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

Jiseung Kang; Hyeon Jin Kim; Min Seo Kim; GBD 2023 Substance Use Collaborators, including; Ibrahim Elsohaby; Ginenus Fekadu; Jae Il Shin; Dong Keon Yon

doi:10.1038/s41591-025-04137-0

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

Jiseung Kang (Co-first Author), Hyeon Jin Kim (Co-first Author), Min Seo Kim (Co-first Author), GBD 2023 Substance Use Collaborators, including, Ibrahim Elsohaby, Ginenus Fekadu, Jae Il Shin^*, Dong Keon Yon^*

^*Corresponding author for this work

Department of Infectious Diseases and Public Health

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

Abstract

Drug use disorders (DUDs) are emerging global public health challenges. Here we investigated the global and regional estimates of the prevalence and burden of DUDs, including amphetamine, cannabis, cocaine and opioid use disorders, from 1990 to 2023 for 204 countries and territories by using the Global Burden of Disease Study 2023. Overall, trends in global age-standardized disability-adjusted life-years of DUDs increased from 169.3 (95% uncertainty interval (95% UI), 134.4–203.9) per 100,000 people in 1990 to 212.0 (95% UI, 179.2–245.6) in 2023. In 2023, both prevalence and burden of DUDs were higher in high-income countries, particularly in the USA. The most prevalent DUDs in 2023 were cannabis use disorder (age-standardized prevalence, 270.8 (95% UI, 201.7–350.0) per 100,000 people) and opioid use disorder (205.9 (95% UI, 178.7–235.0)). Particularly, opioid use disorder showed a nearly twofold increase in prevalence and burden between 1990 and 2023. In 2023, compared with countries where cannabis use was illegal, countries permitting both recreational and medical cannabis use had higher prevalence rates for all types of DUDs. Proactive and effective policies are essential to mitigate the increasing global burden of DUDs. © The Author(s), under exclusive licence to Springer Nature America, Inc. 2026.

Original language	English
Pages (from-to)	527-544
Number of pages	18
Journal	Nature Medicine
Volume	32
Issue number	2
Online published	16 Jan 2026
DOIs	https://doi.org/10.1038/s41591-025-04137-0
Publication status	Published - Feb 2026

Funding

This study was funded by the Gates Foundation, the Australian National Health and Medical Research Council and the Queensland Department of Health, Australia. This paper was developed as part of the GBD Collaborator Network and GBD Protocol with support from the GBD Secretariat, IHME and the GBD Collaborator Network under the IHME ID: 4251 (GBD 2023 Substance Use Collaborators). This work was supported by the Yonsei Fellowship, funded by Lee Youn Jae (to J.I.S.). This research was supported by the Ministry of Science and ICT (grant nos. RS-2024-00509257 and IITP-2024-RS-2024-00438239 to D.K.Y.) and the Ministry of Health & Welfare (grant no. RS-2025-02220492 to D.K.Y.), South Korea. The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. All authors had full access to the study data and had final responsibility for the decision to submit for publication.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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title = "Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990–2023: a Global Burden of Disease Study",

abstract = "Drug use disorders (DUDs) are emerging global public health challenges. Here we investigated the global and regional estimates of the prevalence and burden of DUDs, including amphetamine, cannabis, cocaine and opioid use disorders, from 1990 to 2023 for 204 countries and territories by using the Global Burden of Disease Study 2023. Overall, trends in global age-standardized disability-adjusted life-years of DUDs increased from 169.3 (95% uncertainty interval (95% UI), 134.4–203.9) per 100,000 people in 1990 to 212.0 (95% UI, 179.2–245.6) in 2023. In 2023, both prevalence and burden of DUDs were higher in high-income countries, particularly in the USA. The most prevalent DUDs in 2023 were cannabis use disorder (age-standardized prevalence, 270.8 (95% UI, 201.7–350.0) per 100,000 people) and opioid use disorder (205.9 (95% UI, 178.7–235.0)). Particularly, opioid use disorder showed a nearly twofold increase in prevalence and burden between 1990 and 2023. In 2023, compared with countries where cannabis use was illegal, countries permitting both recreational and medical cannabis use had higher prevalence rates for all types of DUDs. Proactive and effective policies are essential to mitigate the increasing global burden of DUDs. {\textcopyright} The Author(s), under exclusive licence to Springer Nature America, Inc. 2026.",

author = "Jiseung Kang and Kim, {Hyeon Jin} and Kim, {Min Seo} and {GBD 2023 Substance Use Collaborators, including} and Zyoud, {Sa{\textquoteright}ed H.} and Magdalena Zieli{\'n}ska and Bin Zhu and Anthony Zhong and Jingya Zhang and Haijun Zhang and Zeariya, {Mohammed G. M.} and Aurora Zangh{\`i} and Fathiah Zakham and Hadiza Yusuf and Chuanhua Yu and Naohiro Yonemoto and Paul Yip and Dehui Yin and Renjulal Yesodharan and Yahaya, {Zwanden Sule} and Angga Wilandika and Wickramasinghe, {Nuwan Darshana} and Shu Wang and Yuan-Pang Wang and Walde, {Mandaras Tariku} and Yasir Waheed and Vujcic, {Isidora S.} and Manish Vinayak and Georgios-Ioannis Verras and Siavash Vaziri and Vasankari, {Tommi Juhani} and Joe Varghese and Eynde, {Jef Van den} and Vaithinathan, {Asokan Govindaraj} and Atta Ullah and Saeed Ullah and Udoakang, {Aniefiok John} and Ibrahim Elsohaby and Ginenus Fekadu and Shin, {Jae Il} and Yon, {Dong Keon}",

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Global burden of amphetamine, cannabis, cocaine and opioid use in 204 countries, 1990–2023: a Global Burden of Disease Study. / Kang, Jiseung (Co-first Author); Kim, Hyeon Jin (Co-first Author); Kim, Min Seo (Co-first Author) et al.
In: Nature Medicine, Vol. 32, No. 2, 02.2026, p. 527-544.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

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

Abstract

Funding

UN SDGs

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