Drug use disorders are emerging as one of the most serious and rapidly growing public health challenges in the Americas, according to a new study published in the Pan American Journal of Public Health. The findings show that drug use is now among the top 10 risk factors contributing to death and disability across the Region, underscoring the scale and urgency of the crisis.
In 2021 alone, an estimated 17.7 million people in the Americas were living with a drug use disorder. Nearly 78,000 deaths were directly attributed to these conditions, resulting in a mortality rate four times higher than the global average. The analysis, based on data from the Global Burden of Disease 2021 study, reveals that opioid use is the primary driver of this burden and that young men are disproportionately affected.
Opioid use disorders accounted for more than three-quarters of all drug use disorder–related deaths in the Region. The overall impact of drug use disorders has intensified dramatically, with disability-adjusted life years nearly tripling between 2000 and 2021 and rising at an average rate of almost 5% per year. Young adults, especially men, continue to bear the highest burden, while the steady rise in deaths among women has raised additional concerns.
PAHO Director Dr. Jarbas Barbosa emphasized that these outcomes are not inevitable. He noted that drug use disorders are both preventable and treatable, yet they continue to exact a growing toll on families and communities across the Americas. He called on countries to urgently expand evidence-based prevention, treatment, and harm reduction services, particularly for young people and populations at higher risk.
The study also highlights stark regional differences in patterns of drug use. In North America, opioid-related disorders—driven largely by highly potent synthetic opioids such as fentanyl—have risen sharply, alongside increasing amphetamine use. In contrast, cannabis and cocaine have been the main contributors to drug use disorders in the Caribbean, Central America, and South America over the past decade.
Beyond deaths directly linked to drug use disorders, the authors estimate that more than 145,000 deaths in the Americas in 2021 were caused by conditions such as opioid overdoses, liver cancer, cirrhosis, and suicide attributable to drug use. This places drug use alongside major risk factors such as high blood pressure, obesity, unhealthy diets, and tobacco use as a leading cause of mortality and disability in the Region.
The COVID-19 pandemic further intensified the crisis, with significant increases in opioid and amphetamine use disorders observed during this period. Pandemic-related stress, disruptions to health services, and social isolation are believed to have exacerbated existing vulnerabilities and contributed to a surge in drug-related deaths.
In response to these findings, PAHO is calling for urgent and coordinated action across the Americas. The organization urges countries to strengthen prevention programs for youth and high-risk groups, expand access to treatment and harm reduction services—including medication-assisted treatment for opioid use disorders—and integrate substance use care into primary health care and community-based services. Improving surveillance and data systems to track emerging drug trends, particularly synthetic opioids and combined drug use, is also seen as essential, along with adopting gender-responsive approaches to address the rising burden among women.
PAHO also highlights the value of cost-effective screening tools such as the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization, to help close treatment gaps and reduce harm.
Dr. Renato Oliveira E Souza, Chief of PAHO’s Mental Health and Substance Use Unit, stressed the need to place mental health and substance use care at the heart of health systems. He emphasized that community-based, people-centered services, supported by strong public health leadership and national strategies informed by reliable data, have the power to reverse current trends and save thousands of lives across the Americas.
