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Increasing competition for water of good quality and the expectation that at least half of the required increase in food production in the near-future decades must come from the world's irrigated land requires to produce more food by converting more of the diverted water into food. Reuse of the non-consumed fraction ('drainage water') of the irrigation water already diverted is a proven but risky option for better fresh water management. This paper presents an overview of different options for reuse of drainage water and guidelines for its safe use. Criteria for maximum irrigation water salinity to prevent soil deterioration and crop yield reduction, for the maximum concentration of toxic substances and limits for bacteriological water quality are given. Examples of sustainable reuse of drainage water in Egypt, India and the USA are presented. The usefullness of simulation models for the analysis of regional water and salt balances is demonstrated.