Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990-2023: a Global Burden of Disease Study
- PMID: 41545593
- DOI: 10.1038/s41591-025-04137-0
Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990-2023: a Global Burden of Disease Study
Abstract
Drug use disorders (DUDs) are emerging global public health challenges. Here we investigated the global and regional estimates of the prevalence and burden of DUDs, including amphetamine, cannabis, cocaine and opioid use disorders, from 1990 to 2023 for 204 countries and territories by using the Global Burden of Disease Study 2023. Overall, trends in global age-standardized disability-adjusted life-years of DUDs increased from 169.3 (95% uncertainty interval (95% UI), 134.4-203.9) per 100,000 people in 1990 to 212.0 (95% UI, 179.2-245.6) in 2023. In 2023, both prevalence and burden of DUDs were higher in high-income countries, particularly in the USA. The most prevalent DUDs in 2023 were cannabis use disorder (age-standardized prevalence, 270.8 (95% UI, 201.7-350.0) per 100,000 people) and opioid use disorder (205.9 (95% UI, 178.7-235.0)). Particularly, opioid use disorder showed a nearly twofold increase in prevalence and burden between 1990 and 2023. In 2023, compared with countries where cannabis use was illegal, countries permitting both recreational and medical cannabis use had higher prevalence rates for all types of DUDs. Proactive and effective policies are essential to mitigate the increasing global burden of DUDs.
© 2026. The Author(s), under exclusive licence to Springer Nature America, Inc.
Conflict of interest statement
Competing interests: S. Afzal reports support for the present manuscript from the Institute of Public Health Lahore; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Dean Institute of Public Health Lahore; support for attending meetings and travel from the Dean Institute of Public Health Lahore; participation on a data safety monitoring board or advisory board with Pakistan National Bioethics Committee, Institution Review Board of Fatima Jinnah Medical University, Ethical Review Board and Data Monitoring Board with the Institute of Public Health Lahore Pakistan, and is in charge of the Clinical Research Organization King Edward Medical University; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Pakistan Higher Education Commission Research Committee, Pakistan Medical and Dental Research Commission Research and Journals Committee, Pakistan Society of Internal medicine, Pakistan Association of Medical Editors, Medical Microbiology and Infectious Diseases Society, Fellow of Leads International, Fellow of Faculty of Public Heath UK and Fellow of College of Physicians and Surgeons Pakistan; receipt of equipment, materials, drugs, medical writing, gifts or other services from the Bergen University of Norway for research writing; and other financial or nonfinancial interests from Dean Public Health and Preventive Medicine King Edward Medical University; outside the submitted work. M.S. Aslam reports two grants from Xiamen University Malaysia Research Fund (XMUMRF). Grant no.: XMUMRF/2025-C15/ITCM/0006. Project title: Therapeutic and Toxicity Evaluation of Selected Medicinal Herbs for NAFLD: Exploring the Inter-Organelle Contact Sites Modulation. Theory Role: Co-Investigator Dates: January 2025–December 2027 (ongoing). Internal XMUMRF research grant administered by Xiamen University Malaysia, funds disbursed to institutional research accounts only; no salary, honoraria or personal payments to author. Grant no.: XMUMRF/2023-C11/ISEM/0041. Project title: Children’s Rights Education in the Early Years of Divorce: An Exploration of Adolescents’ Perspectives. Role: Co-Investigator Dates: January 2023–December 2025 (ongoing). Internal XMUMRF research grant administered by Xiamen University Malaysia; funds disbursed to institutional research account only; no salary, honoraria or personal payments to author; all outside the submitted work. A.S.B. reports support for attending meetings and/or travel to the American Public Health Conference 2022, 2023 and 2024; American College of Epidemiology 2023, 2024 and 2025; Military Health System Conference 2024; and from the University of Virginia Biomedical Data Science Innovation Lab and Seminar series; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a member of the Board of Directors of the American College of Epidemiology 2024–present; former co-chair of the Publications Committee of the American College of Epidemiology in 2023 and 2024; liaison for the Publications Committee of the American College of Epidemiology in 2024 and 2025; Communications Chair for the American Public Health Association, Health Informatics and Information Technology Section; Associate Editor, Annals of Epidemiology Journal; all outside of the submitted work. S.B. reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Grant-in-Aid for Scientific Research (KAKENHI; Grant ID 23KF0126), JSPS and the Australian Academy of Science, JSPS International Fellowship (Grant ID P23712); leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid, as District Chair, Diversity, Equity, Inclusion & Belonging of Rotary District 9675 (Sydney, Australia), as Chair, Founding Member and Manager of the Global Health & Migration Hub Community, Global Health Hub Germany (Berlin, Germany), as Editorial Board Member of PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research, Neurology International, Diagnostics and BMC Medical Research Methodology; as a member of the College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada; as the Director of Research of World Headache Society (Bengaluru, India); as Expert Adviser/Reviewer of Cariplo Foundation (Milan, Italy); as Visiting Director of National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology, Suita (Osaka, Japan); as Member, Scientific Review Committee of Cardiff University Biobank (Cardiff, UK); as Chair of Rotary Reconciliation Action Plan; and Healthcare and Medical Adviser at Japan Connect (Osaka, Japan); outside the submitted work. A. Caye reports consulting fees from EMS, Knight Therapeutics; outside the submitted work. S.R.C. reports grants or contracts from Janssen Cilag Australia Investigator Initiated Research Grants; Australian NHMRC, MMRF Research Grants; NIMH Research Grants; and XWPharma contract research; all funds paid to the University of Adelaide; consulting fees from Insight Timer and Preventative Health SA; all funds paid to the University of Adelaide; and payment or honoraria for lectures, presentations, speakers bureaus, manuscripts writing or educational events from Servier, Lundbeck-Otsuka, all funds paid to the University of Adelaide; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the Board of Mental Health Foundation of Australia; outside the submitted work. X.D. reports all support for the present manuscript from the Institute for Health Metrics and Evaluation and University of Washington. E.E. reports grants or contracts from Grand Challenges Canada, Canadian Institutes of Health Research, funds paid to their institution; and leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with Global Implementation Society; outside the submitted work. I.F.E.B. reports leadership or fiduciary role in other board, society, committee or advocacy group as Editor in Chief of Recent Advances in Infectious Diseases and as an Editor for Texila American Journals; outside the submitted work. O.F.F. reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the African Tobacco Control Alliance; outside the submitted work. A. Faro reports support for the present manuscript from the National Council for Scientific and Technological Development (CNPq, Brazil). J.F. reports grants or contracts from the National Institute of Mental Health and the National Institute on Drug Abuse; outside the submitted work. J.J.J. reports payment for honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Adamed, Amgen, Boehringer Ingelheim and Sevier; outside the submitted work. S.V.K. reports grants or contracts from the National Institute for Health & Care Research, funds paid to their institution; outside the submitted work. M. Koscik reports grants or contracts from NPO ‘Systemic Risk Institute’ number LX22NPO5101, funded by the European Union – Next Generation EU (Ministry of Education, Youth, and Sports); outside the submitted work. P. Meylakhs reports grants or contracts from the Center for Comparative Research of Social Wellbeing, HSE University; outside the submitted work. T.R.M. reports grants or contracts from the National Institute of Mental Health, payments made to their employer; payment for expert testimony for opioid litigations, payments made to their employer; and from Opioid litigation, Evre, LLC, payments made to them; outside the submitted work. L. Monasta reports support for the present manuscript from the Italian Ministry of Health, payments made to their institution. R.F.P.-A. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Angelini, Casen Recordati, Lundbeck, Neuraxpharm, Rubió, Servier and Takeda; support for attending meetings and/or travel from Angelini, Italfarmaco, Advanz Pharma, Takeda, Lundbeck and Camurus; all outside the submitted work. S.K.P. reports support for the present manuscript from Siksha ‘O’ Anusandhan (Deemed to be University); grants and contracts from File no. 17-59/2023-24/CCRH/Tech./Coll./ICMR-Diabetes/960; outside the submitted work. G.D.P. reports support for attending meetings and/or travel from Roche Hellas and Bayer Greece; outside the submitted work. R. Passera reports participation on a Data Safety Monitoring Board or Advisory Board with the Data Safety Monitoring Board dello studio ‘Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKitreated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patients’ – FIL, Fondazione Italiana Linfomi, Alessandria (Italy); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris, France; and is a former member from 2020 to 2023 of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC (Italy); outside the submitted work. A.E.P. reports support for the present manuscript from the Australian National Health and Medical Research Council (Grant no. APP2009306). V. Sharma acknowledges support from DFSS (MHA)’s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, and RUSA grant to Panjab University by Ministry