Trend analysis and future projections of global burden of opioid use disorder (OUD) from 1990 to 2030

Objectives: Opioid Use Disorder (OUD) is a chronic medical crisis which represents significant public health challenge on global scale. We aim to provide long-term trends and future projections of OUD for effective intervention. Methods: This study utilized data from the Global Burden of Disease (GBD) study 2021 for analysis. OUD burden was assessed using absolute numbers and age-standardized rates of incidence (ASIR), prevalence (ASPR), disability-adjusted life years (ASDR), and mortality (ASMR) per 100,000 population, with 95% uncertainty intervals (UIs). Temporal trends were analyzed using joinpoint regression. Age-period-cohort (APC) models were applied to assess the independent effects of age, time period, and birth cohort on OUD burden. Decomposition analysis quantified the relative contributions of population growth, aging, and epidemiological changes to the overall burden variation. Finally, autoregressive integrated moving average (ARIMA) models were used to forecast OUD burden through 2030. Results: In 2021, an estimated 1.94 million new cases and 16.16 million prevalent cases of OUD were recorded globally, resulting in 11.22 million DALYs and nearly 99,556 deaths. The number of incidence, prevalence, DALYs and mortality of OUD all showed substantial increases. The age-standardized rates also increased but the margins were relatively small. The highest levels and fastest growth were observed in high-SDI regions, particularly North America. Males consistently exhibited higher DALY and mortality rates than females. The burden was greatest among individuals aged 15-49 years. Joinpoint analysis revealed fluctuating trends with notable increases after 2010. APC analysis showed peak incidence at ages 20-25 and declining risk in later birth cohorts. Decomposition analysis indicated that population growth and epidemiological changes were the main contributors to the rising burden. ARIMA forecasting predicted continued increases in incidence and DALYs but slight declines in prevalence and mortality by 2030. Conclusion: The global burden of opioid use disorder (OUD) has continued to rise since 1990, mainly driven by population growth and epidemiological changes. Although age-standardized rates have remained stable or increased slightly, regional disparities persist, with the highest burden in high-SDI areas. Forecasts suggest modest increases in incidence and DALYs by 2030, underscoring the need for sustained, adaptive policies and preventive strategies to mitigate the evolving opioid crisis.