Gauging what different regions are doing to reduce the harms associated with drug use is hindered by the fact that there is no clear concept and consistent way of defining or measuring "harm" related to drugs. Harms occur at different individual and social levels as well as over different periods of time, and are outcomes of interactions between the substance user, the drug itself, and the physical and social environment. Looking at available macro-indicators of harm, movement toward achievement of WHO goals does not appear to be on schedule. For alcohol and tobacco, trends for increased harm are just starting to show in the developing world, and will worsen over the next several decades. For illicit drugs, failing drug control policies have resulted in dramatically negative developments for public health, especially with respect to HIV infections and drug-related deaths, in the developed as well as developing areas. References