Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990–2023: a Global Burden of Disease Study

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

Korea University
Massachusetts General Hospital
Kyung Hee University
Broad Institute
An-Najah National University
Medical University of Warsaw
South University of Science and Technology of China
Harvard Medical School
Huazhong University of Science and Technology
Johns Hopkins University
Al-Azher University
Hail University
Università di Catania and Sezione INFN
Wuhan University
University of Toyama
Juntendo University
University of Hong Kong
Department of Pathology
Manipal Academy of Higher Education
Beijing Tiantan Hospital, Capital Medical University
University of São Paulo
National University of Sciences and Technology (NUST)
University of Belgrade, KCS Institute of Biophysics
Icahn School of Medicine at Mount Sinai
University of Southampton
University of Edinburgh, College of Medicine and Veterinary Medicine
Tampere University
Jazan University
University of Bahrain
University of Nizwa
University of Karachi
Medical Center Boulevard
Dalhousie University, Faculty of Medicine
University of Crete
University of Leicester
University of Massachusetts Dartmouth
University of New South Wales
Department of Epidemiology and Public Health
Universitas Indonesia
University of Swat
Chinese University of Hong Kong
University of Management and Technology Lahore

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4 Scopus citations

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.

Original language	British English
Pages (from-to)	527-544
Number of pages	18
Journal	Nature Medicine
Volume	32
Issue number	2
DOIs	https://doi.org/10.1038/s41591-025-04137-0
State	Published - Feb 2026

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SDG 3 Good Health and Well-being

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@article{649cabb802cd4665a530ca464a14550c,

title = "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.",

author = "Jiseung Kang and Kim, \{Hyeon Jin\} and Kim, \{Min Seo\} and Zyoud, \{Sa{\textquoteright}ed H.\} and Magdalena Zieli{\'n}ska and Bin Zhu and Anthony Zhong and Jingya Zhang and Haijun Zhang and Zeariya, \{Mohammed G.M.\} and Aurora Zangh{\`i} and Fathiah Zakham and Hadiza Yusuf and Chuanhua Yu and Naohiro Yonemoto and Paul Yip and Dehui Yin and Renjulal Yesodharan and Yahaya, \{Zwanden Sule\} and Angga Wilandika and Wickramasinghe, \{Nuwan Darshana\} and Shu Wang and Wang, \{Yuan Pang\} and Walde, \{Mandaras Tariku\} and Yasir Waheed and Vujcic, \{Isidora S.\} and Manish Vinayak and Verras, \{Georgios Ioannis\} and Siavash Vaziri and Vasankari, \{Tommi Juhani\} and Joe Varghese and Eynde, \{Jef Van den\} and Vaithinathan, \{Asokan Govindaraj\} and Atta Ullah and Saeed Ullah and Udoakang, \{Aniefiok John\} and Munkhtuya Tumurkhuu and Tualeka, \{Abdul Rohim\} and Tsermpini, \{Evangelia Eirini\} and Aristidis Tsatsakis and Tsai, \{Alexander C.\} and Tromans, \{Samuel Joseph\} and Duc, \{Nguyen Tran Minh\} and Tran, \{Thang Huu\} and Saddik, \{Basema Ahmad\} and Dian Kusuma and Ahmad Hammoud and Ali, \{Syed Shujait\} and Ali, \{Mohammed Usman\} and Afzal, \{Muhammad Sohail\}",

note = "Publisher Copyright: {\textcopyright} The Author(s), under exclusive licence to Springer Nature America, Inc. 2026.",

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month = feb,

doi = "10.1038/s41591-025-04137-0",

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AU - Zyoud, Sa’ed H.

AU - Zielińska, Magdalena

AU - Zhu, Bin

AU - Zhong, Anthony

AU - Zhang, Jingya

AU - Zhang, Haijun

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AU - Zakham, Fathiah

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AU - Wang, Yuan Pang

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AU - Vaithinathan, Asokan Govindaraj

AU - Ullah, Atta

AU - Ullah, Saeed

AU - Udoakang, Aniefiok John

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AU - Tualeka, Abdul Rohim

AU - Tsermpini, Evangelia Eirini

AU - Tsatsakis, Aristidis

AU - Tsai, Alexander C.

AU - Tromans, Samuel Joseph

AU - Duc, Nguyen Tran Minh

AU - Tran, Thang Huu

AU - Saddik, Basema Ahmad

AU - Kusuma, Dian

AU - Hammoud, Ahmad

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AU - Ali, Mohammed Usman

AU - Afzal, Muhammad Sohail

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N2 - 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.

AB - 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.

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Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990–2023: a Global Burden of Disease Study

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