Nearly half a million people died from drug use in 2023, 29% more than a decade earlier; opioids cause most of these deaths, and although naloxone and opioid agonist treatment are well proven, only about one in 12 people with drug use disorders is in treatment.
Written from the sources listed below, not independently peer-reviewed.
Worldwide, about how many out of every 12 people with drug use disorders are in treatment?
Nearly 500,000
People who died from drug use
UNODC estimate for 2023, 29% more than a decade earlier. Includes indirect deaths such as those from hepatitis C and HIV, not only overdoses.
Data year 2023. Source: United Nations Office on Drugs and Crime, 2026
About 125,000
Deaths from opioid overdose
WHO's most recent global estimate, for 2019. Close to 80% of the roughly 600,000 deaths WHO attributed to drug use that year were related to opioids.
Data year 2019. Source: World Health Organization, 2025
1 in 12
People with drug use disorders in treatment
UNODC estimate published in the World Drug Report 2026. Women are much less likely to be treated (1 in 23) than men (1 in 9).
Data year 2024. Source: United Nations Office on Drugs and Crime, 2026
Unit: countries
Counts of countries where at least one programme operates, from Harm Reduction International's survey; a single programme may reach only a small part of a country's population. For comparison, injecting drug use has been documented in 190 countries and territories.
SDG target 3.5 calls on countries to strengthen the prevention and treatment of substance use by 2030. UNODC finds that deaths from drug use reached nearly half a million in 2023, 29% more than a decade earlier, while drug use grew by about a third over the same period. Treatment coverage, the official indicator for the target, remains very low, and the world is not on track.
Women with drug use disorders are far less likely to get treatment than men: about one in 23 women is in treatment, compared with one in nine men.
Source: United Nations Office on Drugs and Crime, 2026Access to opioid agonist treatment depends heavily on where people live: Western Europe has almost 70 people in treatment for every 100 people who inject drugs, North America about 21%, and Central Asia, Eastern Europe and large parts of sub-Saharan Africa fewer than 2%.
Source: Harm Reduction International, 2024Injecting drug use has been documented in 190 countries and territories, but in 97 of them people who inject drugs cannot reach a needle and syringe programme anywhere in the country.
Source: Harm Reduction International, 2024WHO lists men, older people and people with low socio-economic status as being at higher risk of opioid overdose, along with people who resume use after a period of abstinence, who inject, or who also use alcohol or sedatives.
Source: World Health Organization, 2025Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
LowDeaths from drug use rose by 29% over the decade to 2023, reaching nearly half a million. Falls in fentanyl deaths in the United States and Canada in 2024 are an important exception, not yet a global turn.
How mature and validated are the available solutions?
HighNaloxone, opioid agonist treatment and needle and syringe programmes are well established; WHO describes opioid agonist maintenance treatment as having the strongest evidence of effectiveness and cost-effectiveness for opioid dependence.
How widely are effective solutions actually used?
LowFewer than 10% of people who need treatment for opioid dependence receive it, and only half of countries provide access to effective treatment options.
Global figures are modelled from incomplete national death and toxicology data. WHO's latest overdose estimate is for 2019 and UNODC's for 2023, and the two use different scopes, so their totals cannot be compared directly.
UNODC reports that the total number of drug-related deaths kept rising in 2023, driven by deaths from drug use disorders, mainly overdoses, and from hepatitis C, while HIV-related deaths have fallen. Recent declines in fentanyl deaths in North America have not yet changed the global picture.
UNODC estimates that nearly half a million people died from drug use in 2023, 29% more than a decade earlier, while the number of people who used drugs in the past year rose by about a third over the same period to an estimated 331 million in 2024. About two thirds of drug-related deaths come from indirect causes, mainly infections such as hepatitis C and HIV, and the rest from direct causes, above all overdose. Opioids dominate the toll: WHO's most recent estimate attributes close to 80% of drug-related deaths in 2019 to opioids and puts deaths from opioid overdose alone at about 125,000 that year.
