{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:30:19Z","timestamp":1789763419766,"version":"4.0.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Emergency Department (ED) visits for substance-related concerns among young people have been increasing in recent years. Understanding the factors related to repeated ED visits (two or more ED visits per year) for substance use concerns among young people is critical to developing a more efficient mental healthcare system that does not overburden ED and that provides efficient care for substance use patients. This study examined trends of substance use-related ED visits and factors related to repeated ED visits (two or more ED visits per year, in comparison to one ED visit per year) among adolescents and young adults (aged 13 to 25 years) in the province of Ontario, Canada. Binary logistic regression models were conducted to examine associations between hospital-related factors (hospital size, urbanicity, triage level, ED wait time) and visit status (2+ vs 1 ED visit\/year), controlling for patient characteristics (age\/sex). A population-based, repeated cross-sectional data over a 10-year period (2008, 2013, and 2018) was used. The proportion of substance use-related repeated ED visits significantly and consistently increased in the year 2013 and 2018 compared to 2008 (2008 = 12.52%, 2013 = 19.47%, 2018 = 20.19%). Young adult, male, medium-sized hospital, urban location, wait times longer than 6 hours, and symptom severity was associated with increased numbers of repeated ED visits. Furthermore, polysubstance use, opioid use, cocaine use, and stimulant use were strongly associated with repeated ED visits compared with the use of substances such as cannabis, alcohol and sedatives. Current findings suggest that repeated ED visits for substance use concerns could be reduced by policies that reinforce evenly distributed mental health and addiction treatment services across the provinces in rural areas and small hospitals. These services should put special efforts into developing specific (e.g., withdrawal\/treatment) programming for substance-related repeated ED patients. The services should target young people using multiple psychoactive substances, stimulants and cocaine.<\/jats:p>","DOI":"10.1371\/journal.pone.0282056","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T18:29:23Z","timestamp":1677090563000},"page":"e0282056","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Trends of repeated emergency department visits among adolescents and young adults for substance use: A repeated cross-sectional study"],"prefix":"10.1371","volume":"18","author":[{"given":"Soyeon","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Weekes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M.","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7578-723X","authenticated-orcid":true,"given":"Nathan J.","family":"Kolla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"issue":"4","key":"pone.0282056.ref001","doi-asserted-by":"crossref","first-page":"e20182192","DOI":"10.1542\/peds.2018-2192","article-title":"Trends in psychiatric emergency department visits among youth and young adults in the US","volume":"143","author":"LG Kalb","year":"2019","journal-title":"Pediatrics"},{"issue":"7","key":"pone.0282056.ref002","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1097\/PEC.0b013e31825cf93b","article-title":"Temporal trends in pediatric mental health visits: using longitudinal data to inform emergency department health care planning","volume":"28","author":"S Ali","year":"2012","journal-title":"Pediatric emergency care"},{"issue":"1","key":"pone.0282056.ref003","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/acem.12282","article-title":"Trends in pediatric visits to the emergency department for psychiatric illnesses","volume":"21","author":"ZE Pittsenbarger","year":"2014","journal-title":"Academic Emergency Medicine"},{"issue":"16","key":"pone.0282056.ref004","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1001\/jama.284.16.2043","article-title":"Children with mental problems not getting the care they need","volume":"284","author":"J. 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Institute for Clinical Evaluative Sciences, Toronto, Canada. 2018."