April 27, 2023

What does the rest of 2023 hold for substance abuse and overdoses? Demographic information for 2022 is still relatively sparse. Still, the trends from 2018 to 2021 tell a story of a country fighting a costly battle against opioids, only exasperated by mental health stigmas and the limited availability of recovery and rehabilitation programs.

And while the leading drug use demographics haven’t changed in terms of specific groups or statuses during this reported time, the numbers in each group have. These numbers will impact both the criminal and rehabilitative response of the judicial system, especially with trends pointing towards even more complex issues over the next five years.

Drug Use Statistics by Substance

In 2021, the most reported illicit substance in all age groups was marijuana. In fact, 43% of the total population has used marijuana at least once by the age of 12, according to the National Institutes for Health.

But while marijuana was the most reported illicit substance by use, it was by no means the most threatening substance in terms of misuse, addiction, overdose, or risk of death.

Synthetic Opioids

More than any other drug group, synthetic opioids—primarily fentanyl—are at the root of the highest death rates in the U.S. as of 2021. Even with some decreases in misuse reports between 2020 and 2021, the death rates climb exponentially each year.

Fentanyl-laced vapes are trending. See how PharmChek® helps agencies address this growing concern.


Methamphetamine and other psychostimulants have been the second most deadly category since 2019, following synthetic opioids. And now, with the ubiquity of p2p meth (also known as super meth), this drug type is even more dangerous because of its increased purity and lower cost.

After meth, cocaine is responsible for the next highest death rate, accounting for more than 24,000 deaths in 2021.

These three, however, are the only three substance categories that demonstrate increases in death rates since 2017.

Prescription Drugs

Prescription drug misuse still accounts for some of the highest drug-involved death rates, but these rates seem to be leveling off (see Fig. 2 on the linked page), with some speculating that they may even start to decrease. Focused education on prescription drug misuse, its consequences, and proper disposal methods have helped decrease the impact of prescription medications on substance use disorder and overdose death rates.

Heroin, Benzodiazepines, and Antidepressants

These three categories show signs of decline, with heroin death rates specifically decreasing (from more than 15,000 deaths in 2017 to just over 9,000 in 2021; see Fig. 5).

Drug Use Demographics by Ethnic Group and Sex, 2018-2021

Since 2018, the rate of illicit substance use disorders (SUDs) has more than doubled (from 19.3M in 2018 to 40.3M in 2021). The most significant increase occurred from 2019 to 2020, which is no coincidence. With the 2020 pandemic and lockdowns came dramatic increases in reports of mental health issues and increased reports of drug and alcohol use. While almost every demographic experienced a rise in drug use, a few saw more significant impacts than others.

The Largest Drug Use Demographic: Men

Males comprise approximately 70.2% of drug-involved overdose deaths in 2020 and 2021. And in 2021, 9.8% of U.S. males were diagnosed with a substance use disorder, compared to only 3.7% in 2018. The death rate per 100,000 was 48.2 in 2021.

American Indians and native Alaskans showed the most dramatic increase in SUDs per capita from 2018 to 2021

Impact on American Indians and Native Alaskans

While representing a small percentage of the population, American Indians and native Alaskans showed the most dramatic increase in SUDs per capita from 2018 to 2021. According to SAMHSA’s National State of Drug Use and Health (NSDUH) survey, the death rates for these groups in 2018, for example, were within a percentage point of most other ethnic demographics. By 2021, the 4% rate had increased to 27.6%.

Other Ethnic Groups

Black and White Americans of Non-Hispanic descent reported 17.2% and 17%, respectively. People of Hispanic or Latino origin also saw similar increases, from 3% in 2018 to 15% in 2021. Asian Americans remained the most stable, although they saw an increase of more than 6% for reported substance use disorders.

Non-Ethnic Groups with Higher Risk

Through these surveys and studies, other non-ethnic groups demonstrate higher substance use, abuse, and overdose risks than the general population. Veterans are deeply affected by substance use disorders, as is the LGBTQ+ community. In both cases, per-capita SUD and overdose deaths are higher than the general public.

Drug Use Demographics by Age, Socioeconomic Status, and Education

Beyond ethnicity, drug use demographics from 2018 to 2021 show several social and economic risk factors.

Age-Related Trends

Throughout the 4-year period, people aged 35 to 44 were the most likely to report SUDs and overdose deaths. Drug use, however, was most prevalent in ages 18 to 25. Adolescents saw some decreases in specific substance use, but overall use, misuse, and SUDs increased throughout all age groups.

SUDs and Poverty

Higher poverty correlated with higher rates of SUDs and deaths, specifically as respondents were well under the poverty line. And this connection to poverty also plays into other categories, including employment and education status.

