Global DUD deaths rose 122% between 1990 and 2021 (61,774 → 137,278).

DALYs increased 75% to 15.56 million despite declining incidence rates.

North America had an 11.2-fold surge in drug-related deaths (6,125 → 74,451).

East Asia recorded a 15% decline in new DUD cases.

Opioid-related DALYs rose 32%; cocaine deaths up 108%.

Men aged 20–29 had highest incidence and mortality rates.

Higher Socio-demographic Index correlated with greater DUD burden (r = 0.70).