Over the last 20 years we have gained a better understanding of drug use epidemiology and important biopsychosocial factors that might lead some people to experience harms and problems from drug use. Yet despite significant investment in research, policy, and practice, it is still unclear which are the most effective prevention interventions, and how successfully these might be implemented and transported across cultures. Furthermore, in changing policy, social, and risk environments, that have, for example, seen shifts in legal responses to some drugs in some countries, the adoption of new technologies, new evidence for the therapeutic potential of illicit drugs, and the rapid emergence of novel drugs and new drug behaviours, there is uncertainty around how prevention responses might be updated. This presentation will consider some of these issues, and reflect on the value and utility of prevention today. It will also try and offer some practical suggestions around the expansion of drug prevention to consider wider risk behaviours, and identify some research and practice priorities for the coming years.