U.S. Has High Levels of Illegal Drug Use

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In spite of stringent drug policies and punitive laws, the United States also has high levels of lifetime illegal drug use. A 2018 study found that the United States has illicit drug use rates among the highest in the world. Eastern European nations, however, report the highest rates of alcohol consumption.

According to the 2019 National Survey on Drug Use and Health (NSDUH) conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), around 17% of people in the U.S. aged 12 and over used any illicit drug across the year 2019.

Drug Use by Country

Data from the World Health Organization (WHO) looking at the global burden of disease suggest that 10 countries have nearly half the global population of people with a substance use disorder. The following nations had the largest shares of people with a substance use disorder in 2019:

  • United States: 5.89%
  • Greenland: 5.63%
  • Mongolia: 5.24%
  • United Kingdom: 5.22%
  • New Zealand: 4.91%
  • Kazakhstan: 4.66%
  • Poland: 4.51%
  • Russia: 4.44%
  • Brazil: 4.33%
  • Denmark: 4.26%

The 2018 research above found that European countries had the highest rates of heavy episodic alcohol use and daily tobacco use. Cannabis, opioid, and cocaine dependence were most prevalent in the high-income North American region (U.S. and Canada).

The World Health Organization (WHO) reports that cannabis is the most widely used illicit drug in the world, representing half of all drug seizures worldwide. An estimated 147 million people—2.5% of the world's population—use marijuana each year.

Drug Use in the United States

In the United States, the two most commonly used illicit drugs are marijuana and opioids.

  • Marijuana: Marijuana is the most commonly used illegal drug in the U.S. and the second most commonly used psychoactive drug after alcohol. The 2019 NSDUH indicated that more than 12 million young adults (ages 18 to 25) used marijuana in the past year. 
  • Opioids: In 2019, misuse of prescription pain relievers was the second most prevalent form of illicit drug use in the U.S. Findings from the 2019 NSDUH indicated that 3.5% of the U.S. population aged 12 and over misused prescription pain relievers. The CDC has described opioid misuse in the United States as an "epidemic." Of drug-related deaths in the U.S. in 2018, nearly 70% involved the use of opioids. Between 2017 and 2018, however, there was a drop in opioid-related deaths, including declines in deaths attributed to prescription painkillers and to heroin.
  • Cocaine: In the 2019 NSDUH, there were an estimated 97,000 people aged 12 and over in the U.S. who had used cocaine in the past year. Research also indicates that while cocaine use has increased somewhat since 2011, the rate of cocaine-related deaths has risen at a much faster pace. Older adults are especially at risk of cocaine-involved overdose.

Drug Use Patterns

Drug use overall seems to be on the rise. In 2019, the NSDUH survey found that 165.4 million people in the U.S. aged 12 and over had used substances, including tobacco, alcohol, or illicit drugs, in the past month.

NSDUH also indicated that 20.8% of people aged 12 and over—which amounts to over one-fifth of the population—had used an illicit drug in the past year. This represents a notable increase from 2015, which is mainly due to an increase in the use of marijuana.

In 2019, 17.5% of people aged 12 and over reported past-year marijuana use. This was a 4% increase from 2015 prevalence rates. Young adults ages 18 to 25 have the highest prevalence rates (35.4%).

Drug Policies Are Not Enough

Based on the high prevalence of illicit drug use in the United States, it is clear that punitive drug policies are not enough to prevent or reduce drug use. Research suggests that regions with less punitive harm-reduction policies often have lower rates of drug and alcohol abuse than those who take a criminalized "war on drugs" approach.

According to one report on global drug use, "The Netherlands, with a less criminally punitive approach to cannabis use than the United States, has experienced lower levels of use, particularly among younger adults," the report says. "Clearly, by itself, a punitive policy towards possession and use accounts for limited variation in nation-level rates of illegal drug use."

Youth Drug Use Rates

It can also be helpful to look at drug use patterns among kids under the age of 18. The Monitoring the Future Survey collects data students from schools across the U.S. every year. According to the 2019 results of the survey:

  • 11.8% of 8th graders, 28.8% of 10th graders, and 35.7% of 12th graders reported using marijuana in the past year.
  • 16.5% of 8th graders, 30.7% of 10th graders, and 35.3% of 12 graders reported vaping nicotine in the past year.
  • 1.2% of 8th graders, 2.0% of 10th graders, and 1.7% of 12th graders reported misusing Oxycontin within the past year.
  • 14.8% of 8th graders, 31.0% of 10th graders, and 38.0% of 12th graders reported using illicit drugs during the past year. This includes the use of cocaine, methamphetamine, and synthetic cannabinoids.

Shifting Drug Trends

It is important to note that drug use trends are not static. Previous studies indicated that the United States had some of the highest rates of illicit drug use in the world, but some European countries have seen increases in drug use that have overcome U.S. drug rates.

Drug use also changes in terms of who is using these substances and which substances are most frequently used. Opioid use in the United States saw dramatic increases between the years 2000 and 2014, although prevalence rates from 2018 suggest that these numbers appear to be leveling off or declining.

A Word From Verywell

Understanding drug use patterns in the U.S. and throughout the world can help policymakers develop strategies to respond to illicit drug use. It can also inform the development of community-based programs designed to reduce drug use. The overall goal is to help reduce the heavy individual and societal costs associated with illicit drug use.

10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Peacock A, Leung J, Larney S, et al. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018;113(10):1905-1926. doi:10.1111/add.14234

  2. SAMHSA. Table 1.1A - Types of illicit drug use in lifetime, past year, and past month among persons aged 12 or older: numbers in thousands, 2018 and 2019. 2019 National Survey of Drug Use and Health (NSDUH) Releases.

  3. Global Burden of Disease Collaborative Network. GBD Compare Data Tool.

  4. World Health Organization. Cannabis.

  5. National Institute on Drug Abuse. What is the scope of marijuana use in the United States?.

  6. CDC. Understanding the epidemic.

  7. Cano M, Oh S, Salas-Wright CP, Vaughn MG. Cocaine use and overdose mortality in the United States: Evidence from two national data sources, 2002–2018. Drug Alcohol Depend. 2020;214(1):108148. doi:10.1016/j.drugalcdep.2020.108148

  8. Mehrolhassani MH, Yazdi-Feyzabadi V, Hajebi A, Mirzaei S. Cross-country comparison of treatment policies facing the drug abuse in five selected countries. Addict Health. 2019;11(2):81-92. doi:10.22122/ahj.v11i2.233

  9. Degenhardt L, Chiu WT, Sampson N, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health SurveysPLoS Med. 2008;5(7):e141. doi:10.1371/journal.pmed.0050141

  10. National Institute on Drug Abuse. Monitoring the Future Survey: Trends in prevalence of various drugs.

Additional Reading

By Buddy T
Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.