Cannabis Use Disorder Is Now the World's Most Prevalent Drug Use Disorder | Research

The takeaway

A landmark Global Burden of Disease analysis of 204 countries reveals cannabis use disorder is now the most prevalent drug use disorder globally at 271 per 100,000, with countries allowing recreational cannabis having higher rates of all drug use disorders.

Global health policy makers, WHO officials, drug policy researchers, epidemiologists, and legislators considering cannabis reform.

What the researchers found

In 2023, cannabis use disorder was the most prevalent drug use disorder globally (age-standardized prevalence 270.8 per 100,000), followed by opioid use disorder (205.9). Countries permitting both recreational and medical cannabis had higher prevalence rates for all types of drug use disorders compared to countries where cannabis was illegal.

Why it matters

Published in Nature Medicine, this comprehensive global analysis reveals that cannabis use disorder has become the world's most common drug use disorder, with legalization policies associated with higher rates across all substance categories.

The numbers in context

204 countries; 1990-2023; global DALYs: 169.3→212.0 per 100,000; CUD prevalence 270.8/100,000 (most prevalent DUD); OUD 205.9/100,000 (nearly doubled since 1990); highest burden in high-income countries, especially US; legal recreational+medical countries had higher all-DUD rates

How the study worked

Analysis of Global Burden of Disease Study 2023 data covering 204 countries and territories from 1990-2023, examining trends in prevalence, disability-adjusted life-years, and burden of amphetamine, cannabis, cocaine, and opioid use disorders.

What this study cannot tell us

GBD estimates rely on modeling with data quality varying across countries; cross-country comparisons confounded by reporting differences; association between legal status and DUD prevalence doesn't prove causation; diagnostic criteria may vary across cultures.

How to read the evidence

Nature Medicine publication using the gold-standard GBD methodology across 204 countries provides the most comprehensive global picture, despite inherent modeling limitations.

When this study was published

Published 2026 in Nature Medicine; covers 1990-2023.

The bigger picture

This Nature Medicine study reframes the global drug burden: while opioids dominate harm narratives, cannabis use disorder is actually more prevalent — and the data suggest legalization has unintended consequences across substance categories.

Questions still open

Why do countries with legal cannabis have higher rates of all drug use disorders, not just cannabis? Does legalization cause increased use or does it reflect pre-existing cultural attitudes? How should global health prioritize cannabis use disorder?

Common questions

What is the most common drug use disorder in the world?

Cannabis use disorder, with a global prevalence of about 271 per 100,000 people in 2023 — more common than opioid use disorder (206/100,000), cocaine, or amphetamine use disorders.

Does cannabis legalization increase drug use disorders?

Countries with both recreational and medical cannabis legalization had higher rates of all types of drug use disorders — not just cannabis — though this association doesn't prove legalization directly caused the increase.

Read the original research

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

Nature medicine, 32(2), 527-544

View on PubMed ↗Publisher’s paper ↗

Citation

Kang, Jiseung; Kim, Hyeon Jin; Kim, Min Seo; Shin, Jae Il; Yon, Dong Keon. (2026). Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990-2023: a Global Burden of Disease Study.. Nature medicine, 32(2), 527-544. https://doi.org/10.1038/s41591-025-04137-0