Several drugs have surged in use since 2008, but the most dramatic increase belongs to fentanyl and other synthetic opioids. Deaths involving these substances rose from 0.8 per 100,000 people in 2008 to a peak of 22.7 per 100,000 in 2022, a nearly 30-fold increase. Fentanyl isn’t the only drug with a sharp upward trajectory over this period, though. Methamphetamine, cannabis, gabapentin, and ADHD medications have all seen significant growth driven by very different forces.
Fentanyl and Synthetic Opioids
Synthetic opioids other than methadone, a category dominated by illicitly manufactured fentanyl, have seen the steepest rise of any drug class since 2008. That year, 2,306 people in the United States died from overdoses involving these drugs. By 2022, that number had climbed to 73,838. The increase wasn’t gradual. Overdose deaths held relatively steady between 2008 and 2013, hovering around 0.8 to 1.0 deaths per 100,000 people. Then the curve turned sharply upward.
Between 2013 and 2016, the death rate jumped sixfold, from 1.0 to 6.2 per 100,000. It nearly doubled again by 2018, and then the COVID-19 pandemic accelerated things further. Deaths spiked from 36,359 in 2019 to 56,516 in 2020 and peaked at 73,838 in 2022. The first modest decline came in 2023, when deaths dipped slightly to 72,776. This rise was driven not by doctors prescribing more fentanyl but by illicit manufacturing. Fentanyl is cheap to produce, extraordinarily potent (roughly 50 to 100 times stronger than morphine by weight), and has increasingly been mixed into counterfeit pills and other street drugs.
Methamphetamine’s Geographic Spread
Methamphetamine use has also climbed sharply since 2008, though its trajectory looks different from fentanyl’s. Hospital admissions involving methamphetamine use alongside mental health disorders increased 10.5-fold between 2008 and 2020. What changed wasn’t just how many people used it but where. Methamphetamine was historically concentrated in western states, but over this period it spread rapidly into the South and Midwest.
This geographic expansion happened because the supply chain shifted. After federal laws cracked down on domestic meth production by restricting access to key ingredients, large-scale manufacturing moved to Mexico. The resulting product was cheaper, more pure, and more widely distributed than the small-batch meth previously cooked in domestic labs. The combination of higher purity and lower price opened new markets across the country.
Cannabis: Daily Use Has Doubled
Cannabis use has grown steadily since 2008, fueled in large part by the wave of state-level legalization that began in 2012. The most striking trend isn’t occasional use but daily or near-daily consumption, defined as using on 20 or more days per month.
Among young adults aged 19 to 30, daily or near-daily cannabis use rose from 5.9% in 2013 to 10.4% in 2023. Among adults aged 35 to 50, the increase was even steeper in relative terms: from 2.8% to 7.5% over the same decade, roughly a 168% jump. By 2023, daily cannabis use among young adults had surpassed daily alcohol use (10.4% versus 3.6%), a reversal from 2013 when the two were roughly equal. Among 35- to 50-year-olds, daily cannabis use had nearly caught up to daily drinking.
Gabapentin’s Quiet Rise
Gabapentin, a nerve pain medication, doesn’t get the same headlines as fentanyl or meth, but its growth since 2008 has been remarkable. The proportion of the U.S. population taking a gabapentinoid rose from 1.2% in 2002 to 4.0% in 2015 and continued climbing to 4.7% by 2021. Nearly all of this growth came from gabapentin specifically, not its cousin pregabalin, which stopped increasing after 2008.
The majority of gabapentin prescriptions are for off-label uses, meaning conditions the drug was never formally approved to treat. Chronic pain is the most common reason, and the timing of gabapentin’s rise isn’t coincidental. As doctors faced increasing pressure to reduce opioid prescribing after 2012, many turned to gabapentin as an alternative for pain management. The evidence supporting this substitution is limited, and several states have since added gabapentin to their prescription monitoring programs due to concerns about misuse, particularly when combined with opioids.
ADHD Medications in Adults
Prescriptions for ADHD stimulants like methylphenidate and amphetamine-based medications have grown substantially since 2008, especially among adults. In the U.S., the prevalence of ADHD medication use among adults aged 18 to 64 roughly doubled between 2008 and 2012 alone, rising from about 2.4 per 1,000 men and 1.8 per 1,000 women to 5.3 and 4.4 per 1,000 respectively. International data shows this trend continued and accelerated. In the UK, adult ADHD prescriptions increased 30-fold among men and 15-fold among women between 2000 and 2018.
Several factors converged to drive this growth. Greater awareness of ADHD as a condition that persists into adulthood led more people to seek diagnosis. The expansion of telehealth during the COVID-19 pandemic made it easier to get evaluated and prescribed stimulants without an in-person visit, further accelerating a trend that was already well underway. The rise in prescriptions for women has been particularly sharp, reflecting growing recognition that ADHD in women was historically underdiagnosed.
Why So Many Drugs Rose at Once
The fact that multiple substances surged simultaneously since 2008 isn’t a coincidence. Each drug occupies a different niche, but several common forces are at work. The opioid prescribing crackdown that began around 2012 didn’t eliminate pain or addiction. It redirected both: patients with chronic pain shifted toward gabapentin, while people with opioid dependence increasingly encountered illicit fentanyl. Meanwhile, shifting cultural attitudes toward cannabis and ADHD, combined with policy changes like state legalization and relaxed telehealth rules, lowered barriers to access for those substances.
The COVID-19 pandemic acted as an accelerant across nearly every category. Synthetic opioid deaths jumped 55% between 2019 and 2020 alone. Daily cannabis use climbed. Telehealth visits made it simpler to obtain prescriptions for stimulants and other controlled substances without the friction of an office visit. Isolation, economic stress, and disrupted routines created conditions where both recreational drug use and prescription-seeking behavior increased in parallel.