The number of people with substance use disorders skyrocketed to 39.5 million globally in 2021, a 45% increase over 10 years, according to a new report from the U.N. Office on Drugs and Crime (UNODC).

The U.N. found that demand for cocaine and supply are booming worldwide, while methamphetamine trafficking is spreading beyond established markets, Reuters reports. In 2021 coca bush cultivation and total cocaine production were at record high levels. The global number of people using cocaine, estimated at 22 million in 2021, is steadily rising. Seizures of cocaine have grown more quickly than production. This has contained the total supply to some extent.

UNODC found that new estimates of people who inject substances are higher than previously estimated as treatment services and other interventions fall short.

“The cheap, easy, and fast production of synthetic drugs has radically transformed many illicit drug markets,” UNODC noted in a news release. The report notes that fentanyl has drastically altered the opioid market in North America with dire consequences. In 2021, the majority of the approximately 90,000 opioid-related overdose deaths in North America involved illegally manufactured fentanyl.