About 73.6 million Americans aged 12 or older used an illicit drug in the past year, according to the 2024 National Survey on Drug Use and Health. That’s 25.5% of the population in that age range, up from 22.2% (62 million people) in 2021. When you expand the definition to include alcohol, tobacco, and nicotine vaping, the number jumps dramatically: 168 million people, or 58.3% of Americans aged 12 and older, used at least one of these substances in the past month.
What Counts as “Illicit Drug Use”
The federal government’s annual drug use survey, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), defines illicit drug use broadly. It includes marijuana, cocaine, heroin, methamphetamine, hallucinogens, and the misuse of prescription medications like opioid painkillers, stimulants, and sedatives. “Misuse” means taking a prescription drug in a way other than how it was prescribed, whether at a higher dose, more frequently, or without a prescription at all.
Cannabis drives the bulk of the illicit drug use figure. In states where marijuana is legal, it still counts as “illicit” in the federal survey because it remains a controlled substance under federal law. This is worth keeping in mind when interpreting the 73.6 million number. Many of those individuals are using marijuana legally under their state’s rules.
Not All Use Becomes a Disorder
There’s a meaningful gap between using a substance and developing a problem with it. In 2024, 48.4 million people aged 12 or older met the diagnostic criteria for a substance use disorder. That’s 16.8% of the population in that age group. A substance use disorder means a person’s drug or alcohol use causes significant distress or impairment in their daily life, ranging from mild to severe.
That 48.4 million breaks down further. About 27.9 million had an alcohol use disorder, and 28.2 million had a drug use disorder. Those numbers overlap: 7.7 million people had both. So while roughly one in four Americans used an illicit drug in the past year, closer to one in six developed a clinical problem with drugs, alcohol, or both.
Prescription Stimulant Misuse
About 3.9 million Americans aged 12 and older misused prescription stimulants in 2023, roughly 1.4% of the population. Most of this misuse involves amphetamine-based medications rather than other types. Among young adults aged 19 to 30, the rate was higher at 3.7%, though this actually represents a steep drop from 7.8% the year before.
Some people who misuse prescription stimulants also use other drugs. An estimated 786,000 Americans misused both cocaine and prescription stimulants in the same year. Another 190,000 combined methamphetamine with prescription stimulants, and 182,000 misused all three.
The Rising Risk in the Drug Supply
One of the most dangerous shifts in American drug use isn’t about how many people use drugs. It’s about what’s actually in the drugs they’re taking. The illicit drug supply is increasingly contaminated with substances that buyers don’t know they’re consuming.
Fentanyl, a synthetic opioid far more potent than heroin, has been mixed into the supply for years. More recently, a veterinary sedative called medetomidine has started appearing alongside it. CDC testing from the second half of 2025 found medetomidine in nearly 35% of opioid-positive drug samples at half of its monitoring sites across the country. Of those samples containing medetomidine, 98% also contained fentanyl. This kind of contamination means that people using what they believe is one substance may be exposed to a cocktail of drugs that interact unpredictably, increasing the risk of overdose and complicating emergency treatment.
How These Numbers Are Collected
The main source for national drug use statistics is the NSDUH, a survey SAMHSA conducts every year. It interviews roughly 70,000 people aged 12 and older in their homes, using methods designed to encourage honest answers about sensitive topics. Respondents answer drug-related questions on a laptop with audio assistance rather than face-to-face with an interviewer.
The survey has limitations. It doesn’t cover people who are homeless and not in shelters, those in jails or prisons, or active-duty military personnel living on bases. These are populations with higher-than-average rates of substance use, which means the national figures likely undercount total drug use to some degree. Still, the NSDUH is the most comprehensive tool available for tracking substance use trends across the United States, and the 2024 data represents the most current snapshot.
The Trend Is Upward
The increase from 62 million past-year illicit drug users in 2021 to 73.6 million in 2024 represents a jump of more than 11 million people in three years. Part of this reflects the continuing expansion of legal marijuana access, which both increases willingness to report use and likely increases use itself. But the trend extends beyond cannabis. Prescription drug misuse, stimulant use, and polysubstance use (taking multiple drugs together) all remain significant parts of the picture. With nearly one in four Americans reporting illicit drug use in the past year and one in six meeting the criteria for a substance use disorder, drug use is one of the most common health-related behaviors in the country.