This article analyses how families and communities in Shan State, Myanmar, have responded to rising youth drug use, and the impacts that these responses have on young people. It first examines the factors that have caused drug production and drug use amongst youth in Shan State to increase over the past three decades and places these phenomena in the context of wider political and economic transformations that have shaped Myanmar's borderlands since the late 1980s. Drug-related harms among Shan youth have overwhelmed family and community coping mechanisms in a context where state responses have been ineffective and inadequate. Consequently, families have resorted to increasingly desperate ways to try to protect young family members from drug use. This article focuses on two responses. First, the decision by rural families to send sons and daughters away to big cities or to neighbouring countries to avoid the local drug environment. Second, the decision to send children experiencing drug harms to treatment centres operated by ethnic armed organisations. Both responses, this article argues, expose young people to new forms of vulnerability. Finally, the article reflects on some of the challenges the drug problem poses for government and communities, and offers suggestions for alternative responses.