Drug use disorders are rapidly becoming one of the most pressing public health challenges in the Americas, contributing significantly to premature deaths and disability across the region, according to a new study published in the Pan American Journal of Public Health.

Drawing on data from the Global Burden of Disease 2021, the study estimates that 17.7 million people in the Americas were living with a drug use disorder in 2021. Nearly 78,000 deaths that year were directly attributed to these disorders—translating into a mortality rate four times higher than the global average.

The findings place drug use among the top 10 risk factors for all-cause mortality and disability in the region, alongside conditions such as high blood pressure, obesity, poor diet and tobacco use.

The analysis reveals that opioid use disorders are the dominant driver of drug-related mortality, accounting for more than 75 per cent of all deaths linked to drug use disorders. Overall, the burden of disease—measured in disability-adjusted life years (DALYs)—nearly tripled between 2000 and 2021, rising at an average annual rate of almost 5 per cent.

Young adults, particularly men, bear the heaviest burden. However, researchers also flagged a concerning rise in deaths among women, underscoring the need for gender-responsive prevention and treatment strategies.

“Drug use disorders are a preventable and treatable public health problem, yet they are taking an increasing toll on families and communities across our Region,” said Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO). “Countries must urgently scale up evidence-based prevention, treatment, and harm reduction services—especially for young people and those at higher risk.”

The study highlights stark regional differences in the types of drugs driving the crisis. In North America, there has been a sharp rise in disorders linked to opioids—particularly highly potent synthetic opioids such as fentanyl—as well as amphetamines. In contrast, cannabis and cocaine have been the primary contributors to drug use disorders in the Caribbean, Central America and South America over the past decade.

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 attributable to drug use through conditions such as opioid overdose, liver cancer, cirrhosis and suicide.

The COVID-19 pandemic appears to have worsened the situation. Significant increases in opioid and amphetamine use disorders were recorded during this period, potentially driven by pandemic-related stress, social isolation and disruptions to health and social services.

PAHO says the findings expose major gaps in prevention, treatment access and harm reduction services across the region. The organisation is calling on countries to strengthen youth-focused prevention programmes, expand access to treatment—including medication-assisted therapy for opioid use disorders—and integrate substance use services into primary health care and community-based settings.

Improved surveillance systems are also critical, particularly to detect emerging threats such as synthetic opioids and combined drug use. PAHO further emphasised the importance of gender-sensitive approaches, given the rising burden among women.

Screening tools developed by the World Health Organization, such as the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), were highlighted as cost-effective ways to reduce harm and close treatment gaps.

“We must place mental health and substance use care at the center of our health systems,” said Dr. Renato Oliveira e Souza, Chief of PAHO’s Mental Health and Substance Use Unit. “Community-based, people-centered services, backed by strong public health leadership and data-driven national strategies, can reverse these trends and save thousands of lives across the Americas.”

The study serves as a stark warning that without coordinated, evidence-based action, drug use disorders will continue to exact a heavy and preventable toll on health systems, communities and future generations.