Although drugs are frequently detected when studied in trauma series, the association between specific trauma types (such as gun shot wound) and drug use complicates interpretation of such reports. We carried out a case control study of trauma deaths with drug detection matched by cause with non-drug detection trauma fatality controls. We studied 117 case and control pairs identified from medical examiner's records. By multiple logistic regression analysis, younger adult age (OR 3.1; 95% CI 1.5 to 6.1) and black race (OR 2.3; 95% CI 1.1 to 5.0) were both strongly associated with drug detection. In contrast, neither gender, intent (homicide, suicide or unintentional), primary trauma site, nor ethanol detection were significantly associated with drug detection. Our findings suggest that case mix variables should be considered when interpreting the drug use rates in trauma.