Drug use disorders have become a major global public health challenge, threatening people's health, increasing the disease burden and hindering economic development and social progress. As the burden of disease varies among different drugs, preventing and controlling them has become a major concern for all sectors of society.

To analyse the trend in the disease burden of drug use disorders in China between 1990 and 2021. This includes calculating the age-standardised incidence and DALY rates of drug use disorders and their five subcategories, and making predictions about the incidence and DALY rates from 2022 to 2046. These findings will provide a scientific basis for policy formulation and intervention implementation.

Data from the Global Burden of Diseases 2021 (GBD 2021) database was extracted, including age-standardised incidence rates, disability-adjusted life years (DALY) rates for drug use disorders and five subcategories from 1990 to 2021 (Opioid use disorders, Cannabis use disorders, Cocaine use disorders, Amphetamine use disorders and Other drug use disorders). Joinpoint regression models were used to analyse the age-standardised incidence rates and the annual percent change(APC) and average annual percent change(AAPC) in DALY rates. Bayesian age-period-cohort prediction models were used to predict trends in age-standardised incidence and DALY rates from 2022 to 2046.

Joinpoint regression analysis revealed an overall downward trend in the age-standardised incidence and DALY rates of drug use disorders in the Chinese population from 1990 to 2021 (AAPC values of -0.76% and -2.75%, respectively, both P<0.05). The age-standardised incidence and DALY rates of drug use disorders showed an overall downward trend for both males and females (AAPC values of -0.69% and -2.50% for males, and -0.85% and -3.09% for females, respectively; both P<0.05). Among the five subcategories of drug use disorders nationwide, the age-standardised incidence and DALY rates of cannabis use disorders showed an overall increasing trend (AAPC=0.66%, 0.71%, respectively; both P<0.05). The age-standardised incidence and DALY rates of the remaining four subcategories showed an overall decreasing trend (Opioids: AAPC=-1.97%, -3.41%; Amphetamines: AAPC=-1.50%, -1.66%; Cocaine: AAPC=-0.66%, -2.12%; Other: AAPC=-0.64%, -3.83%; all P<0.05). The Bayesian age-period-cohort prediction models predicted that from 2022 to 2046, the incidence and DALY rates of drug use disorders in both male and female populations in China would increase. The projected increase in incidence was approximately 50.80% for males and 24.27% for females, with a higher increase in males than females. The projected increase in DALY rates was approximately 48.34% for males and 41.46% for females, with a higher increase in males than females.

From 1990 to 2021, the disease burden of drug use disorders in China decreased, with males bearing a higher burden than females. With the exception of Cannabis use disorders, the remaining four subcategories of drug use disorders showed an overall downward trend. The burden due to Opioid use disorders was the most severe. However, it is projected that, from 2022 to 2046, age-standardised incidence and DALY rates will increase.