Most of these deaths are preventable. Naloxone can reverse an opioid overdose if it is given in time, and opioid agonist treatment is the approach with the strongest evidence for treating opioid dependence. Yet fewer than 10% of people who need such treatment receive it, naloxone is hard to obtain in many countries, even in medical settings, and services to prevent infections reach a small share of people who inject drugs in most regions. Risk is highest for people who start using opioids again after a period of abstinence, for people who inject, and for those who also use alcohol or sedatives, and a changing drug supply with potent synthetic opioids such as nitazenes is adding new risks.
There is no single global register of overdose deaths. UNODC and WHO publish modelled estimates built from national death records, toxicology reports and surveys, and they differ in year and scope. The main measures are:
Direct and indirect drug-related deaths
Direct deaths are those caused by drug use itself, mainly overdose. Indirect deaths are caused by conditions linked to drug use, such as liver disease from hepatitis C or HIV acquired through shared injecting equipment. UNODC counts both and finds that indirect causes make up about two thirds of the total.
Opioid overdose deaths
WHO estimates deaths caused directly by opioid overdose separately. In 2019 these were about a quarter of all opioid-related deaths.
Treatment coverage (SDG indicator 3.5.1)
The official indicator for SDG target 3.5 measures how many people with drug use disorders receive treatment. UNODC reports it in its annual World Drug Report.
Availability of harm reduction services
Harm Reduction International counts the countries with at least one needle and syringe programme, opioid agonist treatment programme, naloxone programme or supervised consumption site. A single programme can serve only part of a country, so these counts say little about how many people are actually reached.
What works
Naloxone reverses the effects of an opioid overdose if given in time, and WHO recommends making it available, with training, to people who are likely to witness one, such as friends and family. In a 2019–2020 WHO-supported study in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine, about 40,000 naloxone kits were distributed; around 90% of participants who witnessed an overdose used naloxone, and in almost all recorded cases the person survived.
Limits
Many countries still have limited naloxone even in hospitals and clinics, and it only works if someone is present who has it and knows how to use it.
What works
Long-term treatment with methadone or buprenorphine, combined with psychosocial support, has the strongest evidence of effectiveness and cost-effectiveness for opioid dependence.
Limits
Fewer than 10% of people worldwide who need this treatment receive it, and only half of countries offer effective treatment options for opioid dependence.
What works
Providing sterile injecting equipment prevents HIV and hepatitis C, which cause many of the indirect deaths linked to drug use. In 2024, 93 countries had at least one programme.
Limits
Injecting drug use has been documented in 190 countries and territories, so people in 97 of them cannot reach any programme, and only Oceania reaches high coverage.
What works
Staff can respond immediately when an overdose happens. Insite in Vancouver has recorded no overdose deaths on its premises and has reversed almost 12,000 overdoses.
Limits
Only 18 countries had legal, operating sites in 2024, and each site serves only its immediate area.
What works
Reducing inappropriate prescribing and monitoring how opioids are prescribed and dispensed lowers the number of people exposed to high doses of prescription opioids.
Limits
Rules must be balanced against the need for pain relief: WHO also issues guidance to ensure that people in pain and in palliative care can get opioid medicines.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
Australia, Canada, Italy, Ukraine and the United Kingdom have made naloxone available over the counter, so it can be bought without seeing a doctor. How much this raises the share of overdoses where naloxone is at hand still needs to be measured.
Programmes in which people who use drugs hand out naloxone to their peers are spreading slowly: Nigeria has started one, and India has piloted take-home naloxone for community distribution. Worldwide, peer distribution operated in 24 countries in 2025.
UNODC's Early Warning Advisory collects reports of new substances and toxicity cases so that health services can react to threats such as nitazenes, of which at least 34 types have been identified in 37 countries. In 2024, 160 nitazene-related toxicity cases were reported to it.
A few countries, six in 2025, make prescribed stimulants available as a harm reduction measure for people who use stimulants such as methamphetamine. The approach remains rare, and evidence on its effects is still limited.
Implementation gap
Only about one in 12 people with drug use disorders is in treatment, and among women only one in 23.
