Illicit drug use is a major cause of preventable mortality and is associated with many acute and long-term conditions – including cardiovascular and respiratory diseases, neurological and mental health disorders, infectious diseases such as hepatitis C and HIV – as well as heightened risk of overdose. These risks are especially pronounced when the drugs are consumed regularly and/or in large quantities. In 2021, drug use was responsible for 5.1% of deaths caused by non-communicable diseases before the age of 70 across OECD countries (IHME, 2025[1]). Cannabis, opioids and cocaine are among the most used drugs. Over the past decade, notable increases in cocaine use have been observed, largely driven by trends in North America, South America and Europe (UNODC, 2025[2]).
In 2023, around 9% of people aged 15‑64 years had used an illicit drug in the last year, mainly driven by cannabis use. The highest rates were found in Australia, where nearly 18% of people aged 15‑64 had used an illicit drug in the last year, and the United States, where the rate was 25% (Figure 4.4). In nearly all countries, illicit drug use is higher among men than women. In 12 out of 25 countries, this difference exceeded 5 p.p.
Cocaine use in the last year was reported by 1.3% of people aged 15‑64 across OECD countries (Figure 4.5). The proportions were highest in Australia, Canada, France and the Netherlands (2.7% or above). Men were more likely to use cocaine than women in all countries except Israel and Japan, and on average across 33 OECD countries, 2% of men had used cocaine in the past year compared to less than 1% of women.
The misuse of opioids – a narcotic pain medication used for treating moderate to severe pain – has become an increasingly serious public health concern in recent years. Illicit opioid use can lead to addiction, and is responsible for many deaths by drug overdose – notably in countries that have been hit by the opioid crisis, including the United States and Canada. In 2022, opioid use disorders were responsible for nearly 74 000 deaths across OECD countries (IHME, 2025[1]).
In 2023, illicit opioid use during the past year was reported by 0.7% of people aged 15‑64 in 35 OECD countries (Figure 4.6). This proportion was lowest in Türkiye and Israel (below 0.1%). Conversely, rates exceeded 2% in Australia and Sweden, and reached 3.6% in the United States. In accession/partner countries, rates were high in India (2.1%) and below 0.5% in Indonesia, Romania and Croatia. There is no consistent gender pattern in countries with available data.
Global efforts to prevent and reduce illicit drug use have involved a combination of strategies including law enforcement and regulation, prevention efforts such as public education campaigns, harm reduction strategies, and improving access to treatment and recovery services. Countries have adopted harm reduction strategies – such as drug checking, supervised consumption sites, and needle and syringe programmes – to mitigate the risk of overdose and infectious diseases due to injecting drugs (e.g. HIV and hepatitis C). To reduce deaths from overdose, take‑home naloxone programmes (providing an opioid antagonist capable of temporarily reversing the effects of an opioid overdose) are implemented in countries including Australia, Canada, Croatia, Finland and the United States.
