Drug use, abuse prevalence, and trends in Romania are strongly associated with drug policy and drug prevention system development. Studies have shown that since 1995, drug use among adolescents increased almost four times in less than 4 years. Experimental and recreational drug use among teenagers decreased slightly in Romania from 2000 to 2002. In attempts to address the problem, drug policy and drug prevention implementation in Romania has been at a poor level of development. The primary drug prevention programs that were developed and implemented by governmental agencies were concentrated in urban areas and were short-term. Romania's primary drug prevention strategies aimed at reducing drug demand are in place, but without indispensable, standard evaluation procedures, only suggested impact can be made on the impact on urban youth. With Romania continuing to be a drug transit country, it is stressed that without evidence-based, up-to-date national and regional drug policies, the risk for drug use and abuse could rise even higher. It is recommended that more long-term, user-focused, demand-centered prevention activities be carried out in more and more diversified settings and evaluations should be thoroughly considered. Figures, tables, and references