Driving while impaired by drugs – whether licit or illicit – has emerged as an important road safety issue. This report provides a state-of-the-art review of the role and impact of drugs in road accident risk. It reviews the legislation, deterrence and roadside detection practices in member countries as well as preventative measures to combat drug use while driving. It provides recommendations on strategies to adopt in addressing this issue, with a view to contributing to a safe system approach and saving further lives on the roads.