This report examines recent shifts in United States drug policy at state and local levels. It documents how some jurisdictions have expanded harm reduction, decriminalization, and treatment services, while others have returned to punitive approaches. Case studies include Oregon’s reversal of drug decriminalization, San Francisco’s new drug-testing requirements for public assistance recipients, and Louisiana’s law classifying fentanyl distribution causing injury as felony homicide. The report highlights the complex social, economic, and political factors shaping drug policy and underscores the need for ongoing data collection, community engagement, and cross-sector approaches to address addiction, overdose, and public health.