The drug trade has increased globally in intensity and reach, and substance abuse in South Africa has escalated rapidly. (1,2) Drug misuse is a major social, legal and public health challenge despite the war on drugs, in which the USA has a disproportionate influence. Why this lack of progress and what can be done about it? The use of psychotropic substances is as old as human history. Some use drugs as part of religious observations. The majority of people who partake of drugs use them for recreational purposes. Some become addicted and may cause harm to themselves, their families and society. If drugs are bad it seems logical to wage war on them. However, although ‘get tough’ measures sound attractive they are often counterproductive.