Blood or tissues from drivers killed in road fatalities in 3 Australian states (Victoria, New South Wales and Western Australia) underwent analysis for presence of alcohol and drugs. The researchers collected records of fatalities occurring within a ten-year period (Victoria, 1990-1999; NSW, Jan 1991-March 1993, 1995-1999; Western Australia, 1990-1992, 1995-1999), obtaining records from the coroner’s offices, excluding all drivers who died by natural causes, were presumed suicides, or who survived while hospitalized for 4 or more hours before death. Substances other than alcohol were detected in 23.5% (approximately 799) of 3398 fatalities meeting the conditions described above, with the largest percentage being cannabinoids, (13.5%), opiates (4.9%) and stimulants (4.1%, or 139 cases). (By comparison, 29.1%, or approximately 988 cases, involved blood alcohol levels above 0.05 mg/100 ml.) At least two impairing substances were detected in a majority of fatalities involving at least one substance (approximately 13.38% of 23.5). Methamphetamine was the most frequently detected stimulant (51 cases, or 0.02% of 3398), MDMA was detected in blood in 6 fatalities (or 0.002% of the sample). Mean blood MDMA level was 0.26 mg/L (range 0.05-0.38 mg/L, median 0.12 mg/L), though the authors warn that MDMA levels may be elevated due to changes in tissue drug distribution after death. Drivers with detectable blood stimulant levels were as likely to be in single-vehicle as multiple-vehicle accidents, but were more likely to be truckers than car drivers. The number of drug-related fatalities in vehicle drivers increased during the 1990s in the selected Australian states while the number of alcohol-related fatalities declined. This was true of fatalities involving "stimulants’ as well, with 38 cases in 1990-1993, 32 in 1994-1996, and 68 in 1997-1999. Overall, it appears that MDMA is associated with some traffic fatalities, but that it is not associated with the majority of them.