This article examines the recent trends in international, in particular multilateral, drug policy and the implications of these changes for shifting alignments and coalitions of actors and stakeholders. It places these changes in the context of the system’s historical developments and applies previously unutilised analyses of other international governance structures. It suggests that the the international drug control system is undergoing a long-term process of fragmentation and evolution towards a ‘regime complex’. In the short to medium term it suggests that exogenous challenges to the system remain somewhat limited. This is due to institutional battles over issue suzerainty and a limited funding incentive for other agencies to become involved. Instead, endogenous challenges and changes within the system represent the main avenues of adaptation. It continues on to suggest that in the longer term these endogenous changes will encourage and accelerate exogenous interactions with the system from other regimes and issue areas and thereby expand the terrain for cross-issue and cross-sectoral engagements. Thus, the short to medium term trends within drug control, while in some cases appearing to be in stasis or moving backwards, continue the overarching trend of regime fragmentation and shifting into an archetypal regime complex.