Background and Objective:
Adolescents substance use is public health challenge and changing phenomenon that requires regular monitoring in order to provide adequate interventions. The aim of this study was to explore prevalence and trends in substance use among Serbian school students and compare it with other European countries.

Methods:
This is a secondary analysis of data obtained through the European School Survey Project on Alcohol and Other Drugs (ESPAD), a repeated, cross-sectional study of substance use and other forms of risk behavior among students in European countries aged 15-16 years. The ESPAD is carried out every 4 years at European level and Serbia participated in this study in 2008, 2011 and 2019. Descriptive statistic was used for this analysis.

Results:
Data from ESPAD 2019, show that lifetime prevalence (LTP) of any illicit substance use among Serbian school students 16 years old (8.6%) is lower than ESPAD average (17%) with only three ESPAD countries reporting smaller prevalence in 2019. Cannabis is the most used substance with LTP 7.3% which is more than twice lower than ESPAD average (16%). Prevalence of high-risk cannabis users in total sample of students (2.0%) is also lower than ESPAD average (4.0%), but higher among last 12 months cannabis users (38.0% in Serbia compared to ESPAD average (36%). In total, there is a slight increase in LTP cannabis use (from 7% in 2008 to 8% in 2019) with stable trend among boys and slight increase among girls.

Conclusions:
LTP of all explored illicit substances stance use is lower in Serbia compared to EU average that correspond with lower prevalence of substance use among adult general population. There are no major changes in the trends for the period 2008-2019. In depth analysis is needed to determine the wider determinants related to differences in substance use among countries.