By the time national delegations met for the HLS of the CND in March 2009, the UN General Assembly (UNGA) had twice unanimously endorsed its commitment to provide people at risk of HIV with harm reduction services, including NSPs. Observers of events in Vienna, however, could be forgiven for overlooking the commitments made in New York in 2001 and 2006. As the UNGASS decade saw the practice of soft defection from the GDPR become increasingly apparent in the national policy choices of some regime members, so parallel and often very heated debates on the issue of harm reduction became more commonplace within the Commission on Narcotic Drugs; especially its Committee of the Whole (COW) where resolutions are debated and usually agreed. Within a regime well populated by a range of diverse states, there will of course always be a certain degree of debate and disagreement concerning the actions of individual nations and any desire to influence and shape the structure of which they are a part. In this regard, treaty making is a process rather than a one-off event. Diplomats and international civil servants involved with drug control at the UN are thus quick to stress that energetic discussion within and around the Commission is a natural and indeed healthy characteristic of the regime’s operation. This may be the case. Yet the emergence of such fundamentally different positions on harm reduction among a range of actors within the regime between 1998 and 2009 must be seen as more than the standard functioning of a stable multilateral structure. Rather, it was a manifestation, at times very visible, of extraordinary internal tension.