Fifty years ago, the U.S. President's Commission on Law Enforcement and Administration of Justice saw drugs as a modest but growing problem for the criminal justice system. The reemergence of heroin occupied the Commission's attention. Many recommendations are admirable, such as a focus on public health interventions and a concern about the appropriateness of criminal prohibitions on marijuana use. Throughout the past 50 years, the problem has both massively expanded and changed in many ways; the principal drug of abuse has shifted multiple times, as has the populations most affected by them. Policy, largely stuck on tough enforcement for 30 years, is now moving in a direction more consistent with the Commission's views. Researchers have made only modest advances in understanding what enforcement can do to reduce drug use and related problems, but society has made some progress in developing interventions that have both a sound theoretical base and the promise of avoiding the unintended negative consequences of the highly punitive system of the 1980s and 1990s. A Commission in 2018 would face a much different and larger problem that has transformed many aspects of criminal justice. Investing in more data collection and evaluation research would be among its major recommendations, as would an admission of considerable uncertainty about what to do with the latest twist in the U.S. drug problem, the addition of the much more dangerous fentanyls.