Drug misuse is a global problem. Markets that supply illegal drugs often span international borders. However, each country has different primary drugs of use, populations that are using and consequences of use. The policy approach of each country to addressing substance use disorders can be characterized along a continuum between purely public health approaches and purely law enforcement approaches. There is a growing movement towards use of a public health approach. This article provides four case examples, Ukraine, Philippines, Nigeria and Peru, where there is movement to develop addiction public health infrastructure.