We aimed to examine trends in substance use-related emergency department (ED) visits for youth from 2018 to 2023, compare the patient characteristics, types of substance involved, and ED disposition for these visits, and calculate revisit frequency. Retrospective review of electronic health records (EHRs) from six EDs in an urban healthcare system to identify 12-21-year-old patients with substance use-related ED visits from 2018 to 2023. Visits were identified by International Classification of Diseases, 10th Revision Clinical Modification codes for substance use.