Drug abuse and addiction touch every community in the United States, crossing lines of age, income, geography and background. Understanding which substances are most commonly misused, and what the data actually show about their prevalence and harm, is essential for recognizing a problem early, having informed conversations with loved ones and understanding the scale of what America’s treatment system is asked to address.
This article shares current, verified data about the most commonly abused substances in America from primary government and peer-reviewed sources. All figures come from the 2024 National Survey on Drug Use and Health (NSDUH), the most recent annual survey released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2025, along with the CDC National Center for Health Statistics (NCHS) and the National Institute on Drug Abuse (NIDA). Where older data are cited, the source and year are clearly noted.
If you or someone you love is struggling with substance use, the National Rehab Hotline is available 24/7 to provide information, guidance, and referrals to local treatment resources. Call 866-210-1303 — it’s free and confidential.
The Scope of Substance Use in America
According to the 2024 NSDUH, approximately 1 in 4 Americans ages 12 or older reported using an illicit drug in the past year. That comes to 73.6 million people, or 25.5% of that population. Nearly 50 million Americans (16.8% of people ages 12 or older) met the criteria for a substance use disorder (SUD) in the past year. Of those, 27.9 million had an alcohol use disorder, 28.2 million had a drug use disorder and about 1 in 6 had both. Drug abuse affects not just individual health but also families, workplaces and communities at every level of society.
1. Alcohol
Alcohol remains the most widely used and most commonly abused substance in America. In 2024, 134.3 million people ages 12 or older reported using alcohol in the past month, more than any other substance, according to the 2024 NSDUH.
Use alone does not capture the scope of the problem. Among past-month drinkers:
- Alcohol Use Disorder. 27.9 million people ages 12 or older met criteria for an alcohol use disorder (AUD) in 2024.
- Binge Alcohol Use. Binge alcohol use, defined as five or more drinks for males or four or more for females on the same occasion at least once in the past 30 days, declined from 2021 to 2024 but remains widespread.
- Heavy Alcohol Use. Heavy alcohol use, defined here as binge drinking on 5 or more days in the past 30 days, also declined over the same period.
- Severity of AUD. The majority of people with AUD had a mild disorder; approximately 1 in 5 had a severe disorder.
Alcohol is connected to a wide range of serious health consequences, including liver disease, cardiovascular disease, cancer and mental health disorders, and it is involved in tens of thousands of traffic fatalities and accidents each year. It is also frequently involved in polysubstance overdose deaths alongside opioids and sedatives.
2. Marijuana / Cannabis
Marijuana is the most commonly used illicit drug in the United States and one of the fastest-growing substances in recent years. According to the 2024 NSDUH:
- Past-Year Use. 64.2 million people ages 12 or older reported past-year marijuana use, representing 22% of that population.
- Past-Month Use. 44.3 million people reported past-month marijuana use, up from 37.0 million in 2021, a significant increase over four years.
- Use Trends. Past-year and past-month marijuana use increased significantly between 2021 and 2024 across adult age groups.
Marijuana use disorder is now the most common drug use disorder in the United States:
- Marijuana Use Disorder Prevalence. 20.6 million people had a marijuana use disorder in 2024, the highest of any single drug.
- Severity of Disorder. The majority of those with marijuana use disorder had a mild disorder; about 1 in 5 had a severe disorder.
The continued expansion of legal marijuana markets, now available recreationally in the majority of U.S. states, has contributed to declining perception of risk and rising use, particularly among young adults. Underage use, however, showed no statistically significant change from 2021 to 2024, with approximately 10.5% of individuals ages 12 to 20 using marijuana in the past month.
3. Prescription Opioids
Prescription opioid misuse, the nonmedical use of pain relievers such as oxycodone, hydrocodone and other opioid analgesics, remains a major driver of opioid use disorder and overdose deaths in the United States, though the trend has moved in a more encouraging direction. According to the 2024 NSDUH:
- Prescription Opioid Misuse. 7.6 million people ages 12 or older misused prescription opioids in the past year.
- Recent Trend. Past-year prescription opioid misuse declined from 2021 to 2024, one of the few positive trends in the overall drug abuse picture.
- Opioid Use Disorder. 4.8 million people had an opioid use disorder in 2024, making it the second most common drug use disorder after marijuana.
