.6). Between 2008 and 2016, the marijuana-related visit rate per 10,000 ED visits increased for all ages: 18 to 24 (226.3%), 45 to 64 (242.0%), 65 to 84 (760.2%) and >=85 (862.0%), which is higher than any of the other drug-related visit rates per 10,000 ED visits. The number of ED visits for ages 18 to 44 decreased from 71.7% of all encounters to 67.5%. No significant association was found between age and drug-related ED visit rates.
Conclusion: Marijuana-related ED visits significantly increased from 2008 to 2016. ED visits related to opiate and alcohol use also increased, but to a lesser degree compared to marijuana-related ED visits. The notable increase in marijuana-related ED visits across all age categories may be attributed to the increased availability of marijuana and a shift in the perception of the legal ramifications associated with its use, compared to previous years.