Changing Patterns of Alcohol and Cannabis Acute Care Admissions by Age in the United States, 2016–2023

OBJECTIVE: Age-related differences in alcohol and cannabis use are well established, yet age-specific trends in substance-related acute morbidity remain incompletely understood. The authors examined age-specific trends in alcohol- and cannabis-related emergency department and inpatient admissions from 2016 to 2023. METHODS: codes F10-F19, excluding nicotine). Outcomes included the proportion of substance-related encounters involving alcohol or cannabis, stratified by six age groups (16-18, 19-24, 25-34, 35-44, 45-54, and 55-64 years). Secondary analyses examined primary substance diagnoses, severe alcohol-related morbidity, and cannabis-related encounters involving psychosis or vomiting (hyperemesis). Weighted linear regression estimated age-specific annual changes in encounter proportions, and Poisson models assessed trends in total encounter volume and substance involvement per encounter. RESULTS: Among 5,190,680 substance-related encounters, alcohol and cannabis exhibited divergent age patterns. Alcohol accounted for 19%-26% of adolescent admissions, increasing to 73%-76% among adults ages 55-64 years, whereas cannabis involvement was highest among adolescents (70%-78%) and lowest among older adults (10%-11%). Alcohol-related admissions increased significantly among adults ages 25-34 years (1.80 percentage points annually, 95% CI=1.59, 2.00) and 35-44 years (1.19 points, 95% CI=0.99, 1.38). Cannabis-related admissions increased most rapidly among individuals ages 19-24 years (1.81 points annually, 95% CI=1.57, 2.04) and 16-18 years (0.83 points, 95% CI=0.61, 1.06), with notable increases in presentations involving psychosis and vomiting. When restricted to primary diagnoses, cannabis-related trends were attenuated, with adolescents showing annual declines (-1.46 points, 95% CI=-1.98, -0.94). CONCLUSIONS: Alcohol- and cannabis-related acute care presentations follow divergent age-specific trajectories, with cannabis increasingly predominant among adolescents and young adults and alcohol predominant among older adults.