Drugs (psychoactive): 296 million people used drugs in 2021—39.5 million affected by drug use disorders
Drugs (psychoactive): 296 million users, 600,000 deaths—treatment gap leaves millions without care
Sarah Mitchell started using prescription painkillers after a car accident left her with chronic back pain.
At first, the opioids her doctor prescribed worked well—they dulled the pain enough that she could work and care for her two children. But over time, she needed higher doses to achieve the same effect. When her doctor, concerned about dependence, stopped prescribing, Sarah turned to buying pills from acquaintances. Then to street drugs when pills became too expensive.
“I didn’t think I was the kind of person who becomes addicted,” Sarah recalled. “I was a nurse, for God’s sake. I knew about addiction. But knowing about it doesn’t protect you from it.”
Sarah’s story illustrates a reality affecting millions worldwide. According to WHO’s information on psychoactive drugs, about 296 million people aged 15-64 used psychoactive drugs in 2021, and approximately 39.5 million people are affected by drug use disorders.
These aren’t just statistics. They’re nurses like Sarah, students struggling with anxiety, laborers trying to cope with demanding work, adolescents experimenting at parties, pain patients whose treatment became problematic, and people seeking escape from trauma or poverty.
And here’s the crisis: most people with drug use disorders receive no treatment. They suffer in silence, face stigma and discrimination, and too often, they die—about 600,000 people annually from drug-related causes.
The question isn’t whether we understand the problem. We do. The question is whether we’re willing to treat drug use disorders as the health conditions they are, rather than as moral failures deserving punishment.
Understanding Psychoactive Drugs
Psychoactive drugs, as WHO defines them, are substances that affect mental processes—perception, consciousness, cognition, mood, and emotions when taken into one’s system. They belong to a broader category of psychoactive substances that also includes alcohol and nicotine.
The term “psychoactive” doesn’t necessarily imply dependence-producing. In common usage, it’s often left unstated, as in “drug use” or “substance use.”
Many psychoactive drugs have legitimate medical uses—controlling pain, treating anxiety or depression, managing seizures, or aiding anesthesia. But production, distribution, sale, or non-medical use of many psychoactive drugs is controlled or prohibited outside legally sanctioned channels.
At the international level, three UN drug conventions control production and distribution: the 1961 Single Convention on Narcotic Drugs (amended by a 1972 Protocol), the 1971 Convention on Psychotropic Substances, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.
These conventions classify psychoactive drugs according to a hierarchy of schedules based on their health risks and therapeutic usefulness.
The challenge is balancing two competing needs: preventing non-medical use and ensuring medical access to essential controlled medicines. Get the balance wrong, and either dangerous drugs flood communities or patients in pain can’t access needed medications.
For more on the complexities of drug policy, see our article on controlled medicines and access.
The Devastating Health Impact
The use of psychoactive drugs without medical supervision is associated with significant health risks and can lead to development of drug use disorders.
According to WHO’s Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders released in June 2024, over 3 million annual deaths are due to alcohol and drug use, with the majority among men.
Specifically for drugs, an estimated 600,000 deaths occur annually—about 420,000 male and 160,000 female deaths. More than 36 million years of healthy life (DALYs—disability-adjusted life years) were lost to drug use in 2019.
Drug use disorders, particularly when untreated, increase morbidity and mortality risks, trigger substantial suffering, and lead to impairment in personal, family, social, educational, occupational, and other important areas of functioning.
The economic costs are staggering—lost productivity, premature mortality, increased healthcare expenditure, and costs related to criminal justice, social welfare, and other social consequences.
An especially vulnerable population is people who inject drugs. Globally, there are 14.8 million people who inject drugs, of whom 15.2% live with HIV and 38.8% live with hepatitis C. WHO’s Global HIV, Hepatitis and STIs Programme works specifically with this population.
Dr. James Omondi, an addiction medicine specialist in Nairobi, described the cascading consequences: “A young person starts using drugs recreationally. They develop dependence. Their school performance drops, they lose their job, relationships fracture. They may contract HIV or hepatitis through needle sharing. Without treatment, many die of overdose, infection, or suicide. It’s a preventable tragedy that unfolds again and again.”
WHO’s Public Health Approach
Since its creation, WHO has played an important role within the UN system in addressing the world drug problem.
WHO’s activities counter the drug problem across five main dimensions:
Prevention of drug use and reduction of vulnerability and risks through evidence-based prevention programs, particularly for young people.
