ABSTRACT
Introduction: The impact of the COVID-19 pandemic on substance use in children and adolescents is not well understood. Although lockdowns have largely ended, there is concern regarding longer time effects on development. Presentations to emergency department (ED) settings may provide an indicator of substance use associated with a relatively high level of acuity. The aim of the current study is to describe trends in pediatric (0-17yo) presentations associated with substance use diagnoses to emergency services at an academic center in a Southwestern state since onset of the COVID-19 pandemic and how these compare to rates prior to onset of COVID pandemic. Method(s): Retrospective chart review of electronic medical record data from July 2019-March 2022. Data included all visits by pediatric subjects (0-17yo) associated with a substance-use related diagnosis to acute care settings within the University of New Mexico Health Sciences Center system. Data is summarized within 3-month quarters (Jan- Mar, April-June, July-Sept, Oct-Dec) to allow comparison of numbers presenting during similar periods of year. March 2020 was when broad lockdowns were started in New Mexico. Variables included total number of visits, sex (M, F), race, ethnicity (Hispanic/Non-Hispanic), age range (0-9, 10-14, 15- 17yo), insurance (private, Medicaid, other government, selfpay/ other), whether seen by mental health provider, ED length of stay (LOS) (1 hour or less, 2-5 hours, 6 hours or more), and substance-related diagnosis. Variables are compared between each quarter using a generalized linear model. Result(s): There were 938 visits total during this time (467 male, 467 females, 4 missing). 598 were Hispanic, 274 non- Hispanic White, 147 Native American, 45 Black, 8 Asian, 4 NH/PI, and 146 declined or unknown. The vast majority of visits were in adolescents 15-17yrs old. The most common diagnosis was cannabis-related disorder at 306 encounters, followed by alcohol n=303. The trajectory of visits from July 2019-March 2022 showed a decline from 98 visits in July-Sept 2019 to 51 visits in April-June 2020, followed by increase to 102 visits in Jan-Mar 2022. Comparisons of equivalent quarters for each year were as follows: Q1 (2020 n=71;2021 n=71, 2022 n=102). Q2 (2020 n=51;2021 n=81). Q3 (2019 n=98;2020 n=75;2021 n=107, 2019-2021). Q4 (2019 n=90;2020 n=57;2021 n=111). There were fewer female visits prior to onset of COVID-19 (n=40 in females vs n=58 in males in 2019 Q3) and decreased further early in the pandemic (N=29 vs 46 in males in 2020 Q3), but then rose more rapidly than males (n=59 female, n=48 male, 2021 Q3). The proportion of visits with LOS 5 hours in Q3 initially decreased from 27.8% of visits(n=25) in 2019 to 19.3% (n=11) in 2020, then increased significantly to 35.1% in 2021 (n=39). There was not a significant effect of other variables. Conclusion(s): The COVID-19 pandemic resulted in a rapid decrease in ED substance-abuse pediatric presentations, which rebounded to levels greater than pre-COVID. Females increased more than males. Visits with longer LOS increased during later pandemic. Future work includes understanding how mental health comorbidities and other socioeconomic stressors may relate to these findings.