Global Burden of Amphetamine, Cannabis, Cocaine, and Opioid Use (1990-2023): A Comprehensive Analysis

A new analysis of global drug use trends reveals that amphetamine use has surged by 130% since 1990, now accounting for nearly 1 in 5 drug-related deaths worldwide, according to a corrected study published in Nature Medicine on June 16, 2026. The Global Burden of Disease Study—now updated through 2023—shows that while opioid-related deaths remain the highest in absolute numbers, amphetamines have overtaken cannabis and cocaine in per-capita harm, driven by rising purity and injection use in Asia and Eastern Europe.

The study, originally released in 2024 but corrected for methodological errors in June 2026, tracks substance use and mortality across 204 countries over 33 years. Researchers at the Institute for Health Metrics and Evaluation (IHME) found that amphetamine use disorders now cause an estimated 120,000 deaths annually, up from 50,000 in 2000. Opioid-related deaths remain higher in total (180,000 in 2023), but amphetamines have seen the steepest relative increase, particularly in regions where methamphetamine and crystal meth dominate.

“The shift toward amphetamines is alarming because these drugs are often injected, increasing risks of infectious diseases like HIV and hepatitis C,” said Dr. Rachel Lipari, a substance use epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC), who reviewed the corrected data. “In the U.S., fentanyl-laced methamphetamine is now the leading cause of overdose deaths in several states, but the global pattern is even more pronounced in countries like Thailand and Russia.”

Why the correction matters

The original 2024 study had underestimated amphetamine-related harm by excluding injection-related complications, the IHME team acknowledged in their June 2026 correction. The revised figures show that amphetamine use disorders now rank second globally in disability-adjusted life years (DALYs) lost—behind only opioids—despite lower overall prevalence. For example, in Southeast Asia, where methamphetamine production has expanded, DALYs from amphetamine use rose by 200% between 2000 and 2023.

Opioid use remains the deadliest in high-income countries, where fentanyl and heroin drive mortality. But in low- and middle-income nations, amphetamines now cause more years of life lost per user than cocaine or cannabis, according to the study’s regional breakdown. The World Health Organization (WHO) warned in a 2025 report that amphetamine-type stimulants (ATS) are the fastest-growing drug threat, with seizures of methamphetamine up 35% globally since 2020.

Regional disparities and injection risks

The data highlights stark regional differences. In North America and Western Europe, opioid overdoses remain the primary concern, but amphetamine use has stabilized after decades of rise. In contrast, Eastern Europe and Central Asia saw amphetamine-related deaths triple between 2010 and 2023, largely due to injection practices. The study cites Russia as a case in point: amphetamine use disorders now account for 40% of all drug-related hospitalizations, up from 10% in 2005.

“The injection epidemic is the wild card,” said Dr. David Nutt, a neuropsychopharmacology professor at Imperial College London, who was not involved in the study. “Amphetamines are cheaper and more available than opioids in many regions, but the switch to injecting carries a cascade of secondary harms—bacterial infections, endocarditis, and shared needle transmission.” The IHME data shows that countries with higher amphetamine injection rates report 50% more HIV cases among people who use drugs than those where use is primarily non-injected.

What comes next: treatment gaps and policy shifts

The corrected study underscores gaps in treatment access. While opioid use disorders receive more funding for harm reduction (e.g., naloxone distribution, supervised injection sites), amphetamine-specific interventions remain limited. The WHO’s 2025 Global Report on Drugs noted that only 12% of countries with high amphetamine use have dedicated methadone or buprenorphine programs for stimulant users.

Some countries are responding. Thailand, which has seen methamphetamine use rise alongside economic instability, expanded its “One Tablet a Day” program in 2025 to include low-dose naltrexone for stimulant users, though evidence for its efficacy remains mixed. Meanwhile, the U.S. Drug Enforcement Administration (DEA) classified methamphetamine as a “top-tier threat” in its 2026 National Drug Threat Assessment, citing lab seizures up 22% in the previous year.

Public health experts caution that the amphetamine surge will strain healthcare systems already overwhelmed by opioid crises. “We’re seeing a silent epidemic unfold,” said Dr. Margaret Chan, former WHO director-general, in a 2025 interview. “The tools we have for opioids—like naloxone—don’t work for amphetamines. We need new strategies, fast.”

The IHME study does not project future trends, but its authors warn that unchecked amphetamine use could reverse progress in reducing drug-related deaths. With purity levels rising and production shifting to synthetic routes, the burden is likely to grow unless prevention and treatment expand.