Different drugs produce different effects and pose different risks. The legal status of any given drug is not necessarily a reliable indicator of its potential for harm. Whereas marijuana has never been shown to cause an overdose death, alcohol poisoning kills more people every year than all illegal drugs combined. Former U.S. Surgeon General C. Everett Koop, M.D. has described tobacco as more addictive than heroin. Anti-social behavior is oftentimes associated with illegal drugs, when drug prohibition plays a critical role in exacerbating problem behavior. During a 1988 government hearing Dr. Koop testified that "[i]f tobacco suddenly were unavailable and was as expensive as heroin and cocaine, I think that you would find that the behavior of some tobacco addicts would be very much like the behavior of some addicts of heroin and cocaine."

Because different drugs pose different risks, different responses are required. Harm reduction measures like methadone maintenance are proven health interventions for problem heroin users. However, such therapies have limited application for other drugs. Likewise, there is a strong case to be made for taxing and regulating the sale of marijuana, but the arguments that support such a shift, namely the need to separate the hard and soft drug markets, don’t lend themselves to drugs like cocaine. Regardless of the legal status of any given drug, harm reduction is the appropriate response.

Harm reduction is an alternative approach to drug policy and treatment that focuses on minimizing the adverse effects of both drug use and drug enforcement. Critical to reducing harm is reality-based drug education. In theory teenagers aren’t allowed to drink alcohol, but that doesn’t mean they shouldn’t be taught to always use designated drivers when attending parties where alcohol is consumed. Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users "where they're at," addressing conditions of use along with the use itself.

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