Treatment and care of people with drug use disorders using evidence-based interventions including medication-assisted treatment, psychosocial interventions, and rehabilitation services.
Prevention and management of harms associated with drug use through harm reduction measures—needle and syringe programs, opioid substitution therapy, overdose prevention including naloxone distribution, and HIV/hepatitis prevention and treatment.
Access to controlled medicines by ensuring that essential medicines under international control (like pain medications) remain available for legitimate medical and scientific purposes while preventing diversion to non-medical use. WHO’s guideline on balanced national controlled medicines policies released in July 2025 addresses this critical balance.
Monitoring and evaluation through data collection and analysis to understand the scope of drug use, track trends, and evaluate interventions.
UN Sustainable Development Goal 3, Target 3.5 commits governments to strengthen prevention and treatment of substance abuse. Other relevant targets include ending the AIDS epidemic (3.3), preventing noncommunicable diseases and promoting mental health (3.4), achieving universal health coverage (3.8), and providing access to affordable essential medicines (3.b).
The 2016 UN General Assembly Special Session (UNGASS) on the world drug problem marked a crucial shift in drug policy discourse to highlight public health and human rights dimensions and achieve better balance between supply reduction and public health measures.
WHO participates actively in international drug policy discussions, including the 67th session of the Commission on Narcotic Drugs in March 2024 and the recent UN Commission approval of WHO recommendations in March 2025.
Recent Developments and Guidelines
WHO continues updating guidance based on the latest evidence.
In February 2025, WHO updated guidelines on opioid dependence treatment and overdose prevention, strengthening recommendations for opioid agonist maintenance treatment (OAMT) and naloxone distribution.
WHO’s October 2025 implementation guidance emphasizes maintaining opioid agonist maintenance treatment as an essential health service, even during disruptions like pandemics or conflicts.
WHO works with UNODC (UN Office on Drugs and Crime) and UNESCO on joint publications including International Standards for the Treatment of Drug Use Disorders, International Standards on Drug Use Prevention, and guidance on education sector responses.
WHO’s Expert Committee on Drug Dependence regularly reviews substances to provide recommendations on international scheduling, including the well-publicized cannabis review.
What Must Happen
Addressing the drug crisis requires fundamental shifts in approach.
Treat drug use disorders as health conditions, not criminal issues. People with drug dependence need treatment and support, not incarceration. Countries that have adopted health-centered approaches see better outcomes.
Scale up evidence-based treatment. Opioid agonist maintenance treatment, when properly delivered, dramatically reduces mortality, prevents HIV and hepatitis transmission, and helps people rebuild their lives. Yet most people who need it can’t access it.
Implement harm reduction comprehensively. Needle and syringe programs, supervised consumption sites, drug checking services, and naloxone distribution save lives while connecting people to treatment.
Ensure access to controlled medicines for legitimate medical purposes. Millions suffer unnecessarily from untreated pain because of overly restrictive policies created to prevent misuse.
Address stigma and discrimination that prevent people from seeking help. Language matters—using person-first language (“person with substance use disorder” rather than “addict”) and avoiding criminalization reduce stigma.
Strengthen prevention based on evidence, not fear. Effective prevention addresses risk factors, builds protective factors, and provides young people with skills and opportunities.
Improve data collection to understand the scope of drug use, identify emerging threats, and target interventions where they’re needed most. WHO’s resources for prevention and treatment compile available data.
Sarah, the nurse whose story opened this article, eventually found treatment. It took losing her nursing license, her marriage ending, and nearly dying of an overdose before she accessed an opioid agonist maintenance program.
“The medication stopped the cravings, the counseling helped me understand my addiction, and the program helped me rebuild my life,” Sarah explained. “I’ve been stable for three years now. I’m rebuilding my relationship with my kids. I’m working again—not as a nurse anymore, but as a peer counselor helping others like me.”
She paused. “But I think about all the people who don’t get this chance. Who die because treatment isn’t available or they can’t afford it or they’re too afraid of being arrested to ask for help. We can do better.”
With 296 million people using drugs, 39.5 million affected by drug use disorders, and 600,000 dying annually, we must do better. The evidence is clear, the interventions work, and the human cost of inaction is unbearable.