},{"issue":"40","key":"pone.0282056.ref007","doi-asserted-by":"crossref","first-page":"E1183","DOI":"10.1503\/cmaj.180277","article-title":"Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: a population-based study","volume":"190","author":"NR Saunders","year":"2018","journal-title":"CMAJ"},{"issue":"14","key":"pone.0282056.ref008","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1177\/0009922814541806","article-title":"Emergency department visits for mental health conditions among US children, 2001\u20132011","volume":"53","author":"AE Simon","year":"2014","journal-title":"Clinical pediatrics"},{"issue":"1","key":"pone.0282056.ref009","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/070674371005500103","article-title":"Regional and individual influences on use of mental health services in Canada","volume":"55","author":"N Diaz-Granados","year":"2010","journal-title":"The Canadian Journal of Psychiatry"},{"issue":"4","key":"pone.0282056.ref010","doi-asserted-by":"crossref","first-page":"10","DOI":"10.12927\/hcq.2020.26090","article-title":"Measuring Access to Home and Community Care and to Mental Health and Addictions Services in Canada","volume":"22","author":"G Paltser","year":"2020","journal-title":"Healthcare quarterly (Toronto, Ont)"},{"key":"pone.0282056.ref011","unstructured":"Ontario Hospital Association. Ontario hospitals-leaders in efficiency. 2019."},{"key":"pone.0282056.ref012","unstructured":"Canada S. Table 17-10-0009-01 population estimates, quarterly. Statistics Canada Ottawa; 2020."},{"issue":"2","key":"pone.0282056.ref013","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1093\/pch\/18.2.81","article-title":"The current state of mental health services in Canada\u2019s paediatric emergency departments","volume":"18","author":"SL Leon","year":"2013","journal-title":"Paediatrics & child health"},{"issue":"2","key":"pone.0282056.ref014","first-page":"82","article-title":"Trends and Predictors of Repeat Mental Health Visits to a Pediatric Emergency Department in Hamilton, Ontario","volume":"28","author":"T Rosic","year":"2019","journal-title":"Journal of the Canadian Academy of Child and Adolescent Psychiatry"},{"key":"pone.0282056.ref015","doi-asserted-by":"crossref","unstructured":"Barker LC, Sunderji N, Kurdyak P, Stergiopoulos V, Gonzalez A, Kopp A, et al. 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Canadian Institute for Health Information Ottawa (ON); 2015."},{"issue":"9","key":"pone.0282056.ref017","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1097\/PEC.0b013e3182a393e7","article-title":"Emergency psychiatric care for children and adolescents: a literature review","volume":"29","author":"A Janssens","year":"2013","journal-title":"Pediatric emergency care"},{"issue":"10","key":"pone.0282056.ref018","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1377\/hlthaff.2020.00232","article-title":"Deconstructing The Rise In Mental Health\u2013Related ED Visits Among Children And Youth In Ontario, Canada: Study examines the rise in mental health-related emergency department visits among children and youth in Ontario","volume":"39","author":"M Chiu","year":"2020","journal-title":"Health Affairs"},{"issue":"5","key":"pone.0282056.ref019","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S0196-0644(97)70074-X","article-title":"Intoxicated ED patients: a 5-year follow-up of morbidity and mortality","volume":"30","author":"P Davidson","year":"1997","journal-title":"Annals of emergency medicine"},{"issue":"4","key":"pone.0282056.ref020","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/CXA.0000000000000033","article-title":"Alcohol-related emergency department visits among adolescents and young adults in Sherbrooke, Canada","volume":"9","author":"C Paradis","year":"2018","journal-title":"Canadian Journal of Addiction"},{"issue":"3","key":"pone.0282056.ref021","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/ADM.0000000000000479","article-title":"Trends and related factors of cannabis-associated emergency department visits in the United States: 2006\u20132014","volume":"13","author":"JJ Shen","year":"2019","journal-title":"Journal of addiction medicine"},{"issue":"6","key":"pone.0282056.ref022","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/ADM.0000000000000256","article-title":"Trends and correlates of cannabis-involved emergency department visits: 2004 to 2011","volume":"10","author":"H Zhu","year":"2016","journal-title":"Journal of addiction medicine"},{"issue":"6","key":"pone.0282056.ref023","doi-asserted-by":"crossref","first-page":"224","DOI":"10.24095\/hpcdp.38.6.02","article-title":"Evidence synthesis-The opioid crisis in Canada: a national perspective","volume":"38","author":"B Lisa","year":"2018","journal-title":"Health promotion and chronic disease prevention in Canada: research, policy and practice"},{"issue":"4","key":"pone.0282056.ref024","doi-asserted-by":"crossref","first-page":"10","DOI":"10.12927\/hcq.2018.25430","article-title":"Opioid-related harms in Canada","volume":"20","author":"V Grywacheski","year":"2018","journal-title":"Healthc Q"},{"key":"pone.0282056.ref025","unstructured":"Government of Canada. A Common Statement of Principles on Shared Health Priorities. 