The United States remains a pacesetter in drug research and drug policy initiatives, yet unfortunately can be found at the front of the pack in drug use as well. A Reuters report this week summarized a survey from World Health Organization researchers that found higher rates of substance use in the U.S. than in other developed countries with less punitive measures against use. The survey, involving 54,000 people in 17 countries, found that U.S. residents were the most likely to have smoked, although the current smoking rate of 27% was far below a 74% lifetime prevalence. Differences with other nations were more glaring for cocaine, where the lifetime use rate of 16% in the U.S. was far ahead of the next highest rate (New Zealand's 4.3%). The international research team suggested that a higher minimum drinking age and tougher strategies to combat illegal drug use do not appear to be working as deterrents. The numbers appear to offer more evidence that prevention approaches need a thorough re-examination, both nationally and in communities.