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Among teenagers needing emergency care for substance-related problems, 84% had at least one encounter involving cannabis, while alcohol was more common among older adults, according to a new national study.
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The research, published in The American Journal of Psychiatry, analyzed more than 5 million substance-related emergency department visits and hospitalizations between 2016 and 2023.
For emergency nurses and other healthcare professionals, the findings highlight how substance-related health risks differ across age groups and why those differences matter when assessing patients.
84% of Teens Had a Cannabis-Involved Emergency Encounter
The researchers analyzed insurance claims involving more than 1.3 million people ages 16–64 who had at least one substance-related emergency care encounter during the eight-year study period.
Among adolescents ages 16–18, 84% had at least one encounter involving cannabis, the highest percentage of any age group. By comparison, the figure was 19% among adults ages 55–64.
Young adults ages 19–24 experienced the largest increase in the proportion of substance-related encounters involving cannabis, rising approximately 1.8 percentage points annually. Among teenagers, that proportion increased approximately 0.8 percentage points per year.
“In general, we have seen that cannabis use is trending up and alcohol use is trending down; but until now, we haven’t had high-quality data tracking what kind of use is causing immediate harm — emergency room visits and hospitalizations,” said Kevin Y. Xu, MD, an assistant professor of psychiatry at WashU Medicine.
“Understanding age differences in high-risk use is critical for being able to offer effective and meaningful care for people at different life stages.”
High-Potency Cannabis Raises Concerns About Psychosis and Severe Vomiting
The study also identified increases in cannabis-related hospital admissions involving psychosis and severe vomiting among younger patients.
Xu noted that increasingly potent cannabis products can expose users to substantially higher amounts of tetrahydrocannabinol (THC), the compound responsible for cannabis’s psychoactive effects.
These products may pose particular risks for adolescents and young adults, whose brains are still developing.
Heavy cannabis use during adolescence has been associated with an increased risk of psychotic symptoms, although most people who use cannabis do not experience these complications.
Xu also cited recent research suggesting that cannabis use disorder becomes more likely when consumption exceeds approximately 40 milligrams of THC weekly in adults and 30 milligrams in adolescents.
However, the researchers cautioned that cannabis involvement in an emergency encounter does not necessarily mean cannabis caused the medical emergency.
The study included encounters in which cannabis appeared anywhere in a patient’s diagnosis list, including visits involving injuries, psychiatric emergencies, or unrelated medical conditions. Nearly half of cannabis-related encounters also involved at least one other substance.
When researchers examined hospitalizations where cannabis was the primary reason for admission, they found that the trend among adolescents declined.
Alcohol-Related Emergency Care More Common Among Older Adults
While cannabis was more prominent among younger patients, alcohol showed the opposite pattern.
Among adolescents ages 16–18 who experienced substance-related emergency care, 33% had at least one alcohol-related encounter. That percentage increased steadily with age, reaching 70% among adults ages 55–64.
Despite broader declines in alcohol consumption nationally, alcohol-related emergency care remained substantial among older adults.
Among adults ages 25–34, the proportion of hospitalizations primarily attributed to alcohol increased by 3.6 percentage points annually, the steepest increase identified in the study.
The findings suggest that declining alcohol consumption across the general population does not necessarily translate into fewer serious alcohol-related medical complications.
What the Findings Mean for Emergency Nurses
The findings offer important context for emergency nurses assessing patients with suspected substance-related complications.
For younger patients, cannabis involvement may warrant attention, particularly in encounters associated with psychosis, severe vomiting or multiple substances. Among older adults, alcohol remains a prominent factor in substance-related emergency care.
Because the researchers analyzed insurance claims rather than individual clinical circumstances, the findings cannot establish whether cannabis or alcohol directly caused a particular emergency visit or hospitalization.
Understanding these age-related patterns may help nurses and other clinicians provide more individualized patient education about substance use risks.
“There are many lingering questions to answer, especially about understanding why substance use-related harm patterns vary so greatly across the lifespan,” said Jacob T. Steinle, MD, the study’s first author and a clinical fellow in psychiatry at Mass General Brigham.
“We plan to continue our research, building upon these foundations so that clinicians can better inform each individual patient and the public at large around the risks of substance use.”
