• The present study investigated differences in drugged driving among US older adults. • Sexual minority older adults were more likely to engage in drugged driving. • Findings may inform harm reduction efforts. Older lesbian, gay, and bisexual (LGB) adults are often neglected in healthcare settings, despite increases in risk behaviors and substance use. The present study assessed drugged driving among older adults in the United States and investigated differences by sexual orientation. The 2015–2019 National Survey on Drug Use and Health data were analyzed among 43,238 adults aged 50 years or older. Associations between drugged driving and demographic information were examined using weighted logistic regression models. An estimated 4.82% (n = 2,120) of older adults drove under the influence of alcohol in the past year, 1.33% (n = 619) drove under the influence of marijuana in the past year, and 1.48% (n = 683) drove under the influence of illicit drugs in the past year. Compared to heterosexual counterparts, individuals who identified as a sexual minority were at increased risk for driving under the influence, with individuals who identified as bisexual nearly 4 times more likely to drive under the influence of marijuana (95% CI = 2.39, 6.51) and 4.5 times more likely to drive under the influence of illicit drugs (95% CI = 2.84, 7.08) within the past year. Older LGB adults are at increased risk for drugged driving. Harm reduction efforts and behavioral interventions are currently warranted for healthcare improvement. [ABSTRACT FROM AUTHOR]