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Cannabis Is the Second Leading Drug Use Disorder in the Americas, Affecting 5.6 Million People

Retrospective CohortStrong evidence
The takeaway

Cannabis use disorders accounted for 31.5% of all drug use disorders in the Americas in 2021, second only to opioids, with the overall burden of drug disorders rising nearly 5% annually.

Public health officials, addiction treatment planners, and policymakers across the Americas.

5.6 million people with cannabis use disorders in the Americas

What the researchers found

In 2021, 17.7 million people in the Americas had drug use disorders, with opioids (42.7%) and cannabis (31.5%) dominating. Drug use disorder deaths reached 77,717 (6.9 per 100,000), higher than global estimates. Age-standardized DALYs increased 4.95% annually, reaching 695 per 100,000. The burden was highest among young adult males.

Why it matters

Cannabis use disorders affect an estimated 5.6 million people across the Americas (31.5% of 17.7 million). As cannabis legalization expands, understanding the scale of cannabis-specific disorder burden is essential for allocating treatment resources.

The numbers in context

17.7 million with drug use disorders (2021). Cannabis: 31.5% (~5.6 million). Opioids: 42.7%. Deaths: 77,717 (6.9/100,000). DALYs: 695/100,000, rising 4.95% annually. 145,515 all-cause deaths attributed to drug use (1.6% of total deaths).

How the study worked

Analysis of Global Burden of Disease Study 2021 estimates across 38 countries in the Americas from 2000 to 2021. Examined morbidity, mortality, and DALYs from opioid, cocaine, amphetamine, cannabis, and other drug use disorders. Trends assessed using average annual percentage change via regression analysis.

What this study cannot tell us

Global Burden of Disease estimates rely on modeling with inherent uncertainty. Cannabis use disorder diagnosis varies across countries. The study period (2000-2021) includes major policy changes in several countries that may affect reporting and diagnosis rates.

How to read the evidence

Global Burden of Disease estimates covering 38 countries over 21 years. Strong population-level evidence with inherent modeling uncertainty.

When this study was published

Published in 2025 with data through 2021.

The bigger picture

The Americas bear a disproportionate share of the global drug use disorder burden. While opioids drive the most deaths, cannabis disorders affect the second-largest population and may be growing as legal access expands.

Questions still open

  • Is the rising cannabis disorder burden driven by increased use, increased diagnosis, or both? How do cannabis disorder trends differ between countries with and without legal cannabis?

Common questions

What is a cannabis use disorder?
A clinical diagnosis characterized by problematic cannabis use leading to significant impairment, including inability to cut down, use in dangerous situations, tolerance, withdrawal, and interference with daily responsibilities.
Why are the Americas hit harder than the global average?
Higher rates of drug use, greater availability of potent substances, and opioid epidemic-specific factors in North America contribute to the region having higher drug disorder rates and deaths than the global average.

Read the original research

The rising burden of drug use disorders in the Americas, 2000-2021.

Revista panamericana de salud publica = Pan American journal of public health, 49, e132

Citation

Martinez, Ramon; Zapata, Mario A; Tausch, Amy; Lange, Shannon; Russell, Cayley; Hennis, Anselm; E Souza, Renato Oliveira. (2025). The rising burden of drug use disorders in the Americas, 2000-2021.. Revista panamericana de salud publica = Pan American journal of public health, 49, e132. https://doi.org/10.26633/RPSP.2025.132

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