- Severity of Disorder. Of those, 37.1% had a severe disorder.
Prescription opioid misuse is closely intertwined with the broader opioid crisis. Many people who transition to heroin or illicitly manufactured fentanyl initially began with prescription opioid misuse. Addressing the prescription side of this crisis through better prescribing practices, prescription drug monitoring programs and expanded access to medication-assisted treatment (MAT) remains a central pillar of the national overdose response.
4. Illicit Opioids: Heroin and Illicitly Manufactured Fentanyl
While prescription opioid misuse has declined, illicitly manufactured fentanyl (IMF) has become the dominant driver of opioid overdose deaths and the single most lethal force in the current drug crisis.
Overdose Deaths: A Historic Decline in 2024
After years of dramatic increases, overdose deaths fell sharply in 2024. According to CDC NCHS Data Brief No. 549 (released January 2026), total drug overdose deaths in the U.S. fell from 105,007 in 2023 to 79,384 in 2024, a 26.2% decline in the age-adjusted rate and the largest single-year drop on record. Synthetic opioids, primarily fentanyl, showed the largest individual decline. This is the most significant recent development in the overdose picture and reflects the impact of expanded naloxone access, harm reduction programs and increased treatment availability.
Fentanyl’s Continued Dominance
Despite the 2024 decline, fentanyl remains the most common drug involved in overdose deaths in the U.S. Between 2003 and 2023, the age-adjusted rate of drug overdose deaths involving synthetic opioids rose from near-zero to a peak before declining in 2024, per CDC NCHS Data Brief No. 522. Fentanyl is 50 to 100 times more potent than morphine and is now routinely found in supplies of heroin, counterfeit pills, cocaine and methamphetamine, meaning users across drug categories face exposure without knowing it.
Heroin Use
Heroin use continues to decline as fentanyl has largely displaced it in the illicit supply. According to the 2023 NSDUH, approximately 660,000 people ages 12 or older used heroin in the past year. The age-adjusted overdose death rate for heroin dropped from 1.8 per 100,000 in 2022 to 1.2 per 100,000 in 2023, per CDC NCHS Data Brief No. 522.
5. Cocaine
Cocaine remains one of the most widely used illicit stimulants in the United States, though use has declined modestly in recent years. According to the 2024 NSDUH:
- Past-Year Cocaine Use. 4.3 million people ages 12 or older used cocaine in the past year, representing 1.5% of that population, down from 1.7% (4.8 million) in 2021.
- Young Adult Trend. Past-year cocaine use declined significantly among young adults ages 18 to 25, from 3.7% in 2021 to 2.3% in 2024.
- Cocaine Use Disorder. Approximately 1.3 million people had a cocaine use disorder in the past year, per the 2023 NSDUH.
Cocaine overdose deaths have risen dramatically over the past decade, primarily because cocaine is often adulterated with fentanyl. This has turned what many users once considered a relatively controlled risk into a far more unpredictable one.
According to CDC NCHS Data Brief No. 522, the age-adjusted rate of overdose deaths involving cocaine rose from 1.8 per 100,000 in 2003 to 8.6 per 100,000 in 2023. The 2024 data showed a decline from 2023 levels as part of the broader overdose death decrease.
6. Methamphetamine
Methamphetamine is one of the most consequential substances in the current drug crisis. It is second only to synthetic opioids in its contribution to overdose deaths and is the primary driver of stimulant-involved fatalities. According to the 2024 NSDUH:
- Past-Year Methamphetamine Use. 2.4 million people ages 12 or older used methamphetamine in the past year, representing 0.8% of that population.
- Recent Trend. Past-year use showed no significant change from 2021 to 2024, remaining stable at roughly 2.4 to 2.6 million.
Methamphetamine’s overdose impact is more alarming than use prevalence alone suggests. According to CDC NCHS data via NIDA, the age-adjusted rate of overdose deaths involving psychostimulants, a category that includes methamphetamine, rose from 0.4 per 100,000 in 2003 to 10.6 per 100,000 in 2023, an increase of more than 23-fold.
By 2023, opioids were involved in an estimated 69.4% of psychostimulant overdose deaths, often because methamphetamine supplies are increasingly contaminated with illicitly manufactured fentanyl or because users combine the two substances. The 2024 data showed a decline in stimulant-involved deaths as part of the broader overdose reduction.
