Substance use driving increases in emergency department visits, hospitalizations for young mothers

Emergency department (ED) visits for use of substances, especially opioids, amphetamines and cannabis, by mothers with dependent children increased almost 5% a year, in contrast to an increase of almost 2% a year among females without children, according to a large study in Canadian Medical Association Journal. These increases were largely in mothers under age 25, in whom rates grew more than four times faster than among other females.

Over the past 20 years, use of opioids, stimulants, cannabis and hallucinogens has increased in the general population in North America. The burden of substance use affects more than just the person who uses the substances.

“Growing up with a parent who has a substance use disorder is considered an adverse childhood experience, which can increase a child’s risks of poor health, developmental challenges and future substance use,” says Dr. Colleen Webber, an investigator at Bruyère Health Research Institute, Ottawa, Ontario, and Bruyère Health lead of OnSPARK, with co-authors. “Despite this, there is surprisingly little evidence on substance use in parents, although many studies have been conducted on the general population.”

To understand whether rising substance use was also occurring in parents, researchers examined ICES data from 2008 to 2024 on all females in Ontario who were giving birth and who had at least one child age 18 or younger. They compared these birthing parents with other females who did not have children. The large study included 988,106 birthing parents matched in age to 1,198,063 other females.

“We talk a lot about the opioid and toxic drug crises, and much of the focus has been on overdoses and deaths,” says Dr. Daniel Myran, a co-author who is Gordon F. Cheesbrough Research Chair at North York General, a scientist with the University of Toronto’s Department of Family and Community Medicine, ICES, and the Bruyère Health Research Institute.

“We wanted to understand some of the broader effects of rising substance use. In this study, we asked whether mothers have been spared these overlapping crises, and the answer appears to be no. Substance harms have risen in moms at least as much as in females who do not have children.”

In particular, the youngest mothers are driving the increases in substance use, with rates for emergency visits increasing more than four times faster than for other females. Patterns for hospital admissions for substance use were similar.

“That has really important implications first for the care of mothers and second for children since most mothers will have kids they are caring for,” says Myran. “Previous studies have found that many children in the United States have lost a parent to an overdose. But living with a parent who has a substance use disorder can have very negative impacts on a child, and this has not received much focus. Our study suggests an increasing number of children in Ontario may be growing up with a mother who has a serious substance use disorder.”

The authors emphasize that the study does not examine whether it’s motherhood or parenthood itself that is resulting in increasing substance use. The higher rates in mothers younger than 25 likely relate to other factors leading to having children earlier in life that may also increase the risk of substance use.

Although relative increases were highest for amphetamines, cannabis and opioids, alcohol is still the biggest driver of emergency visits and hospital admissions for substance use, with alcohol use accounting for 46% of ED visits and 41% of hospitalizations for substance use in mothers in 2024.

“While ED visits and hospitalizations for substance use remain relatively rare in mothers, affecting around 0.5%, we should be concerned that for each mother seeking care in these settings there are multiple others who did not seek care either because of stigma or because their substance use was not severe enough to need hospital care,” says Myran.

“While cannabis, opioids and amphetamines increased the most over time, alcohol remained the most common substance problem for mothers,” says Webber. “That may reflect the ‘pinking’ of alcohol, where products are being specifically marketed to women and to moms through ‘mommy wine culture.'”

They call for better supports for young parents.

“Adapting care to better meet the needs of this unique population could include integrated services that address both substance use and mental health and programs that accommodate parenting responsibilities. Upstream interventions, including income and housing supports and measures to mitigate and prevent intimate partner violence, may help address some of the social drivers that contribute to substance use,” the authors write.

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