Substance-related emergency visits rising fastest among young mothers, Ontario study finds

Emergency department visits and hospital admissions for substance use have been climbing among mothers with dependent children in Ontario, Canada, and the steepest increases have occurred in the youngest mothers, according to a large observational study published in the Canadian Medical Association Journal. Over a sixteen-year study window, substance-related emergency visits among birthing parents rose by almost five percent each year on average, compared with an increase of just under two percent per year among females of similar age who did not have children. Among mothers under the age of twenty-five, rates grew more than four times faster than among other females, rising roughly eight percent annually against two percent in the comparison group.

The study, led by researchers affiliated with Bruyère Health Research Institute in Ottawa, North York General Hospital, the University of Toronto, and ICES, drew on health administrative data covering the period from 2008 to 2024. The research team identified all females in Ontario who had given birth and who had at least one child aged eighteen or younger, then matched them by age to females without children. The final cohort included 988,106 birthing parents, representing forty-seven percent of the study population, matched to 1,198,063 other females, or fifty-three percent. This design allowed the investigators to compare trends in acute care use for substance use between two large groups distinguished primarily by parental status.

The findings arrive against a backdrop of rising substance use across North America. Over the past two decades, use of opioids, stimulants, cannabis, and hallucinogens has increased in the general population, and the toxic drug crisis has driven steep increases in overdose deaths. What has been far less documented, the authors note, is how these trends have affected parents, despite the fact that growing up with a parent who has a substance use disorder is recognized as an adverse childhood experience that can raise a child’s risks of poor health, developmental challenges, and future substance use of their own.

Dr. Colleen Webber, an investigator at the Bruyère Health Research Institute and Bruyère Health lead of OnSPARK, emphasized the gap in the evidence base. Despite many studies of substance use in the general population, she said, there is surprisingly little research on substance use in parents specifically. The new analysis was designed to test whether mothers had been spared the overlapping crises that have reshaped acute care use in the broader population, and the answer, according to the research team, appears to be no.

The temporal patterns in the data reveal how sharply the crisis accelerated and then partially eased. The period from 2014 to 2018 saw the highest annual increases, with substance-related emergency visits among birthing parents rising by eleven percent per year, before the rate of increase slowed to about two percent annually in later years. Hospital admissions told a parallel story. Among birthing parents, admissions for substance use climbed from ninety-nine to 259 per 100,000 person-years over the study period. Among females without children, admissions rose as well, from 136 to 209 per 100,000 person-years, but the trajectory was less steep, meaning the gap between the two groups widened over time.

Dr. Daniel Myran, a coauthor who holds the Gordon F. Cheesbrough Research Chair at North York General Hospital and is a scientist with the University of Toronto’s Department of Family and Community Medicine and ICES, framed the motivation for the study. Much of the public conversation about the opioid and toxic drug crises, he noted, has centered on overdoses and deaths. The research team wanted to understand some of the broader effects of rising substance use, and to ask whether mothers had been spared these crises. The data suggest they have not, with substance harms rising in mothers at least as much as in females who do not have children.

The concentration of increases among the youngest mothers carries particular weight for the researchers. Because most mothers in the cohort had children they were caring for, rising substance-related acute care use among young parents has implications that extend beyond the patients themselves. Previous studies have found that many children in the United States have lost a parent to an overdose, but Myran pointed out that living with a parent who has a substance use disorder can also have serious negative impacts on a child, an outcome that has received comparatively little attention. The study’s findings suggest that an increasing number of children in Ontario may be growing up with a mother who has a serious substance use disorder.

The authors are careful about what the study does and does not show. The analysis does not examine whether motherhood or parenthood itself is driving the increases in substance use. The markedly higher relative increases among mothers younger than twenty-five likely relate to other factors that lead to having children earlier in life, factors that may also independently raise the risk of substance use. As an observational study of health administrative data in a single Canadian province, the research documents trends in acute care use rather than establishing causal mechanisms, and the findings describe Ontario’s population and health system rather than necessarily generalizing elsewhere.

Substance-specific patterns add nuance to the headline trends. Relative increases were highest for amphetamines, cannabis, and opioids, mirroring broader shifts in the North American drug supply and patterns of use. Yet alcohol remains the single largest driver of acute care burden among mothers. In 2024, alcohol use accounted for forty-six percent of emergency department visits and forty-one percent of hospitalizations for substance use among mothers in the cohort. Webber suggested this may reflect what has been described as the pinking of alcohol, with products increasingly marketed specifically to women and to mothers, a phenomenon sometimes referred to as mommy wine culture. While cannabis, opioids, and amphetamines increased the most over time, alcohol remained the most common substance problem for mothers throughout the period.

The researchers stress that although emergency visits and hospitalizations for substance use remain relatively rare among mothers, affecting roughly half a percent of the group, the treated cases likely represent the visible portion of a larger problem. For each mother seeking care in an emergency department or hospital, Myran noted, there are multiple others who did not seek care, whether because of stigma or because their substance use had not yet become severe enough to require hospital-level care. The authors call for better supports for young parents, including integrated services that address both substance use and mental health, programs designed to accommodate parenting responsibilities, and upstream interventions such as income and housing supports and measures to prevent intimate-partner violence, which may help address some of the social drivers that contribute to substance use in this population.

Subject of Research: Trends in substance-related emergency department visits and hospitalizations among mothers with dependent children in Ontario, Canada

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

Article References: Substance use driving increases in emergency department visits, hospitalizations for young mothers. Original publication (Bibliographic details unavailable.)

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Keywords: substance use, opioids, amphetamines, cannabis, alcohol, emergency department visits, hospitalizations, young mothers, Ontario, adverse childhood experiences, CMAJ, observational study