Mexican drug trafficking organizations (DTOs) pose the greatest organized crime threat to the United States. Intelligence estimates indicate a vast majority of the cocaine available in U.S. drug markets is smuggled by Mexican DTOs across the U.S.-Mexican border, and Mexican DTOs control drug distribution in most U.S. cities. Further, they are gaining strength in markets they do not yet control. Violent urban gangs control most retail-level drug distribution nationally. Cocaine poses the most serious threat, although its availability in the United States is lower than 2005 and 2006 levels. On the other hand, domestic methamphetamine production is projected to surpass 2007 levels. The level of domestic outdoor cannabis cultivation is very high and possibly increasing, and marijuana potency has increased to the highest level recorded. Lucrative northeastern white heroin markets are attracting Mexican DTOs; however, Southwest and Southeast Asian heroin availability is limited. The level of prescription drug abuse is very high, as individuals are able to acquire them from numerous sources. Asian DTOs are producing MDMA (Ecstasy) in large clandestine laboratories in Canada. DTOs, gangs, and drug users are continually adapting to changes in drug policy, counterdrug initiatives, and numerous other factors that affect their operations. Although forecasting drug trends is difficult because of significant intelligence gaps, this report presents several predictive estimates regarding drug trafficking and abuse. On the positive side, it predicts that the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 will most likely reduce the number of rogue Internet pharmacies that are selling controlled prescription drugs. Also, treatment admissions for MDMA addiction may increase, given the distribution of MDMA tablets adulterated with highly addictive substances increases. Appended maps, tables, figures, and assessment methodology