The distorted illusion that drinking alcohol in excess and/or using drugs is fun, sexy, and accepted as the ‘thing to do’ has unfortunately become mainstream. The health effects associated with substance use and abuse in Canada have direct implications on health service utilization, especially when emergent services are required. The prevalence of substance related ED visits in Winnipeg have never been reported, so it was not known if the prevalence of such presentations in Winnipeg were consistent with those rates in other developed nations. The overall aim of this study was to explore, using retrospective secondary analysis methodology and being guided by the Circle of Frequency, what the prevalence, patient profiles, and visit characteristics of substance-related ED presentations in Winnipeg from January 1, 2011-December 31, 2013. 14,255 substance-related ED visits were identified during this study time, accounting for 2.1% of the overall ED visits. Following frequency analysis, young-adult, unmarried men were identified as the ones most likely to arrive to the ED in Winnipeg with substance-related care needs arriving during inopportune times (on weekends and during the night when staffing levels and support are less), via ambulance, with acute CTAS scores secondary to substance misuse/intoxication, however not requiring admission. The significance of such presentations to the ED in Winnipeg has direct and indirect clinical implications which impacts clinical nursing practice, education, research, and patient care. Strategies to better identify and treat such care needs in the ED are evident and paramount to ensure best practice is provided, and optimal care is achieved.