2017."},{"key":"pone.0282056.ref026","unstructured":"Government of Canada. Shared Health Priorities. 2019."},{"issue":"2","key":"pone.0282056.ref027","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/0706743715621254","article-title":"Mental health service use among children and youth in Ontario: population-based trends over time","volume":"61","author":"S Gandhi","year":"2016","journal-title":"The Canadian Journal of Psychiatry"},{"key":"pone.0282056.ref028","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3389\/fpsyt.2019.00026","article-title":"Changes in the use of emergency care for the youth with mental health problems over decades: A repeated cross sectional study","volume":"10","author":"X Benarous","year":"2019","journal-title":"Frontiers in psychiatry"},{"issue":"6","key":"pone.0282056.ref029","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1017\/S148180350000350X","article-title":"Revisions to the Canadian emergency department triage and acuity scale (CTAS) guidelines","volume":"16","author":"MJ Bullard","year":"2014","journal-title":"Canadian Journal of Emergency Medicine"},{"key":"pone.0282056.ref030","unstructured":"STATA 16.0 StataCorp. Stata Statistical Software: Release 16.: College Station, TX: StataCorp LP.; 2019."},{"issue":"5\u20136","key":"pone.0282056.ref031","doi-asserted-by":"crossref","first-page":"176","DOI":"10.24095\/hpcdp.40.5\/6.06","article-title":"Original quantitative research-Psychotic disorder and cannabis use: Canadian hospitalization trends, 2006\u20132015","volume":"40","author":"B Maloney-Hall","year":"2020","journal-title":"Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice"},{"key":"pone.0282056.ref032","unstructured":"Government of Canada. Canadian Tobacco Alcohol and Drugs (CTADS): 2015 Summary. 2017."},{"key":"pone.0282056.ref033","unstructured":"Boak A, Elton-Marshall T, Mann R, Hamilton H. Drug use among Ontario students, 1977\u20132019: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS). Toronto, ON: Centre for Addiction and Mental Health. 2020."},{"key":"pone.0282056.ref034","unstructured":"Payer D, Young M, Maloney-Hall B, Mill C, Leclerc P, Buxton J. Adulterants, contaminants and cooccurring substances in drugs on the illegal market in Canada: an analysis of data from drug seizures, drug checking and urine toxicology. Ottawa, ON: Canadian Centre on Substance Use and Addiction. 2020."},{"key":"pone.0282056.ref035","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.drugalcdep.2017.12.032","article-title":"Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: an observational analysis","volume":"185","author":"N Baldwin","year":"2018","journal-title":"Drug and alcohol dependence"},{"issue":"5","key":"pone.0282056.ref036","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/add.14474","article-title":"Illicit fentanyls in the opioid street market: desired or imposed?","volume":"114","author":"SG Mars","year":"2019","journal-title":"Addiction"},{"issue":"2","key":"pone.0282056.ref037","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S2352-4642(18)30342-0","article-title":"Effects of increasing cannabis potency on adolescent health","volume":"3","author":"J Wilson","year":"2019","journal-title":"The Lancet Child & Adolescent Health"},{"issue":"18","key":"pone.0282056.ref038","doi-asserted-by":"crossref","first-page":"E969","DOI":"10.1503\/cmaj.111043","article-title":"Wait times in the emergency department for patients with mental illness","volume":"184","author":"CL Atzema","year":"2012","journal-title":"CMAJ"},{"issue":"6","key":"pone.0282056.ref039","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.annemergmed.2005.06.013","article-title":"Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen","volume":"46","author":"TC Chan","year":"2005","journal-title":"Annals of emergency medicine"},{"key":"pone.0282056.ref040","doi-asserted-by":"crossref","unstructured":"Woodruff A, Frakt AB, editors. 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