Global burden of disease data from 1990-2021 shows cannabis use disorder has the highest prevalence among all drug use disorders, while opioid use disorder causes the most disability and death.
Global health policymakers, addiction epidemiologists, and public health researchers.
Cannabis use disorder has the highest prevalence rate of any drug use disorder globally
What the researchers found
Cannabis use disorder leads all five drug use disorder categories in age-standardized prevalence rates globally. Opioid use disorder has the highest disability and mortality rates. The burden of drug use disorders is significantly greater in high-SDI (high-income) areas, with income inequality exacerbating uneven distribution of disability-adjusted life years.
Why it matters
Establishing that cannabis use disorder is the most prevalent drug use disorder globally provides important context for legalization debates and healthcare resource allocation.
The numbers in context
Cannabis use disorder has the highest ASPR among 5 drug use disorder categories. Opioid use disorder has the highest ASDR and ASMR. High-SDI areas bear significantly greater burden. Opioid use disorder ASIR declining least among 5 categories.
How the study worked
Analysis of Global Burden of Disease (GBD) 2021 data examining incidence, prevalence, mortality, and DALYs for drug use disorders. Decomposition analysis for age, gender, and SDI effects. Health inequality analysis using slope index and concentration index.
What this study cannot tell us
GBD estimates rely on available data that varies greatly by country and region. Cannabis use disorder diagnostic criteria have changed over time. Some countries have minimal surveillance data. Cannot distinguish between cannabis use and cannabis use disorder in many settings.
How to read the evidence
GBD data provides the most comprehensive global estimates available, though data quality varies significantly by country and diagnostic standards have evolved.
When this study was published
2025 publication with 1990-2021 GBD data.
The bigger picture
The concentration of drug use disorder burden in high-income regions challenges the perception that substance use disorders are primarily a developing-world problem. The finding that income inequality worsens the distribution highlights structural determinants of addiction.
Questions still open
- How will cannabis legalization trends affect global CUD prevalence in coming decades?
- Why is opioid use disorder ASIR declining less than other drug categories?
Read the original research
Global, regional and national burden of drug use disorders, 1990-2021: decomposition analysis, health inequality analysis and predictions to 2035.
Frontiers in public health, 13, 1588607
Citation
Jin, Ruiying; Zhang, Shenyu; Xiong, Jun; Liu, Baixi. (2025). Global, regional and national burden of drug use disorders, 1990-2021: decomposition analysis, health inequality analysis and predictions to 2035.. Frontiers in public health, 13, 1588607. https://doi.org/10.3389/fpubh.2025.1588607
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