The Burden of Opioid Use Disorders in the Americas from 1990 to 2023 and Projection to 2050.

BACKGROUND: Opioid use disorder (OUD) is a severe public health crisis in the Americas. This study aimed to comprehensively evaluate the spatiotemporal trends, socioeconomic inequalities, and future projections of the OUD burden across the region from 1990 to 2050. METHODS: Data from the Global Burden of Disease 2023 study were utilized to extract incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for OUD. Trends were quantified using average annual percent change (AAPC). Health inequalities were assessed via the Slope Index of Inequality (SII) and Socio-demographic Index (SDI) correlations. Bayesian Age-Period-Cohort models were employed to project the burden to 2050. RESULTS: In 2023, High-income North America bore the most severe OUD burden, with an age-standardized mortality rate (ASMR) of 19.08 per 100,000, surging dramatically since 1990 (AAPC: 8.35). Latin America exhibited a stable incidence but rising mortality. The burden was disproportionately concentrated in higher SDI regions, with absolute inequality in fatal outcomes widening significantly. Projections indicate a catastrophic escalation in mortality across the Americas by 2050. CONCLUSION: The OUD epidemic in the Americas is escalating and profoundly unequal. Urgent, context-specific interventions and enhanced surveillance are critical to mitigate this worsening crisis.