Global Drug Use Disorder Burden: Fewer New Cases But More Deaths Over 30 Years
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?Why is drug use disorder mortality rising while incidence declines?
- ?Is the increasing potency of substances — including cannabis — contributing to more severe cases?
Trust & Context
- Key Stat:
- Evidence Grade:
- Comprehensive global analysis using the gold-standard GBD methodology, though dependent on variable data quality across countries.
- Study Age:
- The most comprehensive and current global analysis of drug use disorder trends available, covering three decades of data.
- Original Title:
- 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.
- Published In:
- PloS one, 20(8), e0328276 (2025)
- Authors:
- Zhu, David T, Kwon, Ye In Christopher, Lai, Alan, Park, Andrew Min-Gi, Barnes, Andrew J, Chapman, Derek A
- Database ID:
- RTHC-08049
Evidence Hierarchy
Frequently Asked Questions
Is drug addiction getting worse globally?
It's complex — fewer new cases are developing (8% decline) but more people are dying (31% increase), suggesting the cases that do occur are more severe or less effectively treated.
Where does cannabis rank among drug use disorders?
Cannabis contributes to the overall disability burden but is far less fatal than opioids, which dominate mortality statistics. The main cannabis concern is disability (DALYs) rather than deaths.
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Cite This Study
https://rethinkthc.com/research/RTHC-08049APA
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
MLA
Zhu, David T, et al. "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, 2025. https://doi.org/10.1371/journal.pone.0328276
RethinkTHC
RethinkTHC Research Database. "Global burden of disease due to opioid, amphetamine, cocaine..." RTHC-08049. Retrieved from https://rethinkthc.com/research/zhu-2025-global-burden-of-disease
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.