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
