Substantial numbers of deaths are related to disease and injury resulting from the use of drugs, alcohol and firearms worldwide. Death rates associated with these exposures were compared with those from motor vehicle crashes in the US from 1979 to 2003 by race. Among Caucasians, drug-induced death rates rose sharply after 1990 and surpassed deaths involving alcohol and firearms in 2001 and 2002, respectively. Among African-Americans, drug-induced deaths surpassed alcohol-induced deaths for the first time in 1999.