Introduction and aims. In Iran, alcohol consumption is prohibited except for non-Muslim minority groups, and zero tolerance is applied for impaired driving. Since 2010, several new laws and regulations have been implemented regarding alcohol and drug consumption (i.e., focus on harm reduction) and impaired driving (e.g., license suspension). The aim of this presentation is to examine alcohol and drug use and impaired driving in Iran. Methods. A systematic search was conducted on national surveys on alcohol and drug use and on studies related to impaired driving up to the 2021 in Iran published in English. A combination of key words such as “alcohol consumption”, “drug use”, “substance use”, “traffic accidents/crashes”, “traffic injuries”, “road accidents/crashes” and “Iran” on five databases: Iranian databases (Scientific Information Database; SID) and International electronic databases (PubMed, Scopus, and Google Scholar). Results and discussion. Results of four surveys on adults showed that few respondents reported alcohol or drug use: lifetime history (less than 10%), use in previous year (about 5%), or criteria for use disorder (about 2%). Males reported these behaviors 7-18 times more than females, and reported use was 3 times higher in 18-30 years old compared to adults older than 30 years of age. Twelve studies on impaired driving using different methods were retrieved. Results showed that about 15% of the drivers reported consumption of alcohol and drugs two hours before driving. Alcohol alone was found in about 4% of the deceased drivers and 8% of the injured drivers. Presence of drug in injury and fatal crashes ranged from about 12% to 46%, with highest percentages for opium and morphine. Combined presence of alcohol and drugs were found in about 64% to 77% of the injured drivers tested in the hospital following a motor vehicle crash. There are gaps in information regarding the prevalence of alcohol and drug use in the general population and among drivers in Iran. Studies on impaired driving by alcohol/drug are geographically and methodologically limited. The results will also be considered in light of current policies in Iran. Conclusion. The discrepancy between self-reported alcohol and drug use among the population and the high percentages of alcohol and drugs found in injury and fatal road crashes suggest underestimation of the magnitude and scope of the problem and the need for intervention

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