Employment Status

Alongside poverty level, employment status correlates with drug use trends. Those in full- and part-time employment have far lower rates of substance use. Meanwhile, unemployed individuals observed a much higher rate of drug use.

Additionally, those in non-paid positions (workers compensated for duties by means other than money, including services, housing, and care) and construction workers show the highest levels of drug overdose deaths nationwide as of 2021.

The Correlation to Education

Likewise, an individual’s education level had clear connections to the rate of misuse and overdose. College graduates were least likely to have a SUD or experience death from overdose, while those without a high school diploma had the highest likelihood.

Compounding Risk Factors for Substance Use Disorders

An emerging trend in drug use demographics is the connection to risk factors outside of ethnic, educational, and socioeconomic status. Three critical risks in substance use and drug-involved death create rapidly compounding conditions. And these conditions are most often created by co-occurring disorders (having a co-existing mental illness and substance use disorder).

Polysubstance Use

Single-substance use is commonplace, but statistics show that people are increasingly likely to misuse more than one substance in many cases. Most polysubstance use includes alcohol or marijuana in conjunction with stronger illicit drugs. But when stimulants and opioids are used simultaneously, the likelihood of overdose death increases quickly (see Fig. 6).

Mental Health

Co-Occurring mental health diagnoses and substance use disorders accounted for 7.6% of the total population over 18 years of age in 2019 (just short of 400,000 individuals; see the 2019 NSDUH report summary, slide 53). But in 2021, that same cross-section increased to 935,000 (see below).

In more at-risk populations, including veterans and the LGBTQ+ community, the rates of both SUD and major depressive episodes increase even more, often twice that of non-veteran and heterosexual rates.

Relapse Risks

A significant risk factor for drug-involved overdose deaths is relapse after recovery. While rehabilitation patients account for some of the statistics, the most at-risk group is individuals recently released from prison that had a previous SUD. With a decreased tolerance for substance use after abstinence during incarceration, many of these individuals return to their former substance use patterns with deadly consequences. This is evidenced in higher recidivism rates for SUDs for reentry into the community where treatment is absent a testing modality or when testing is absent a treatment program. The two must be tethered for better outcomes.

Responses to Changes in Drug Use Demographics

There is a clear need for better responses to drug use disorders, specifically when addressing synthetic opioid use. In many cases, these disorders are paired with compounding issues like socioeconomic status, mental health issues, or other drug use. What has worked in the past for most other substances does not work in the same way for opioids like fentanyl, as indicated by the exponential increase in overdoses and deaths.

Between cost and availability, inpatient recovery programs are not prepared to meet the demand of the opioid crisis.

Increased Access to Inpatient Recovery Programs

The vast majority of people diagnosed with a SUD do not receive adequate treatment for their diagnosis. In 2017, for example, less than 20% of people who needed treatment actually received it. And according to the 2021 NSDUH survey, 2,511,000 people received treatment for illicit drug use (Table 5.11A), compared to 24,000,000 people diagnosed with a SUD during the same period (Table 5.2A).

Between cost and availability, inpatient recovery programs are not prepared to meet the demand of the opioid crisis.

Availability of Mental Health Treatment and Therapy

Co-occurring disorders of both mental illness and substance use dramatically increase the risk of overdose and death. And until better mental health access and coverage are widely available, we will most likely continue to see increased death rates of these coinciding issues.

Better Interventions for Polysubstance Use Risks

According to statistics collected by NIDA, when opioids and another substance are used simultaneously, death rates increase dramatically compared to single-substance use without opioids. In some cases, the rates nearly tripled (Figures 6 and 7). Polysubstance use represents a critical risk factor for drug overdose and death.

Drug Use Detection and Accountability

Better substance detection and monitoring for at-risk individuals will be a key component of modern interventions, whether voluntary or court-ordered. The immediate and emergent risk of overdose from opioid use makes it clear that it is less a matter of if a user will overdose but a matter of when. Without comprehensive monitoring, people with substance use disorders are seriously disadvantaged by the potency of modern synthetic opioids.

The PharmChek® Sweat Patch: A Next-Generation Intervention Tool

The pressing need for better detection and monitoring requires a comprehensive testing tool that collects samples continuously for extended periods. The PharmChek® Sweat Patch does precisely that.

With up to 10 days of continuous sample collection (or up to 14 days when paired with the PharmChek® Overlay), a nearly tamper-proof design, and forensically defensible results, the Sweat Patch offers a reliable method to provide accountability for behavioral modification therapy, court-required monitoring, and rehabilitation and recovery abstinence support.

Learn how the PharmChek® Drugs of Abuse Sweat Patch is poised to meet the demands of the growing opioid crisis here.