CNS stimulant use disorder, which includes cocaine, methamphetamine and prescription stimulant misuse, affected 4.3 million people in 2024. Approximately half, 48.3%, had a severe disorder, according to the 2024 NSDUH highlights.
7. Prescription Sedatives and Benzodiazepines
Prescription sedatives and tranquilizers, a category that includes benzodiazepines such as Xanax, Klonopin and Valium as well as sleep medications, represent one of the more underreported parts of the drug abuse problem. According to the 2024 NSDUH:
- Prescription Sedative or Tranquilizer Misuse. 4.6 million people ages 12 or older misused prescription tranquilizers or sedatives in the past year.
- Substance Use Disorder Prevalence. Approximately 2.3 million people had a substance use disorder involving tranquilizers or sedatives in the past year, per the 2023 NSDUH.
The overdose risk from benzodiazepines does not come mainly from the drugs alone. It comes from combining them with opioids. Benzodiazepines and opioids both suppress the central nervous system’s control of breathing. Together, they greatly increase the risk of fatal respiratory depression. The FDA has issued black box warnings about this interaction.
The growing presence of illicit benzodiazepines, including designer variants like bromazolam and clonazolam that are not detected by standard drug tests, adds even more danger to an already complex drug supply.
8. Prescription Stimulants
Prescription stimulant misuse, primarily involving amphetamine products such as Adderall and Vyvanse and methylphenidate products such as Ritalin and Concerta, has become one of the most discussed drug trends in the United States, particularly among young adults. According to the 2024 NSDUH:
- Prescription Stimulant Misuse. 3.9 million people ages 12 or older misused prescription stimulants in the past year, representing 1.4% of that population, unchanged from 2021 to 2024.
- Young Adult Rate. Misuse was highest among young adults ages 18 to 25, at 2.7% of that age group.
- Substance Use Disorder Prevalence. Approximately 1.7 million people had a substance use disorder involving prescription stimulants in the past year, per the 2023 NSDUH.
Prescription stimulant misuse carries risks of cardiovascular complications, psychological dependence and overdose, particularly when combined with other substances. The number of stimulant prescriptions in the U.S. increased 57.9% from 2012 to 2022, according to the DEA’s IQVIA report. That increase may have contributed to greater availability of these medications for both legitimate use and diversion.
9. Synthetic and Emerging Drugs
The illicit drug supply in the United States has become far more complex and dangerous in recent years, with a growing range of synthetic substances appearing in the drug supply, often without users knowing what they’re consuming. The DEA has described “drug cocktails,” meaning samples containing multiple substances, as the new normal in the illicit supply.
Xylazine (“Tranq”)
Xylazine is a veterinary sedative not approved for human use that has emerged as a dangerous adulterant in the illicit opioid supply, particularly in the Northeast and Mid-Atlantic states. It’s typically found alongside fentanyl, as users seek to extend the drug’s short duration of effect. Xylazine isn’t an opioid, which means naloxone (Narcan), the standard opioid overdose reversal medication, doesn’t counteract its effects.
According to CDC data, overdose deaths involving xylazine increased 34-fold from 2018 to 2021. A 2022 analysis found xylazine present in 6.7% of overdose deaths across 10 jurisdictions in all four U.S. Census regions. SAMHSA’s 2024 NSDUH release specifically flagged xylazine as an emerging threat of national concern alongside fentanyl and novel synthetic opioids such as nitazenes.
Synthetic Cannabinoids (K2/Spice)
Synthetic cannabinoids, sold under names like K2, Spice and many others, are chemical compounds designed to mimic THC but are structurally distinct and significantly more unpredictable. They can produce severe psychiatric symptoms, cardiovascular events and, in some cases, death. Unlike marijuana, they’re unregulated, untested and constantly reformulated to evade legal detection. The DEA has documented more than 300 novel psychoactive substances (NPS) encountered by law enforcement, with the list growing each year.
Novel Synthetic Opioids and Designer Benzodiazepines
Beyond fentanyl, a growing range of synthetic opioids and other emerging drugs have been documented in the illicit drug supply. These include nitazenes, some of which are significantly more potent than fentanyl, carfentanil, a veterinary opioid estimated to be 10,000 times more potent than morphine, and designer benzodiazepines such as bromazolam. These substances often aren’t detected by standard toxicology screens, making their involvement in overdose deaths difficult to fully characterize.
