Introduction: Drug abuse has reached alarming levels in Nigeria, with systemic vulnerabilities exacerbating the crisis. This systematic review evaluates the prevalence and patterns of drug abuse, examines the impact of collective actions and inactions, and identifies socio-economic and gender-specific barriers to treatment. Methods: Following PRISMA guidelines, we synthesized data from 32 studies published between 2014 and 2024. Inclusion criteria focused on drug abuse in Nigeria, comprising observational, qualitative, and mixed-methods studies. Data extraction encompassed study details, methodologies, key findings, and quality assessments via the Mixed Methods Appraisal Tool (MMAT). Results: The pooled prevalence of drug abuse stands at 14.4% among individuals aged 15 to 64, with significant regional disparities. Urban areas, particularly among youth, exhibited higher rates of opioid misuse, driven by poverty and accessibility. Policy inaction, exemplified by underfunded rehabilitation services, and stigma further compound the issue. Gender-specific barriers, particularly for women, are marked by stigma, lack of childcare support, and socioeconomic vulnerabilities. Collective actions have shown some success, yet limited implementation undermines overall impact. Conclusion: The review highlights a pressing need for coordinated efforts across sectors to combat drug abuse effectively. Addressing systemic issues such as poverty, stigma, and inadequate healthcare access is crucial. Implementing the National Drug Control Master Plan and prioritizing gender-sensitive policies will enhance treatment accessibility. Collaborative initiatives must focus on education, stigma reduction, and integrated healthcare to reverse the devastating trends of drug abuse in Nigeria.

The authors have declared no competing interest.

This study did not receive any funding

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