{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:43:35Z","timestamp":1780343015089,"version":"3.54.1"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011251","name":"Northern Ontario Academic Medicine Association","doi-asserted-by":"publisher","award":["C-23-14"],"award-info":[{"award-number":["C-23-14"]}],"id":[{"id":"10.13039\/100011251","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Our objective was to evaluate the association between two types of substance use presentations in the emergency department (ED) (opioid and alcohol) and the subsequent risk of hospital admission.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study is a retrospective observational cohort study using administrative data from all patients presenting with substance use disorder (SUD) at Health Sciences North (HSN) from January 1, 2018, to August 31, 2023. Patients were placed in two groups: those with alcohol-related presentations and those with opioid-related presentations. The outcome was the time and number of ED visits between the index ED visit and first admission to the hospital for the substance-related presentation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 5,240 individuals (45.98%) presented with opioid use, and 6,140 individuals (45.61%) presented with alcohol use. The opioid group was younger (mean age\u2009=\u200936.86 years, compared to 44.58 years in the alcohol group) and had higher rates of current homelessness (37.47% vs. 9.63%), a higher prevalence of mental disorders (15.71% vs. 10.68%), and a greater likelihood of being diagnosed with cellulitis (5.24% vs. 0.52%). Despite similarities in 30-day ED revisits (41.53% for alcohol vs. 40.88% for opioids) and mean length of stay (12.16 days for opioids vs. 10.04 days for alcohol), individuals in the opioid group had a higher likelihood of inpatient admission with each additional ED visit (hazard ratio\u2009=\u20091.28, 95% CI [1.19, 1.37]).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our findings highlight the healthcare needs of individuals presenting to the ED with opioid use versus alcohol use, with opioid-related cases involving more acute and complex healthcare presentations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0325083","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T17:57:03Z","timestamp":1749664623000},"page":"e0325083","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["A retrospective cohort study evaluating the association between opioid and alcohol-related emergency department presentations and the subsequent risk of hospitalization"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4059-3475","authenticated-orcid":true,"given":"Kristen A.","family":"Morin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Knowlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adele","family":"Bodson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Nikodem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Aubin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8769-1785","authenticated-orcid":true,"given":"David C.","family":"Marsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Leary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"issue":"12","key":"pone.0325083.ref001","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S2215-0366(18)30337-7","article-title":"The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"5","author":"GBD 2016 Alcohol and Drug Use Collaborators","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"pone.0325083.ref002","author":"World Health Organization","year":"2024"},{"issue":"38","key":"pone.0325083.ref003","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.241173","article-title":"Management of opioid use disorder: 2024 update to the national clinical practice guideline","volume":"196","author":"I Yakovenko","year":"2024","journal-title":"CMAJ"},{"key":"pone.0325083.ref004","article-title":"Results from the 2013 National Survey on Drug Use and Health: Summary of national findings. In: health Saam, editor","author":"Administration SAaMHS","year":"2014"},{"key":"pone.0325083.ref005","article-title":"A cohort study evaluating the association between concurrent mental disorders, mortality, morbidity, and continuous treatment retention for patients in opioid agonist treatment (OAT) across Ontario, Canada using administrative health data","author":"K Morin","year":"2020","journal-title":"Harm Reduct J"},{"issue":"1","key":"pone.0325083.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/j.annemergmed.2011.03.007","article-title":"Effectiveness of interventions targeting frequent users of emergency departments: a systematic review","volume":"58","author":"F Althaus","year":"2011","journal-title":"Ann Emerg Med"},{"issue":"5","key":"pone.0325083.ref007","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.5811\/westjem.2021.3.50839","article-title":"Emergency Department Visits by Patients with Substance Use Disorder in the United States","volume":"22","author":"X Zhang","year":"2021","journal-title":"West J Emerg Med"},{"issue":"1","key":"pone.0325083.ref008","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12873-022-00673-x","article-title":"Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada","volume":"22","author":"J Moe","year":"2022","journal-title":"BMC Emerg Med"},{"issue":"1","key":"pone.0325083.ref009","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/acem.13060","article-title":"Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review","volume":"24","author":"J Moe","year":"2017","journal-title":"Acad Emerg Med"},{"key":"pone.0325083.ref010","article-title":"Measuring the burden of opioid-related mortality in Ontario, Canada","author":"T Gomes","year":"2018","journal-title":"J Addict Med"},{"issue":"10","key":"pone.0325083.ref011","article-title":"Evidence of increased age and sex standardized death rates among individuals who accessed opioid agonist treatment before the era of synthetic opioids in Ontario, Canada","volume":"13","author":"KA Morin","year":"2021","journal-title":"Cureus"},{"issue":"40","key":"pone.0325083.ref012","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.230715","article-title":"Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder","volume":"195","author":"E Wood","year":"2023","journal-title":"CMAJ"},{"key":"pone.0325083.ref013","unstructured":"Roadmap to wellness: a plan to build Ontario\u2019s mental health and addictions system. 