The opioid crisis has been declared a "public health emergency." Spine surgeons are treating more patients with substance use disorders (SUD).Investigate the outcomes of patients with SUD who undergo spine surgery.A retrospective chart review was performed on patients with SUD who underwent non-elective spine surgery by orthopedic or neurosurgical staff from 2012-2017 at a level one trauma center and spine referral center. Three elective cases were excluded.A total of 49 patients undergoing 72 surgeries were reviewed. The most common substances of abuse were opioids (44/49 patients; 90%). Of 31 multi-substance use patients (63%), 29 misused opioids. The most common indications for surgery were infection (26/49, 53%), trauma (13/49, 27%), and myelopathy (7/49, 14%). Fusions (35/49, 71%) and irrigation and debridement surgeries (12/49, 24%) predominated. Twenty-nine percent (14/49) of patients had complications, the most common being hardware failure (7/49, 14%). Twenty percent (10/49) of patients left against medical advice (AMA) and 22% (11/49) did not follow-up after hospital discharge. The average length of hospital stay was 22 days. Forty-five percent (22/49) of patients were known to be in a drug program pre-operatively versus 39% (19/49) post-operatively. Sixty-five percent (32/49) were prescribed opioids in the immediate post-operative period and 47% (23/49) continued to abuse drugs post-operatively.Patients with SUD are at increased risk of complications and inadequate follow-up. Additional studies are warranted to determine whether additional peri-operative education, psychiatry consultations, or prescription of opioid addiction treatment regimens will improve drug use cessation and outcomes.