Blood and/or urine from fatally injured drivers in Washington State were collected and tested for the presence of drugs and alcohol. Drug and/or alcohol use was a factor in 52% of all fatalities. Among single vehicle accidents, alcohol use was a factor in 61% of cases versus 30% for multiple vehicle accidents. Drugs most commonly encountered were marijuana (11%), cocaine (3%), amphetamines (2%), together with a variety of depressant prescription medications. Trends noted included an association of depressant use with higher blood alcohol levels, while marijuana use was associated with lower blood alcohol levels. Marijuana use was noted to be most prominent in the 15-30 year age group, stimulant use in the 21-40 year old group, and prescription depressant use was more prevelant in the 45 + age group. Drug use demographics in this population are consistent with those noted in other jurisdictions.