Frequently Asked Questions (FAQs)
Psychoactive drugs are substances that affect mental processes—perception, consciousness, cognition, mood, and emotions—when taken into one’s system. They belong to a broader category of psychoactive substances including alcohol and nicotine. According to WHO, about 296 million people aged 15-64 used psychoactive drugs in 2021, with approximately 39.5 million people affected by drug use disorders (harmful pattern of drug use or drug dependence). Production, distribution, sale, or non-medical use of many psychoactive drugs is controlled or prohibited by law through international drug conventions: the 1961 Single Convention on Narcotic Drugs (amended 1972), the 1971 Convention on Psychotropic Substances, and the 1988 Convention Against Illicit Traffic. Psychoactive drugs have different degrees of restriction based on health risks and therapeutic usefulness, classified according to schedules at national and international levels.
Drug use without medical supervision carries significant health risks and can lead to drug use disorders. About 600,000 deaths occur annually attributable to drug use (approximately 420,000 male, 160,000 female deaths). More than 36 million years of healthy life (DALYs) were lost to drug use in 2019. According to WHO’s June 2024 report, over 3 million annual deaths result from alcohol and drug use combined. Drug use disorders increase morbidity and mortality risks, trigger substantial suffering, and impair personal, family, social, educational, and occupational functioning. They’re associated with significant societal costs—lost productivity, premature mortality, increased healthcare expenditure, and criminal justice costs. Among 14.8 million people who inject drugs globally, 15.2% live with HIV and 38.8% with hepatitis C. Details at WHO’s drugs health topic page and Global Status Report.
WHO activities address the drug problem across five main dimensions: prevention of drug use and reduction of vulnerability/risks; treatment and care of people with drug use disorders using evidence-based interventions; prevention and management of harms through harm reduction measures (needle/syringe programs, opioid substitution therapy, overdose prevention, HIV/hepatitis services); ensuring access to controlled medicines for legitimate medical purposes while preventing diversion; and monitoring/evaluation through data collection and analysis. UN Sustainable Development Goal 3, Target 3.5 commits governments to strengthen prevention and treatment of substance abuse. The 2016 UNGASS outcome document marked a shift to highlight public health and human rights dimensions. WHO’s Alcohol, Drugs and Addictive Behaviours Unit leads this work. WHO participates in the Commission on Narcotic Drugs and provides recommendations for international control.
In February 2025, WHO updated guidelines on opioid dependence treatment and overdose prevention, strengthening recommendations for opioid agonist maintenance treatment (OAMT) and naloxone distribution. WHO’s October 2025 implementation guidance emphasizes maintaining OAMT as an essential health service even during disruptions like pandemics or conflicts, as this treatment is proven safe and effective in addressing health outcomes, reducing mortality, and preventing HIV/hepatitis transmission. WHO also published a guideline on balanced national controlled medicines policies in July 2025 to ensure medical access and safety, with a rapid communication version released in May 2025. WHO collaborates with UNODC on International Standards for Treatment of Drug Use Disorders and International Standards on Drug Use Prevention. See also WHO’s opioid overdose fact sheet.
Countries should: treat drug use disorders as health conditions requiring treatment and support, not criminal issues; scale up evidence-based treatment including opioid agonist maintenance therapy, which dramatically reduces mortality and disease transmission but remains inaccessible to most who need it; implement comprehensive harm reduction including needle/syringe programs, supervised consumption sites, drug checking services, and naloxone distribution that save lives while connecting people to treatment; ensure access to controlled medicines for legitimate medical purposes by balancing prevention of misuse with treatment of pain and other conditions; address stigma and discrimination through person-first language and avoiding criminalization; strengthen evidence-based prevention addressing risk factors and building protective factors; and improve data collection to understand scope, identify emerging threats, and target interventions. WHO provides resources for prevention and treatment and works to improve prevention and treatment for drug use disorders. WHO’s work on cannabis provides example of evidence-based policy development.
- WHO Drugs (Psychoactive) Health Topic
- Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders
- WHO Guidelines on Opioid Dependence Treatment
- Opioid Agonist Maintenance Treatment Implementation Guidance
- Balanced National Controlled Medicines Policies Guideline
- WHO Opioid Overdose Fact Sheet
- International Standards for Treatment of Drug Use Disorders
- International Standards on Drug Use Prevention
Disclaimer: This article is an adaptation of publicly available information from WHO’s Drugs (psychoactive)
health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the
content or accuracy of this adaptation. This content is for informational and educational purposes
only and does not constitute medical advice. ObserverVoice.com is a news and information platform
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