of Education, Govt. of India; outside the submitted work. J.I.S. reports support from the Yonsei Foundation, funded by Lee Youn Jae. J.P.S. reports support for the present manuscript from the Portuguese Foundation for Science and Technology. L.M.L.R.S. reports grants or contracts with SPRINT – Sport Physical Activity and Health Research e Innovation Center, Polytechnic of Guarda, 6300-559 6 Guarda, Portugal; and collaboration with RISE–UBI, Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal; outside the submitted work. J.A.S. reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA Inc., Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc., Adept Field Solutions, Clinical Care Options, Putnam Associates, FocusForward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications and the National Institutes of Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Simply Speaking; support for attending meetings and/or travel from OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, as past steering committee member to attend their meeting every 2 years; participation on a Data Safety Monitoring Board or Advisory Board with FDA Arthritis Advisory Committee (unpaid); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a past steering committee member of the OMERACT; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc., Seres Therapeutics, Tonix Pharmaceuticals Holding Corp., Aebona Pharmaceuticals and Charlotte’s Web Holdings, Inc., and previously owned stock options in Amarin, Viking and Moderna Pharmaceuticals; all outside the submitted work. D.J.S. reports consultancy honoraria from Discovery Vitality, Kanna, L’Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda and Wellcome. R.T.-S. reports grants or contracts from Valencian Regional Government’s Ministry of Education (PROMETEO/CIPROM/2022/58) and the Spanish Ministry of Science, Innovation and Universities (PID2021-129099OB-I00). The funders were not involved in the design of the manuscript or decision to submit the manuscript for publication, nor will they be involved in any aspect of the study’s conduct; all outside the submitted work. S.J.T. reports grants or contracts from part of the 2023/4 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England. This is a contracted study from NHS Digital, via the Department of Health and Social Care. S.J.T. has also contributed to multiple chapters of the 2023/4 Adult Psychiatric Morbidity Survey report, payments made to the University of Leicester. S.J.T. led a study funded by the National Institute for Health and Care Research Clinical Research Network, on optimizing survey design for people with learning disability and autistic people, payments made to the University of Leicester. S.J.T. led a study from the National Institute for Health and Care Research related to reviewing a national training program for health and social care professionals relating to learning disability and autism, payments made to the University of Leicester. S.J.T. was co-applicant on a study funded by the National Institute for Health and Care Research related to identification, recording and reasonable adjustments for people with a learning disability and autistic people in NHS electronic clinical record systems, payments made to the University of Leicester. S.J.T. was co-applicant on a study funded by the National Institute for Health and Care Research related to medication support interventions and strategies for people with learning disabilities, payments made to the University of Leicester. S.J.T. was lead applicant on a study funded by the Baily Thomas Charitable Fund investigating barriers, enablers and interventions to facilitate deprescribing for people with intellectual disability, payments made to the University of Leicester. S.J.T. reports support for attending meetings and/or travel from the Royal College of Psychiatrists for accommodation and travel to conference events due to their role as academic secretary in the faculty of the Psychiatry of Intellectual Disability, as well as additional conference fees waived for Royal College of Psychiatrists; leadership or fiduciary roles as Academic Secretary for the Neurodevelopmental Psychiatry Special Interest Group and Psychiatry of Intellectual Disability Faculty at the Royal College of Psychiatrists; Associate Editor for Journal of Mental Health Research in Intellectual Disabilities; Editorial Board Member for Progress in Neurology and Psychiatry, Advances in Mental Health and Intellectual Disability, Advances in Autism, BMC Psychiatry and BJPsych Open (no payments received for these roles); royalties received as Editor of Psychiatry of Intellectual Disability Across Cultures (Oxford University Press); outside the submitted work. A.C.T. reports support for the present manuscript from the US National Institutes of Health (K34DA061696); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, from Elsevier, Inc. as Co-editor in Chief of SSM – Mental Health, and from BMJ Publishing Group, Ltd, as Clinical Editorial Advisor for The BMJ; outside the submitted work. M.Z. is an Alexion, AstraZeneca Rare Disease employee.
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