In this final chapter, we step back from the details and assess the prospects for significant change in American drug laws. On the surface, those prospects appear slim for cocaine, slight for heroin, and slender for cannabis. A more balanced assessment suggests that at least for cannabis, there is a small but real chance that public views might support significant change. But the uncertainty and complexity of the case for legal change tends to support adherence to the status quo, putting reformers at a significant disadvantage. An examination of the politics surrounding marijuana reform, medical marijuana, needle exchange, and heroin maintenance – each far more incremental than cocaine or heroin legalization – suggests that the most crucial barrier to change is the unwillingness to consider tolerating increases in drug use to achieve reductions in drug-related harm.

The next sections of the chapter examine two types of explanations for this attitude. One is consequentialist; the notion that, in fact, society would be worse off in the end. We confront this view by examining the argument that harm reduction and other drug reforms “send the wrong message.” Our analysis suggests that even though this fear isn't groundless, there are good reasons to believe that micro harm reduction (programs that protect the average user) can produce macro harm reduction (net benefits for society as a whole). Harm reduction as a philosophy might significantly improve all aspects of American drug policy.