Introduction: A paradox in global drug use
New international data reveal a troubling paradox: the incidence of drug use disorders (DUDs) is not rising as rapidly as death and disability from drug use. A comprehensive analysis based on the 2021 Global Burden of Disease (GBD) study shows that while new cases of drug addiction have fallen or grown slowly in many regions, mortality from drug-related causes has more than doubled since 1990, and disability-adjusted life years (DALYs) have surged. This disconnect highlights critical gaps in harm reduction, treatment access, and long-term recovery services across the world.
The scope of the problem
Drug addiction affects an estimated hundreds of millions globally, with opioids, cannabis, and stimulants like amphetamine and cocaine at the forefront. The recent analysis shows a 36% increase in drug-use disorder incidence from 1990 to 2021, with 13.6 million new cases in 2021 and a total case count of 53 million. Yet mortality rose by 122% over the same period, reaching 137,278 deaths in 2021. This rise in deaths occurs even as the global age-adjusted incidence rate declines modestly, signaling that fewer people may be starting drug use, but more are dying once affected by a DUD.
Regional and demographic patterns
The burden is not evenly distributed. The wealthier, highly developed regions—especially North America—recorded the most striking increases in mortality and DALYs. Affluent areas saw a dramatic rise in opioid-related deaths and a substantial uptick in cocaine fatalities. In contrast, some middle-income regions experienced smaller increases, and East Asia managed a decline in new cases attributed to stringent anti-drug policies. The United States led in incidence and prevalence rates, with 531 and 3,821 cases per 100,000 people, respectively, while mortality in North America climbed far more steeply than in other regions.
Who is most affected?
The analysis highlights that younger adults are at heightened risk. Men aged 20–24 show markedly higher incidence rates than women, and the risk among males aged 15–19 is particularly acute. The greatest share of deaths occurs among people in the 25–29 age bracket. These patterns underscore how drug addiction intersects with education, employment, poverty, and social isolation, and explain why marginalized communities—including inmates and residents of low-income neighborhoods—bear a disproportionate share of the burden.
Substance-specific dynamics
Opioids remain the leading driver of the mortality and DALY increases. Their impact is magnified by both legal prescriptions and illicit markets, alongside regulatory failures that slow effective controls. Opioid-related deaths and DALYs rose by roughly 39% and 32%, respectively. Cocaine deaths more than doubled, and co-use of opioids and cocaine has synergistic effects that amplify harm. Amphetamine use rose in some settings, but its incidence declined in others, yet mortality rose in several regions, signaling rising clinical severity or gaps in treatment access. Cannabis and several other drugs showed relative stability or declines in incidence.
Implications for policy and practice
The key take-away from the GBD-based study is clear: reducing new cases is not enough. Without robust, accessible, and sustained treatment and harm-reduction programs, drug addiction mortality can outpace gains in prevention. Public health leaders must design integrated strategies that combine prevention with evidence-based treatment (including medication-assisted therapy for opioid use disorder), harm-reduction services (such as naloxone distribution and safe-use education), and long-term recovery support. This approach should be tailored to sociodemographic contexts and should address social determinants like education, employment, and housing to be truly effective.
Call to action
Regional health authorities, policymakers, and clinicians should work together to implement scalable, data-informed programs that bridge gaps between prevention and treatment. The GBD study urges an evidence-driven commitment to integrated care models, continuous monitoring, and equitable access to life-saving interventions. With the right investments, the global community can bend the trajectory of drug addiction—reducing both new cases and the human toll of existing disorders.
About the study
The findings stem from the evolving burden of drug use disorders analysis, drawn from the 2021 Global Burden of Disease study and published in Frontiers in Psychiatry. The work emphasizes that prevention must be coupled with harm reduction and treatment to address the current crisis.
