Temporal trends in the burden of drug use disorders in East and Southeast Asian countries and territories from 1990 to 2021: findings from the Global Burden of Disease Study 2021.

Background: East and Southeast Asia face a severe drug epidemic. A detailed analysis of specific drug use disorders (DUDs) is urgently needed to inform targeted interventions.Objective: To quantify trends in the burden of four DUDs in East and Southeast Asia from 1990 to 2021.Methods: Using Global Burden of Disease Study 2021 data, we analyzed trends (1990-2021) in incidence, prevalence, and DALYs for four DUDs across 20 countries/territories. Estimated annual percentage changes and age-period-cohort models assessed trends and independent effects.Results: Significant disparities were observed. Amphetamine DALYs were higher in East Asia (41-79 per 100,000), while cocaine DALYs peaked in high-income Asia-Pacific (15-16 per 100,000). Amphetamine-related DALYs declined sharply in East Asia (net drift: -3.08%; 95% CI: -3.20 to -2.95, p < .001) but increased in Southeast Asia (0.16%; 0.11 to 0.22, p < .001). Cannabis-related DALYs rose in East Asia (0.27%; 0.2 to 0.35, p < .001). Cocaine-related DALYs fell markedly (-3.81%; -3.95 to -3.68, p < .001). Age effects peaked at 15-34 years.Conclusions: The patterns of drug prevalence and their changing trends in East Asia and Southeast Asia show regional characteristics. The proliferation of amphetamines is becoming increasingly severe in Southeast Asia, while in East Asia, although some success has been achieved in controlling other drugs, risks related to cannabis are continuously rising. Public health strategies must focus on subregional interventions, prioritizing the growing problem of amphetamines in Southeast Asia and the emerging trend of cannabis use among young people.