Key Trends Across All Substances
The overall overdose picture improved sharply in 2024. Total drug overdose deaths fell 26.2% from 2023 to 2024, to 79,384, the largest single-year decline on record, according to CDC NCHS. This reflects the real impact of expanded naloxone access, harm reduction investment and greater treatment capacity. However, public health experts say this progress is fragile, and some states reported renewed increases in early 2025.
Polysubstance Use Is Now the Norm
Polysubstance use is now the norm, not the exception. Most overdose deaths involve more than one substance. Fentanyl contamination of cocaine, methamphetamine, counterfeit pills and even benzodiazepines means drugs that once seemed separate now carry overlapping risks. Anyone using an illicit substance in the current environment is at risk of accidental fentanyl exposure.
Marijuana and Hallucinogen Use Increased
Marijuana and hallucinogen use increased while most other categories declined or stabilized. The 2024 NSDUH shows significant increases in marijuana use and marijuana use disorder from 2021 to 2024, along with higher hallucinogen use. That’s different from the broader pattern of declining or stable use across most other drug categories.
Disparities Persist Across Communities
Racial and geographic disparities persist and, in some cases, have grown. American Indian and Alaska Native individuals consistently face the highest rates of methamphetamine-related and opioid-related overdose deaths. Black Americans experienced the steepest increases in methamphetamine use disorder between 2015 and 2019.
Rural and nonmetropolitan areas continue to face higher rates of several drug use disorders than urban areas. These disparities aren’t random. They reflect real gaps in healthcare access, economic opportunity and community infrastructure that can increase vulnerability to addiction.
The Treatment Gap Remains Large
In 2024, an estimated 52.6 million Americans, or 18.2% of people ages 12 and older, needed treatment for a substance use disorder in the past year. The gap between people needing help and actually getting it remains one of the biggest unmet challenges in public health today.
Help Is Available 24/7
You’ve seen how widespread substance use is in the United States and how quickly the risks can grow. But statistics only tell part of the story. Behind every number is a person, a family and a situation that can change with the right support. When you’re ready to take the next step, help is just a phone call away. Call the National Rehab Hotline at 866-210-1303 — available 24 hours a day, 7 days a week, 365 days a year. You don’t have to face this alone.
FAQ: Most Commonly Abused Drugs in America
- What is the most commonly abused drug in America?
By the numbers, alcohol is still the most widely used and most commonly abused substance in the United States. In 2024, 134.3 million people reported past-month alcohol use, and 27.9 million met the criteria for alcohol use disorder, according to the NSDUH. Among illicit drugs, marijuana is the most commonly used, with 64.2 million past-year users. It also accounts for the most common single drug use disorder, affecting 20.6 million people. - Which drug causes the most overdose deaths in America?
Illicitly manufactured fentanyl and other synthetic opioids cause the most overdose deaths in the United States. Even though overall overdose deaths dropped in 2024, fentanyl remained the deadliest drug in the supply. Methamphetamine and other stimulants are the next most common category involved in overdose deaths, and meth is increasingly involved in deaths alongside opioids. - Is drug use in America increasing or decreasing overall?
It depends on the substance. Some trends moved in a better direction from 2021 to 2024. Prescription opioid misuse, cocaine use, binge drinking and heavy alcohol use all declined or stayed stable. At the same time, marijuana use and hallucinogen use increased. So while some use rates improved, the drug supply itself has become more dangerous because fentanyl and other synthetic substances are now showing up in more places. - What drugs are trending upward?
Marijuana use and marijuana use disorder both increased from 2021 to 2024. Hallucinogen use also went up during that period. On the supply side, xylazine and novel synthetic opioids such as nitazenes are becoming more common and more concerning. That matters because people may be exposed to these drugs without realizing it. - What is the treatment gap for substance use disorder?
The treatment gap is the difference between how many people need help and how many actually get it. In 2024, an estimated 52.6 million Americans, or 18.2% of people ages 12 and older, needed treatment for a substance use disorder. Most didn’t receive it. Many said they weren’t ready to stop using, treatment cost too much or they didn’t know where to turn.
If you don’t know where to start, the National Rehab Hotline can help. Call 866-210-1303 — it’s free, confidential and available 24/7.
