In order to qualify for inclusion in the DAWN database, an ED visit must have involved consumption of a drug, either as the direct cause of the visit or as a contributing factor. Data are collected on numerous illicit drugs, including cocaine, marijuana, heroin, and stimulants (amphetamines and methamphetamines). This report focuses on geographic variations in ED visits that involved illicit drug use in 2009. It compares 11 metropolitan statistical areas (MSAs) with the national rates. Nation-wide in 2009, there were an estimated 973,591 ED drug-related visits. This was a rate of 317 such visits per 100,000 population. Four metropolitan areas had significantly higher rates than the Nation as a whole: Boston (571 per 100,000 population); New York City (555 per 100,000 population); Chicago (507 per 100,000 population); and Detroit (462 per 100,000 population). Differences in ED visits that involved specific illicit drugs were examined by metropolitan area. The national rate for visits that involved cocaine was 138 per 100,000 population in 2009. Compared with the national rate, the rates of ED visits that involved cocaine were significantly higher in New York City, Boston, Chicago, and Detroit, listed in ranking order. ED visits that involved heroin were 69 per 100,000 population nation-wide. Rates were significantly higher in Boston, Chicago, New York City, Detroit, and Seattle, listed in order of ranking. ED visits that involved the consumption of alcohol in combination with an illicit drug are also reported for the Nation as a whole and by MSA. 1 table and 3 figures