About 70 million Americans aged 12 or older used an illicit drug at least once in the past year, based on federal survey data. That figure includes everything from marijuana to heroin to misused prescription medications. Of those, roughly 28.2 million met the clinical threshold for a drug use disorder in 2024, meaning their use caused significant problems in their daily lives.
The Big Picture: Overall Drug Use
The most widely used federally illegal drug is cannabis. About 52.5 million Americans, or 19% of the population, used it at least once in 2021, according to the CDC. Marijuana accounts for the vast majority of all illicit drug use in the country, so when you see large headline numbers about “drug users,” cannabis is doing most of the heavy lifting.
Beyond marijuana, the numbers drop sharply. Among Americans aged 12 and older in 2023, 8.9 million people misused opioids in the past year (about 3.1% of the population). That category includes 8.6 million who misused prescription pain relievers and 660,000 who used heroin. An estimated 3.7 million adults injected drugs as of 2018, representing 1.5% of the adult population.
Substance Use Disorders by the Numbers
Using a drug and having a disorder are different things. A substance use disorder means someone’s drug or alcohol use has become compulsive and is interfering with work, relationships, or health. In 2024, 48.4 million people aged 12 or older, about 1 in 6 Americans, had a substance use disorder. That includes 27.9 million with an alcohol use disorder and 28.2 million with a drug use disorder. About 7.7 million had both.
The rate of drug use disorders has been climbing. In 2021, 8.7% of the population aged 12 or older qualified. By 2024, that had risen to 9.8%. Young adults aged 18 to 25 are hit hardest: 17.8% had a drug use disorder in 2024, compared to 6.6% of adolescents aged 12 to 17. One bright spot is that substance use disorders among adolescents actually declined over this period, falling from 9.2% in 2021 to 7.8% in 2024.
Drug Use Among Teens
The Monitoring the Future study, which surveys 8th, 10th, and 12th graders annually, found that in 2024, 26.2% of 12th graders had used any illicit drug in the past year. For 10th graders, the figure was 16.9%, and for 8th graders, 9.0%. Marijuana dominates teen drug use just as it does among adults: 25.8% of 12th graders used it in the past year, while only 6.5% used any illicit drug other than marijuana.
Notably, traditional cigarette smoking has nearly vanished among teens. Less than 1% of students in every grade reported smoking in the past year. Nicotine vaping, however, remains common: 21% of 12th graders vaped nicotine in the past year. Alcohol use still outpaces illicit drug use at every grade level, with 41.7% of 12th graders drinking in the past year.
Differences Across Racial and Ethnic Groups
Drug use rates vary across demographic groups, though not always in the ways people assume. In 2021, American Indian or Alaska Native people (36.1%) and multiracial people (34.6%) had the highest rates of past-year illicit drug use. Black or African American (24.3%) and white Americans (22.5%) fell in the middle, while Hispanic or Latino (19.4%) and Asian Americans (11.1%) reported the lowest rates.
Opioid misuse, interestingly, did not differ significantly by race or ethnicity. Rates ranged only from 2.3% among Asian Americans to 6.3% among multiracial individuals, with no statistically meaningful gaps between most groups. Substance use disorder rates followed a similar pattern to overall use: American Indian or Alaska Native people (27.6%) had the highest rates, and Asian Americans (8.0%) had the lowest.
The Opioid Crisis and Overdose Deaths
Synthetic opioids, primarily fentanyl, have driven the deadliest drug crisis in American history. In 2023, 72,776 people died from overdoses involving synthetic opioids other than methadone. But 2024 brought a notable shift: deaths from synthetic opioids dropped 35.6%, falling to 47,735. The death rate went from 22.2 per 100,000 people to 14.3. That decline is significant, though the toll remains enormous, still far exceeding the worst years of the crack or heroin epidemics.
The Treatment Gap
The gap between how many people need help and how many get it is stark. While the most detailed federal analysis is from 2015, it illustrates a persistent problem: of the 21.7 million people who needed substance use treatment that year, only 2.3 million received care at a specialty facility. That means roughly 89% of people who needed treatment didn’t get it. The number of people with substance use disorders has grown considerably since then (from 21.7 million to 48.4 million), while treatment infrastructure has not kept pace. Cost, stigma, lack of available programs, and long wait times remain the most common barriers.