Emergency room visits for substance-use issues and anxiety jumped during the first 18 months of the pandemic, an analysis of Colorado Medicaid data found, despite overall volumes in ERs across the state dropping.

The findings, released last week by the Colorado Department of Health Care Policy and Financing, further illustrate the breadth of the pandemic’s impact on the state’s health care system and residents.

It also matches what providers and individual hospital systems have reported: Utilization of ERs across the state plummeted early in the pandemic, in part because of fewer diseases were spreading among a socially distance population; public fear about catching COVID-19 in hospitals also played a role.

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At the same time, the stressors of the pandemic helped fuel a burgeoning mental health crisis. According to the report, ER visits for alcohol-related issues – the 13th most common reason pre-pandemic – jumped to 5th by September 2021 among Medicaid patients. Other state data further illustrates this trend: Alcohol-related deaths in Colorado jumped from 999 in 2017 to 1,543 in 2020 and 1,653 in 2021.

Visits for anxiety increased, as did those for substance-use issues. The health care policy and financing department found that substance-use problems became the 22nd most common reason for an ER visit among Medicaid members by September 2021, up from 30th pre-pandemic. Since the pandemic began, overdoses in Colorado – particularly those fueled by fentanyl – have skyrocketed.

Tamara Keeney, the research and analysis manager for the agency and the report’s primary author, said the findings about behavioral health were the most surprising.

Coloradans delayed care in the early months of the pandemic. The consequences will last for years.

The intent of the study was to find ways to reduce unnecessary emergency room use by the state’s Medicaid enrollees; the state incentivizes its regional Medicaid managers to help patients get treatment at a more appropriate setting, or earlier. But the past two years have instead been dominated by COVID-19, which initially drove down ER visits, and later lead to an increase in behavioral health concerns across the spectrum.

The report found that ER use among Medicaid members declined “substantially” after the onset of COVID-19. That trend is true across the entire state and nation. Some of it makes simple sense, officials have said: Fewer people out, fewer car accidents, or fights, or common infections spreading.

But missed or delayed treatment for heart attacks or strokes – as well as missed preventative care, like cancer screenings – will have impacts into the future, health officials have said, and it’s playing a role in why some hospitals are seeing sicker patients now than pre-pandemic.

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