Building on Stimson's (2000) analysis, this paper examines the shift from a focus on health towards one of crime within UK drug policy. The increased use of coerced or compulsory treatment of drug users is discussed with reference to harm reduction theory and the question of whose harm is prioritised in shaping drug services. We also identify mechanisms by which the efficacy of treatment approaches based on coercion may be lessened or reduce the efficacy of other existing services. Failure to consider these may be an important omission in any appraisal of the impact of policies that increasingly prioritise crime prevention and coercion over heath and voluntarism.