Kang, JiseungKim, Hyeon JinKim, Min SeoIl Shin, JaeAalruz, HasanAbate, Yohannes HabtegiorgisAbbas, NasirAbbasian, MohammadrezaElHafeez, Samar AbdAbdelmasseh, MichaelAbdollahi, ArashAbdollahi, MohammadAbdoun, MeriemZuñiga, Roberto Ariel AbeldañoAbiodun, Olugbenga OlusolaAbiodun, OlumideAboagye, Richard GyanAbtahi, DariushAbubakar, Ibrahim JatauAbubakar, BilyaminuAbu-Gharbieh, EmanAburuz, SalahdeinAbu-Zaid, AhmedAdane, Mesafint MollaAddo, Isaac YeboahAdeleke, Olumide ThomasAdewuyi, Habeeb OmoponleAdeyeoluwa, Temitayo EstherAdhikari, KishorAfzal, Muhammad SohailAfzal, SairaAgyemang-Duah, WilliamsAhmad, AqeelAhmad, SajjadAhmad, DanishAhmadi, AliAhmed, Syed AneesAhmed, HaroonAhmed, Muktar BeshirAhmed, AymanAhmed, Mehrunnisha SharifAkkaif, Mohammed AhmedAlajlani, Muaaz M.Al-Amer, Rasmieh MustafaAlbashtawy, MohammedAldhaleei, Wafa A.Algammal, Abdelazeem M.Bagheri, NasserBurns, Richard A.Islam, Md RabiulYon, Dong Keon2026-01-312026-01-311546-170XRIS:urn:C14CEADF5511359578C7FCE981ABF0ACRIS:Kang2026WOS:001662314100001ORCID:/0000-0002-7750-4341/work/203697582ORCID:/0000-0001-7891-3756/work/203697993https://hdl.handle.net/1885/733805086Drug 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.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.32enAgeCancerDrugLegalizationStigmaPublic healthRisk factors2026-01-1610.1038/s41591-025-04137-0105028015563