Between 1990 and 2021, global drug use disorder incidence decreased 8% while mortality rose 31%, with 13.6 million new cases and 137,000 deaths in 2021 alone — opioids remained the deadliest.
Public health policymakers, addiction medicine professionals, epidemiologists, and global health researchers.
What the researchers found
In 2021: 13.6 million new drug use disorder cases, 137,278 deaths, 15.6 million DALYs. From 1990-2021: incidence decreased 8.1% but mortality rose 30.8% and DALYs rose 14.8%. Males and high-income regions disproportionately affected. Opioids dominated all metrics.
Why it matters
The paradox of declining incidence but rising mortality suggests treatment hasn't kept pace with the severity of drug use disorders. Cannabis use disorder, while less fatal than opioids, contributes significantly to the overall disability burden.
The numbers in context
2021: 13.6M new cases, 137,278 deaths, 15.6M DALYs. Opioid ASIR: 169.4/100K, ASMR: 1.7/100K. 1990-2021: ASIR -8.1%, ASMR +30.8%, DALY rate +14.8%.
How the study worked
Systematic analysis of the Global Burden of Disease Study 2021, calculating age-standardized incidence, mortality, and DALY rates for opioid, amphetamine, cocaine, and cannabis use disorders across sex, SDI, countries, and regions from 1990-2021.
What this study cannot tell us
GBD estimates rely on available data which varies dramatically by country. Cannabis use disorder diagnosis criteria and reporting have changed over time. Some regions have very limited data.
How to read the evidence
Comprehensive global analysis using the gold-standard GBD methodology, though dependent on variable data quality across countries.
When this study was published
The most comprehensive and current global analysis of drug use disorder trends available, covering three decades of data.
The bigger picture
This 30-year global analysis shows that drug use disorders are becoming more deadly even as fewer people develop them. Cannabis use disorder contributes to the disability burden, though opioids remain the primary driver of mortality.
Questions still open
- Why is drug use disorder mortality rising while incidence declines? Is the increasing potency of substances — including cannabis — contributing to more severe cases?
Common questions
Is drug addiction getting worse globally?
Where does cannabis rank among drug use disorders?
Read the original research
Global burden of disease due to opioid, amphetamine, cocaine, and cannabis use disorders, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.
PloS one, 20(8), e0328276
Citation
Zhu, David T; Kwon, Ye In Christopher; Lai, Alan; Park, Andrew Min-Gi; Barnes, Andrew J; Chapman, Derek A. (2025). Global burden of disease due to opioid, amphetamine, cocaine, and cannabis use disorders, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.. PloS one, 20(8), e0328276. https://doi.org/10.1371/journal.pone.0328276
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