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Observational Study
. 2025 Jun 11;20(6):e0325083.
doi: 10.1371/journal.pone.0325083. eCollection 2025.

A retrospective cohort study evaluating the association between opioid and alcohol-related emergency department presentations and the subsequent risk of hospitalization

Kristen A Morin  1   2   3   4 , Laura Hill  1   5 , Shannon Knowlan  1 , Adele Bodson  1 , Paola Nikodem  1 , Natalie Aubin  1 , David C Marsh  1   2   3   4 , Tara Leary  1   4
Affiliations
Observational Study

A retrospective cohort study evaluating the association between opioid and alcohol-related emergency department presentations and the subsequent risk of hospitalization

Kristen A Morin et al. PLoS One. .

Abstract

Objective: 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.

Methods: 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.

Results: 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 = 36.86 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 = 1.28, 95% CI [1.19, 1.37]).

Conclusion: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Cumulative incidence of hospital admission by intervention in days.
Fig 2
Fig 2. Cumulative incidence of hospital admission by ED visits.
See this image and copyright information in PMC

References

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