Even among its supporters, the American drug control strategy provides few grounds for enthusiasm. Despite many indications that the prevalence of drug use has declined over the past decade, in many ways the severity of the drug problem has remained fairly constant.¹ Moreover, our current mix of policies is expensive, intrusive, and may actually contribute to drug related harm.² Thus there is considerable interest - as documented by a steady stream of popular books, television programmes, and analytic and newspaper essays - in looking at a much wider array of drug control strategies, including approaches that go well beyond simply tinkering at the edges of existing programmes.

In this essay we shall provide a brief overview of one such alternative approach, the harm reduction paradigm.³”⁵ We shall discuss its influence in Western Europe and the barriers to its diffusion into American policy towards illicit drugs, and we shall offer a framework highlighting ways in which harm reduction might be integrated into the underlying logic of American drug control. Finally we tentatively suggest its relevance to smoking policy.