Shifting Drug Landscapes in China: A Multilevel Analysis of Traditional vs New Psychoactive Substance Use and Interregional Differences

Background: China’s drug landscape is rapidly evolving, yet existing research remains fragmented, lacking a comprehensive national perspective. This study analyzes current drug use patterns, trends, and regional differences in China, providing critical insights to guide effective anti-drug policies. Methods: We conducted a comprehensive multilevel analysis of secondary data of drug use data from the China Drug Situation Report (2005– 2023) and 34 academic articles (1990– 2021). Our analysis includes descriptive statistics, time series, regional differences, and population-specific trends. Results: This study identifies a declining trend in traditional drug use, while the use of new synthetic drugs and new psychoactive substances (NPS) is increasing. Strong negative correlations were found between law enforcement intensity and overall drug use ( r : − 0.89 to − 0.92). Significant regional disparity in NPS use was identified, with prevalence substantially higher in southern China than in the north ( p = 0.019). Traditional drugs are more prevalent in the northwest and central regions, while new drugs and NPS are more commonly found in the eastern coastal and central urban areas. The use of NPS is notably higher among adolescents in economically developed regions. Conclusion: The analysis delineates a clear shift in China’s drug landscape from traditional drugs to NPS, with concentrations in southern, coastal, and adolescent demographics. These patterns suggest that effective policy responses should be regionally tailored and prioritize youth prevention in economically advanced areas. Future research is needed to verify these associations and explore underlying causal mechanisms. Keywords: drug use, new psychoactive substances, regional differences, adolescents, China, 21st century