The proliferation and impunity of organized crime groups involved in drug trafficking in recent years is one of the most pressing public concerns in Mexico and the U.S.-Mexico borderlands. While the vast majority of this violence remains concentrated within Mexico, it has raised very serious concerns among U.S. observers about possible “spillover” into U.S. communities along the border. In response to these trends, Mexico and the United States have taken significant measures to try to address the phenomenon of transnational organized crime. However, this pattern accelerated greatly during the Fox and Calderón administrations. This chapter explores two fundamental questions pertaining to Mexico’s ongoing public security crisis. First, why has Mexico experienced this sudden increase in violence among trafficking organizations? Second, what are the current efforts and prospective strategies available to counter Mexican drug trafficking networks? In the process, we explore the development of Mexico’s drug trafficking organizations and identify and consider the merits of the three conceivable scenarios for managing drug use —complicity with traffickers, confrontation of traffickers, or changing the paradigm for regulating drug use— all of which have inevitable undesirable effects.