Prevalence, sex differences, disability burden, and temporal trends of substance use disorders across twenty-two Arab countries, 2019–2023: a secondary analysis of the Global Burden of Disease Study 2023

Background Comparative epidemiological analyses of substance use disorders across the Arab world remain limited despite variability in sociocultural norms, legal environments, conflict exposure, and health-system capacity. No previous study has examined all Global Burden of Disease (GBD) substance use disorder categories across the 22 Arab League member states by sex and disability burden against an explicit global benchmark. Methods We analysed GBD 2023 age-standardised prevalence, disability-adjusted life years (DALYs), and mortality-rate estimates for substance use disorders and seven substance-specific categories across the 22 Arab League member states, by sex, from 2019 to 2023. Regional aggregates were unweighted across-country medians; deviation from the global estimate was expressed as the percentage by which each value fell below or above the GBD 2023 global point estimate. Findings In 2023, regional age-standardised substance use disorder prevalence was 0.78% (median 95% UI 0.66–0.89), approximately 63% below the GBD 2023 global estimate of 2.10%. Alcohol use disorder showed the largest divergence: 0.35% (0.26–0.44), 76% below the global estimate. Opioid use disorder was closest to global levels: 0.19% (0.15–0.24), 11% below the global estimate; the global benchmark was exceeded in the United Arab Emirates. Female opioid use disorder prevalence exceeded male prevalence in 19 of the 22 countries. Four countries (Libya, the United Arab Emirates, Morocco, and Algeria) exceeded the global opioid DALY rate. Interpretation Burden remains below global levels in most Arab League countries but is not uniformly low, and estimates depend on the quality of primary data input, which varies across countries. Findings could support country-specific planning, sex-disaggregated reporting, targeted opioid agonist therapy, and stronger primary surveillance. Funding None.