Burden of disease due to drug use disorders in the European Union: analysis of 1990-2019 trends and patterns

Background: Rising concerns about drug use disorders in the European Union (EU), not only in terms of mortality but also morbidity, require a comprehensive analysis of trends and patterns of the burden of disease due to drug use across the region and over time. This study, drawing from the Global Burden of Disease (GBD) 2019 study data, aims to explore and analyze the evolving patterns of drug use disorders in the EU, as a whole, and in each member-state, between 1990 and 2019.
Methods: Age-standardized, both sexes rates of disability-adjusted life-years (DALYs) due to drug use in the EU and each of the 28 member states were analyzed, per 100,000 inhabitants, between 1990 and 2019. Data from the GBD 2019 study was used. All statistical analysis was performed with RStudio.
Results: The overall burden of drug use disorders in the EU demonstrated an increase from 194.7 DALYs per 100,000 inhabitants in 1990 to 273.8 DALYs in 2019, with a consistent increase which peaked in 2008, followed by a slight decrease until 2014, and a subsequent slight increase until 2019. In 1990, the top 3 countries with the highest burden were Latvia (379.6 DALYs), Estonia (314.9) and Denmark (298.2), while the bottom 3 countries were Slovenia (81.8), Romania (84.3) and Hungary (100.4). In 2019, the top 3 most affected countries were Estonia (991.8), the United Kingdom (530.0) and Lithuania (510.1), while the 3 least affected countries were Romania (86.3), Slovakia (130.8) and Poland (144.7). Opioid use disorders emerged as the predominant cause of burden in the EU between 1990 and 2019, however variation in the secondary contributions was found between member-states, notably regarding cannabis use, which was the second cause of burden in France and Slovenia in 1990 but fell to last place in 2019 in most member-states. 
Conclusions: These findings underscore the dynamic nature of drug use disorder patterns over the past three decades in the EU. Understanding these trends is crucial for targeted interventions and policy formulation to address the evolving challenges associated with drug use disorders in the region. Factors such as socio-demographics, economic changes, and healthcare policies are likely contributors to the dynamic nature of this public health issue.