In Western Europe, the United States, and Canada in the last decade, illegal drugs have become a significant public policy issue. There is a growing interest in comparing and understanding the experiences of different nations. This report offers such a comparison. The United States is more adversely affected by illicit drugs than are any of the other nations considered here. It views the drug problem primarily as a crime problem for which tough law enforcement is the appropriate response. In some Western European nations, the health consequences of drug addiction are emphasized, and there has been a reluctance to use the criminal law against users. Germany, Norway, and Sweden have viewed drug use as a moral issue, using criminal law against users, but not nearly as aggressively as has the United States. This report summarizes the deliberations of officials and experts representing eight nations who participated in a December 1991 meeting on drug policy held in Bellagio, Italy. It also draws on a May 1991 conference of researchers from Western Europe and North America held in Washington, D.C.