Substance misuse is already widespread in UK schools, The greater freedoms of university make undergraduates particularly vulnerable to starting or increasing. Legal and medical agencies focus more on forensic consequences of established addiction. University drug use is not only recreational but may be motivated by improved performance or appearance. It is not clear whether the UK actively pursues eradication of non-medicinal drugs or prefers arrangements for safer consumption. Most universities officially ban drug use, but some student unions are permitted to provide facilities to enhance safer consumption. Lessons can be learned from the benefits and challenges of the UK smoking ‘ban’ and the history of alcohol ‘prohibition’. Drug use prevention and management need more rigorous research to discover what works and what doesn’t. Universities are ideally placed to conduct this. Meanwhile regulations need regular review by students, staff and authorities in collaboration. There is paucity of NHS treatment options for substance misuse. Confidential group-based support such as that provided by 12-step groups may provide particular advantages for students living away from home. Students and staff with drug-related concerns can also access advice from University Counselling Services and University Mental Health Advisors.