Abstract Background The COVID-19 pandemic has had an impact on physical and mental health at all levels, modifying life habits and putting at risk the emergence of ailments or the lack of management of previous comorbidities in the population. Objectives To analyze the evolution of drug consumption during the first year of the Pandemic in the general adult population residing in Andalusia according to the main axes of health inequalities. Methods Probabilistic overlapping panel survey with 11,463 valid telephone interviews distributed in four measurements during 2020 and 2021. Survey participants included individuals aged 16 years or older residing in Andalusia, Spain. The outcomes were drug consumption, type of drug consumed, modification of drug consumption and drugs related to mental health. Descriptive and stratified analysis by the health inequalities axes of sex, age and territory (degree of urbanization) were carried out to examine temporal changes in those outcomes. The sample design established were considered to obtain the estimations and 95% confidence intervals. Results In May 2020, 53.2% of the adult Andalusian population consumed medication in the previous two weeks, while in April 2021 this consumption increased to 58.6%. On the other hand, no differences were observed in the consumption of mental health-related medication in the previous two weeks between different time points, although a relevant difference was observed in the consumption of medication between women and men, being higher in women for all measurements. Regarding the change in medication consumption in the month prior to each measurement, there was an increase between April 2020 and April 2021 of 82.37%. Conclusions Drug consumption increased during the first year of the COVID-19 pandemic, with differences observed between men and women, and no differences between the different territories. Younger age groups of population had a greater increase in drug consumption compared to older age groups. Key messages • Drug consumption increased during the first year of the COVID-19 pandemic, with differences observed between men and women, and no differences between the different territories. • Younger age groups of population had a greater increase in drug consumption.