Implementation gap
Take-home naloxone was available in only 35 countries in 2025, and peer distribution programmes operated in 24.
Coordination gap
Low- and middle-income countries received USD 151 million for harm reduction in 2022, just 6% of the estimated USD 2.7 billion needed each year by 2025, and only 0.7% of HIV funding went to harm reduction.
Coordination gap
In 2025, 112 countries referred supportively to harm reduction in national policy, but funding cuts that year widened the gap, and almost 92% of people surveyed considered harm reduction to be under threat.
Implementation gap
Opioid agonist treatment was available in at least one prison in 61 countries in 2025, and needle and syringe programmes in prisons in only 11, even though restarting opioid use after a period of abstinence carries a high risk of overdose.
Knowledge gap
Potent synthetic opioids are reaching new markets: in the United Kingdom, nitazenes were linked to about 750 overdose deaths between June 2023 and August 2025, and in Canada 68% of opioid overdose deaths in 2024 also involved a stimulant.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
Most global estimates rely on countries with good death registration and toxicology testing. How can overdose deaths be measured reliably in low- and middle-income countries, where few deaths are tested for drugs?
Are current naloxone practices and early warning systems enough when potent synthetic opioids and stimulants are increasingly combined, and which responses reduce deaths fastest when a new substance appears?
Which channels, such as pharmacies without prescription, peer networks, prisons on release or emergency departments, put naloxone in the hands of people most likely to witness an overdose, especially in countries with few services?
What keeps women with drug use disorders out of treatment, such as stigma, childcare or fear of losing custody, and which service designs close the gap?
Find out from a local health service or harm reduction organisation how to recognise an opioid overdose, when to call emergency services and, where naloxone is available, how to get it and how it is used.
Use person-first language such as "people who use drugs" and treat drug use as a health issue. Stigma keeps people from asking for help or using services that could save their lives.
Take opioid medicines only as prescribed, store them out of reach of others, and return leftover medicine to a pharmacy or take-back scheme.
Volunteer with or donate to a treatment or harm reduction service in your area, or speak up for funding when your community or government debates it.
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United Nations Office on Drugs and Crime (June 2026), published 2026
Highlights booklet of the World Drug Report 2026 (report page: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2026.html), copy held by the Irish Health Research Board's National Drugs Library. Source of drug deaths in 2023 and their 10-year rise, drug use in 2024, fentanyl death declines in North America, stimulant co-involvement in Canada and the nitazene figures.
United Nations Office on Drugs and Crime (June 2026), published 2026
UNODC's summary of the report's main findings. Source of the one in 12 treatment figure and the gap between women (one in 23) and men (one in nine).
United Nations Office on Drugs and Crime (June 2026), published 2026
Online data segment of the World Drug Report 2026. Source of the share of drug-related deaths from indirect causes (about two thirds), the rising trend in total deaths and in deaths from drug use disorders and hepatitis C, and the reference to SDG indicator 3.5.1.
World Health Organization (29 August 2025), published 2025
WHO's summary of opioid overdose and its prevention. Source of drug-attributable and opioid overdose deaths in 2019, risk factors, naloxone recommendations, over-the-counter naloxone countries, the S-O-S study and the treatment gap for opioid dependence.
Harm Reduction International (2024), published 2024
Ninth edition of the global survey of harm reduction services. Source of countries with needle and syringe programmes, opioid agonist treatment (2022 and 2024) and drug consumption rooms, regional treatment coverage among people who inject drugs, Insite, and harm reduction funding in 2022.
Harm Reduction International (2025), published 2025
Update based on a September 2025 survey. Source of the 2025 counts of countries with take-home naloxone, peer naloxone distribution, stimulant prescription and prison services, supportive national policies, new programmes in Nigeria and India, and the funding situation in 2025.
DO GOOD International (2026). Preventing Drug Overdose Deaths. Global Challenges. Updated October 15, 2026. https://www.dogood.world/challenges/drug-overdose
For figures, please cite the original sources listed above.