Relative to motor vehicle drivers/occupants, pedestrians are at greater risk for morbidity and mortality, with drug use posited as a primary risk factor. This study aimed to explore the scope of drug use among pedestrian fatalities in the United States between 2008-2017. Data reduction yielded 36,389 cases reported by Fatality Analysis Reporting System (FARS). Analysis revealed that 67.7% of fatalities were screened, with 36.1% testing positive for one of nine drug classifications. Stimulants (30.1%), cannabinoids (23.2%), depressants (16.1%), and narcotics (15.6%) ranking highest among positive results. Cases testing positive for a second (54.3%) and third (46.2%) drug are discussed. This study supports the need for further research to guide evidence-based educational initiatives to protect vulnerable road users.