Cannabis accounted for most of the substance-related acute care encounters among adolescents aged 16-18 years, but among adults aged 55-64 years, alcohol accounted for the largest share, a US study showed. The share of encounters involving alcohol increased most among individuals aged 25-44 years, and the share involving cannabis increased most among those aged 16-24 years.
METHODOLOGY
- Researchers analyzed data from the Merative MarketScan Commercial and Multi-State Medicaid insurance claims databases in the US (2016-2023) to compare how alcohol- and cannabis-related emergency department and inpatient admissions changed across age groups.
- The cohort included 1,355,161 individuals aged 16-64 years (54.7% men; 60.6% enrolled in Medicaid) with one or more substance-related acute care encounters (excluding nicotine-related disorders), identified using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes.
- The primary outcome was the monthly proportion of substance-related encounters involving alcohol or cannabis, stratified into six age groups (16-18, 19-24, 25-34, 35-44, 45-54, and 55-64 years).
- Secondary analyses examined primary-diagnosis inpatient admissions, severe alcohol-related morbidity (external cause codes including acute alcohol poisoning), and cannabis encounters with psychosis or vomiting as proxies for psychiatric morbidity and cannabis hyperemesis syndrome.
TAKEAWAY
- In the overall cohort, 53.2% of individuals had alcohol-related encounters and 40.4% had cannabis-related encounters. Among individuals with substance-related encounters, 33% of those aged 16-18 years had alcohol-related encounters vs 70.4% of those aged 55-64 years (P < .001), whereas cannabis was involved for 83.7% of adolescents vs 18.8% of adults aged 55-64 years.
- Alcohol's share of encounters increased annually by 1.80 percentage points among individuals aged 25-34 years and 1.19 percentage points among those aged 35-44 years but fell by 0.46 points among those aged 16-18 years.
- Cannabis' share increased annually by 1.81 percentage points among individuals aged 19-24 years and by 0.83 percentage points among those aged 16-18 years. However, when limited to inpatient admissions with cannabis as the primary diagnosis, the share among adolescents declined by 1.46 percentage points annually.
- Encounters of cannabis-related psychosis increased annually by 0.50 percentage points among individuals aged 16-18 years and by 0.59 percentage points among those aged 19-24 years; vomiting-related encounters increased by 0.44 and 0.27 percentage points annually, respectively.
IN PRACTICE
"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. Understanding age differences in high-risk use is critical for being able to offer effective and meaningful care for people at different life stages," corresponding investigator Kevin Y. Xu, MD, assistant professor of psychiatry, Washington University School of Medicine, St. Louis, said in a press release.
SOURCE
The study was led by Jacob T. Steinle, MD, Washington University School of Medicine, St. Louis. It was published online on November 4 in The American Journal of Psychiatry.
LIMITATIONS
The study did not examine absolute changes in admission rates. The data lacked geographic identifiers and data beyond 2023 were not studied. Claims data could not differentiate transient psychotic symptoms from confirmed psychotic disorders or capture self-limiting episodes. Lastly, substance involvement may have been underestimated as documentation depended on clinical recognition and coding practices.
DISCLOSURES
The study was funded by the National Institutes of Health and the Washington University Just-In-Time Core Usage Funding Program. Investigator support was received from various organizations. Disclosure information for the study investigators is available in the original study publication.
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