Reflections on drug policy

The history of United States drug policy is complex, ranging from laissez-faire to strict prohibition. In recent years, there has been little federal interest in drug policy reform and a continuing focus on a prohibitionist deterrence approach. During this period, state initiatives have been in the forefront of drug policy experimentation via ballot initiatives, legislative actions, or judicial and administrative policy decisions. The resulting state-level drug policy landscape includes continued prohibition as well as harm reduction, medicalization, and decriminalization. In addition, there has been considerable state-level policy focus on substance abuse treatment quality. With a new presidential administration, there is some indication that drug policy reform may be a national issue as part of the federal health reform agenda. The authors hope that the results of state policy experiments that provide evidence for the viability of harm reduction, quality treatment, and related approaches can be a viable part of the national policy discussion.