Urbanization, probably the single most important demographic shift worldwide over the past and in the new century, represents a sentinel change from how most of the world’s population has lived for the past several thousand years. In addition, as more and more people come to live in urban areas, the urban environment becomes increasingly important as a possible determinant of health and of health behavior. Historically, drug use has been conceptualized as an urban problem. So, with an increase in urbanization, what impacts will that have on drug use? This paper focuses on how characteristics of the urban environment affect drug use and misuse and contributes to explaining intra-urban variability in drug-related behavior. It also summarizes the existing empirical literature substantiating this framework and identifies the direction for future research. It is argued that characteristics of the urban environment shape drug use and misuse patterns. Also, mechanisms that may explain these relations are hypothesized. References