Abstract We present an overview of the current substance misuse situation in Iraq. Numerous indicators as well as first-hand observations of the authors, suggest that substance misuse is increasing in Iraq. Violence, economic uncertainty, poorly monitored borders, and a porous pharmacy system, all appear to be contributing to the problem. Yet, Iraq also has significant features that put some restraints on the size of the problem, most notably highly cohesive families and prevalent religiosity. The Iraqi Ministry of Health is leading an international effort to respond to rising substance misuse and associated mental and physical health conditions