Drug Use Disorders Surge Across the Americas, Driving Rising Deaths and Disability

Drug use disorders have become an increasingly serious public health challenge across the Americas, now ranking among the leading contributors to death and disability in the region. According to new findings published in the Pan American Journal of Public Health, drug use is one of the top ten risk factors for all-cause mortality and disability throughout the Americas.

In 2021 alone, an estimated 17.7 million people in the region were living with a drug use disorder. That year, nearly 78,000 deaths were directly attributed to these conditions, producing a mortality rate roughly four times higher than the global average. These figures highlight the growing human cost of substance use and its profound impact on families, communities, and health systems.

The analysis, based on data from the Global Burden of Disease 2021 study, shows that opioid use is the primary driver behind drug use disorders in the Americas. Young men are disproportionately affected, carrying the greatest share of illness and death related to substance use. Opioid use disorders accounted for more than three-quarters of all deaths linked to drug use disorders.

The overall burden of disease has risen sharply over the past two decades. Disability-adjusted life years, or DALYs, associated with drug use disorders nearly tripled between 2000 and 2021, increasing at an average rate of close to 5 percent per year. While young adult men experienced the highest burden, deaths among women also rose steadily, signaling an expanding and increasingly complex public health concern.

“Drug use disorders are preventable and treatable, yet they continue to take a growing toll on families and communities across our region,” said Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO). “There is an urgent need for countries to expand evidence-based prevention, treatment, and harm reduction services, particularly for young people and those at greatest risk.”

A complex and evolving regional picture

The types of drugs contributing to this burden vary widely across the Americas. In North America, the study points to a sharp rise in opioid-related disorders, driven in large part by highly potent synthetic opioids such as FYL, as well as increased use of amphetamines. In contrast, cannabis and cocaine have been the primary contributors to drug use disorders over the past decade in the Caribbean, Central America, and South America.

Beyond deaths directly caused by drug use disorders, the authors estimate that more than 145,000 all-cause deaths in the Americas in 2021 were linked to conditions associated with drug use. These include opioid overdoses, liver cancer, cirrhosis, and suicide. As a result, drug use now ranks alongside high blood pressure, obesity, unhealthy diets, and tobacco use as one of the region’s top contributors to mortality and disability.

The COVID-19 pandemic further intensified these trends. Significant increases in opioid- and amphetamine-related disorders were observed during this period, likely fueled by heightened stress, social isolation, and disruptions to health and social services. These factors compounded existing vulnerabilities and contributed to a rise in drug-related deaths.

PAHO calls for coordinated, urgent action

The findings highlight persistent gaps in prevention, access to treatment, and harm reduction services throughout the Americas. In response, PAHO is urging countries to take coordinated and comprehensive action to address the crisis.

Key recommendations include strengthening prevention programs for youth and high-risk populations; expanding access to treatment and harm reduction services, including medication-assisted treatment for opioid use disorders; integrating substance use care into primary health care and community-based services; improving surveillance and data systems to better identify emerging trends, particularly those involving synthetic opioids and polysubstance use; and adopting gender-responsive approaches as the burden among women continues to grow.

PAHO also emphasizes the value of proven, cost-effective screening tools such as the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), both developed by the World Health Organization. These tools can help close treatment gaps and reduce harm by identifying risky substance use earlier.

“Mental health and substance use care must be central to our health systems,” said Dr. Renato Oliveira E Souza, chief of PAHO’s Mental Health and Substance Use Unit. “People-centered, community-based services, guided by strong public health leadership and informed by epidemiological data, have the potential to reverse these trends and save thousands of lives across the Americas.”

Source: PAHO