2022."},{"key":"pone.0325083.ref014","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/1471-2318-11-65","article-title":"Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns","volume":"11","author":"B Kaskie","year":"2011","journal-title":"BMC Geriatr"},{"key":"pone.0325083.ref015"},{"key":"pone.0325083.ref016","article-title":"Cohort profile: the provincial opioid agonist treatment cohort in Ontario, Canada","author":"KA Morin","year":"2025","journal-title":"Eur J Epidemiol"},{"issue":"4","key":"pone.0325083.ref017","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s11126-016-9422-6","article-title":"Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders","volume":"87","author":"C Huynh","year":"2016","journal-title":"Psychiatr Q"},{"issue":"5","key":"pone.0325083.ref018","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.5811\/westjem.2021.3.50839","article-title":"Emergency Department Visits by Patients with Substance Use Disorder in the United States","volume":"22","author":"X Zhang","year":"2021","journal-title":"West J Emerg Med"},{"issue":"6","key":"pone.0325083.ref019","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/ajad.12784","article-title":"Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial","volume":"27","author":"ANC Campbell","year":"2018","journal-title":"Am J Addict"},{"issue":"1","key":"pone.0325083.ref020","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s41572-019-0137-5","article-title":"Opioid use disorder","volume":"6","author":"J Strang","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"pone.0325083.ref021","article-title":"Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration","author":"S Galea","year":"2002","journal-title":"Public Health Rep"},{"issue":"10117","key":"pone.0325083.ref022","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","article-title":"Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis","volume":"391","author":"RW Aldridge","year":"2018","journal-title":"Lancet"},{"issue":"2","key":"pone.0325083.ref023","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/add.16357","article-title":"Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: A population-based analysis using coroner and health administrative data from Ontario, Canada","volume":"119","author":"RG Booth","year":"2024","journal-title":"Addiction"},{"issue":"2","key":"pone.0325083.ref024","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3390\/healthcare9020111","article-title":"Why do patients leave against medical advice? Reasons, consequences, prevention, and interventions","volume":"9","author":"A Albayati","year":"2021","journal-title":"Healthcare"},{"issue":"12","key":"pone.0325083.ref025","article-title":"Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review","volume":"105","author":"L Ti","year":"2015","journal-title":"Am J Public Health"},{"key":"pone.0325083.ref026","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1503\/cmaj.160290","article-title":"Caring for patients with opioid use disorder in the hospital","volume":"188","author":"J Donroe","year":"2016","journal-title":"CMAJ"},{"issue":"8","key":"pone.0325083.ref027","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1111\/j.1553-2712.1998.tb02505.x","article-title":"Epidemiology of alcohol-related emergency department visits","volume":"5","author":"G Li","year":"1998","journal-title":"Acad Emerg Med"},{"key":"pone.0325083.ref028","unstructured":"Abuse S. Mental health services administration results from the. 2013;2(013):55\u201368."},{"issue":"12","key":"pone.0325083.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0243317","article-title":"Evaluating the effectiveness of concurrent opioid agonist treatment and physician-based mental health services for patients with mental disorders in Ontario, Canada","volume":"15","author":"KA Morin","year":"2020","journal-title":"PLoS One"},{"issue":"4","key":"pone.0325083.ref030","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jsat.2005.02.007","article-title":"An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research","volume":"28","author":"L Amato","year":"2005","journal-title":"J Subst Abuse Treat"},{"key":"pone.0325083.ref031","article-title":"Addiction consultation services for opioid use disorder treatment initiation and engagement: A randomized clinical trial","author":"J McNeely","year":"2024","journal-title":"JAMA Intern Med"},{"key":"pone.0325083.ref032","article-title":"Building an inpatient addiction medicine consult service in Sudbury, Canada: preliminary data and lessons learned in the era of COVID-19","author":"T Leary","year":"2023","journal-title":"J Subst Use Treat Prev Policy"},{"issue":"12","key":"pone.0325083.ref033","doi-asserted-by":"crossref","first-page":"2796","DOI":"10.1007\/s11606-019-05251-9","article-title":"Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis","volume":"34","author":"H Englander","year":"2019","journal-title":"J Gen Intern Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325083","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T17:57:11Z","timestamp":1749664631000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325083"}},"subtitle":[],"editor":[{"given":"Arunima","family":"Dutta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,11]]},"references-count":33,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0325083","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,11]]}}}