Recent developments in the drug field have prompted claims that criminal justice has displaced health from its formerly dominant position and have also been used to support general claims about the criminalisation of social policy. This article critically assesses such claims and offers an alternative interpretation, arguing that British drug policy has been shaped and reshaped by the broader workings of the modern state. Early controls reflected the influence of medicine and public health over emerging forms of state interventionism, while subsequent arrangements were consistent with the penal-welfare tradition that dominated criminal justice for much of the last century. More recently, it is the transformation of this tradition that has played a key role in reshaping the drug field, producing evidence of both continuity and change. What others have attributed to ‘criminalisation’, therefore, is said to reflect broader changes in the nature of criminal justice itself. Whilst the transformation of penal-welfarism helps to explain the development of more punitive and coercive forms of drug control, this is only part of the story. As with criminal justice more generally, the limitations of the sovereign state have given rise to various adaptive strategies and it is here that considerable continuity can be seen, particularly in relation to the on-going importance of drug treatment and harm reduction.