image: The PAS Meeting connects thousands of leading pediatric researchers, clinicians, and educators worldwide, united by a shared mission: connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health.
Credit: Pediatric Academic Societies
BOSTON, April 24, 2026 – Over the past 16 years, pediatric substance use-related visits (SUVs) to PEDSnet institutions have been increasing across all care settings and have increased at a greater percentage than visits overall, according to a comprehensive retrospective analysis. The largest proportion of SUVs among youth occur in the outpatient setting, and nicotine, cannabis and opioids are driving much of the growth.
The predominance of outpatient care suggests greater recognition of substance use by outpatient providers and ongoing opportunities for early intervention and prevention of substance use related harms. Findings from the research will be presented at the Pediatric Academic Societies (PAS) 2026 Meeting, taking place April 24-27 in Boston.
Pediatric substance use remains a critical public health issue. However, comprehensive analyses of utilization trends across different healthcare settings remain limited. Understanding utilization patterns in outpatient, emergency department, and inpatient settings is essential for healthcare system planning, resource allocation, and identifying opportunities for intervention.
“The landscape of substance use in the U.S. has shifted dramatically over the past decade, as policy changes such as the legalization of cannabis intersect with the rising potency of substances to fundamentally alter the risks facing youth,” said Alexis Ball, MD, MPP, acting assistant professor at Seattle Children's and lead author of the study. “Our understanding of the impact of these trends has often focused on acute care visits or survey data, whereas outpatient trends are not well described. We sought to bridge this gap by analyzing 16 years of data across all care settings within PEDSnet, a large pediatric health network, to understand how this evolving landscape affects the full spectrum of pediatric healthcare.”
Between January 1, 2009 and December 30, 2024, there were 372,282 SUVs [mean age 16.1 (SD 2.23); 50.7% female] by 71,641 individuals. 54.1% of visits occurred in outpatient settings, 29.4% in the emergency department (ED), and 16.5% resulted in inpatient hospitalizations. SUVs increased in all settings over time. Further, since 2009, SUVs have increased by over 450% whereas all visits for this age have increased by less than 200%. Overall, seasonality trends remain unclear. However, when stratified by setting, there is a peak of visits to the ED in mid-February and mid-September. Nicotine was the most common substance (37.1%), followed by cannabis (31.9%), and opioids (15.1%). Nicotine, cannabis and opioids increased consistently in frequency across all care settings whereas alcohol-related visits have declined.
Additional information is included in the below research abstract. The PAS Meeting connects thousands of leading pediatric researchers, clinicians and educators worldwide. View the full schedule in the PAS 2026 program guide. For more information about the PAS Meeting, please visit www.pas-meeting.org.
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The Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and educators worldwide, united by a shared mission: connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. PAS is a partnership of four premier pediatric associations: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, visit www.pas-meeting.org. Follow us on X, Facebook, and Instagram.
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Abstract: Evolution of Pediatric Substance Use Healthcare Patterns: A 16-Year Analysis of Emergency, Inpatient, and Outpatient Utilization among PEDSnet Institutions
Presenting Author
Alexis Ball, MD, MPP, Acting Assistant Professor, Seattle Children's
Organizations
Seattle Children's, Children's Hospital Colorado, Cincinnati Children's Hospital Medical Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Children's National Health System, Nationwide Children’s Hospital, Nemours Children's Hospital, Stanford University School of Medicine, Children's Hospital of Philadelphia
Topic
Adolescent Medicine: Substance Use
Background
Pediatric substance use remains a critical public health issue. However, comprehensive analyses of utilization trends across different healthcare settings remain limited. Understanding utilization patterns in outpatient, emergency department, and inpatient settings is essential for healthcare system planning, resource allocation, and identifying opportunities for intervention.
Objective
To analyze how pediatric substance use related healthcare utilization has changed among different care locations over the past 16 years within PEDSnet, a multi-site pediatric care network.
Design/Methods
We conducted a retrospective analysis of substance use-related visits (SUVs) to 10 PEDSnet institutions among youth aged 12-21 from 2009 through 2024. SUVs were defined using SNOMED codes. We evaluated annual trends of substance use related visits overall and by care setting (outpatient, Emergency Department (ED), inpatient), type of substance, and demographic characteristics. Time series analysis evaluated seasonal/temporal patterns by care setting.
Results
Between January 1st, 2009, and December 30th, 2024, there were 372,282 SUVs [mean age 16.1 (SD 2.23); 50.7% female] by 71,641 individuals. 54.1% of visits occurred in outpatient settings, 29.4% in the ED, and 16.5% resulted in inpatient hospitalizations (Table 1). SUVs increased in all settings over time (Figure 1). Further, since 2009, SUVs have increased by over 450% whereas all visits for this age have increased by less than 200%. Overall, seasonality trends remain unclear. However, when stratified by setting, there is a peak of visits to the ED in mid-February and mid-September. Nicotine was the most common substance (37.1%), followed by cannabis (31.9%), and opioids (15.1%). Nicotine, cannabis, and opioids increased consistently in frequency across all care settings whereas alcohol-related visits have declined (Figure 2).
Conclusion(s)
Over the past 16 years, SUVs to PEDSnet institutions have been increasing across all care settings and have increased at a greater percentage than visits overall. The largest proportion of SUVs occur in the outpatient setting. Nicotine, cannabis, and opioids are driving much of the growth. The predominance of outpatient care suggests greater recognition of substance use by outpatient providers and ongoing opportunities for early intervention and prevention of substance use related harms.
Co-Authors
Danae Massengill, MD, Pediatrician, Medical Toxicologist, Children's Hospital Colorado
Kristen Reilly, Assistant Professor, Cincinnati Children's Hospital Medical Center
Marc Rosenman, MD, Associate Professor of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago
Hiroki Morizono, PhD, Professor, Children's National Health System
Laura Chavez, PhD, Assistant Professor, Nationwide Children’s Hospital
H Timothy Bunnell, PhD, Principal Research Scientist, Nemours Children's Hospital
Nymisha Chilukuri, MD, Clinical Assistant Professor, Division of General Pediatrics and Division of Clinical Informatics, Stanford University School of Medicine
Christopher B. Forrest, MD, PhD, Professor of Pediatrics, Children's Hospital of Philadelphia
Charles Bailey, MD, PhD, Associate Professor of Pediatrics, Children's Hospital of Philadelphia
Nhat Nguyen, PhD, Children's Hospital of Philadelphia
Kym Ahrens, MD, MPH, Professor, Seattle Children's
Tables and Images
Table 1. Characteristics of Substance Use-Related Visits
Figure 1. Substance Use-Related Visits by Location from 2009 through 2024
Monthly substance use-related visit counts by location from 2009 through 2024. Red line represents actual counts and green line represents overall trend overtime.
Figure 2. Substance Use-Related Visits by Substance Type from 2009 through 2024
Rolling average of substance use-related visits stratified by substance from 2009 through 2024. *Y axis scale differs by substance in order to compare trends over time by substance.