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.

Drug use disorders (DUDs) represent a major global health challenge, leading to substantial morbidity and mortality, while also being compounded by social and structural barriers. In this study, we examined global epidemiological trends in DUDs over the past three decades to inform clinical and public health responses. We extracted data on the incidence, deaths, and disability-adjusted life years (DALYs) attributable to DUDs from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study between 1990 and 2021. Age-standardized incidence (ASIR), mortality (ASMR), and DALY rates per 100,000 population were calculated. The analysis focused on four DUDs-opioid, amphetamine, cocaine, and cannabis use disorders-and further stratified rates by sex, Socio-demographic Index (SDI), countries, and world regions. In 2021, there were 13.6 (95% UI, 11.6-15.7) million new cases, 137,278 (95% UI, 129,269-146,181) deaths, and 15.6 (95% UI, 12.8-18.1) million DALYs attributed to DUDs. Between 1990 and 2021, the ASIR decreased by 8.1%, while the ASMR and DALY rates rose by 30.8% and 14.8%, respectively. Opioid use disorder accounted for the highest ASIR (169.4 [95% UI, 145.1-195.0] per 100,000), ASMR (1.7 [95% UI, 1.6-1.8] per 100,000), and age-standardized DALY rate (191.0 [95% UI, 156.1-222.8] per 100,000) in 2021. Sex and geographical variations were notable, with males and world regions like high-income North America, Australasia, and Eastern/Western Europe showing disproportionately higher rates. Overall, these findings highlight rising mortality and morbidity rates despite a modest decline in incidence, underscoring the need for tailored public health interventions, advancing harm reduction programs, and expanding access to treatment.