Background: Emergency department (ED) visits related to substance use are common. ED patients also have high levels of health-related material needs (HRMNs) such as homelessness and food insecurity. However, little research has examined the intersection between ED patient HRMNs and substance use. Methods:We surveyed a random sample of public hospital ED patients. Surveys included validated single-item screeners for unhealthy alcohol and any drug use, and questions on selfreported past year material needs. We compared individual HRMNs and cumulative number of HRMNs by substance use screening status using bivariate and multivariable analyses.Results: 2,312 surveys were completed. Nearly one-third of patients (32.3% [n=747]) screened positive for unhealthy alcohol use, and 21.8% (n=503) screened positive for drug use. Prevalence of HRMNs for all patients -including food insecurity (50.8%), inability to meet essential expenses (40.8%), cost barriers to medical care (24.6%), employment issues (23.8%), and

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