This chapter examines why punishment continues to dominate Lithuanian drug control policy despite comparatively low levels of illicit drug use and growing international support for health-oriented approaches. Drawing on penal legislation, statistical data, and criminological research, it argues that Lithuania’s harsh legal framework—characterised by long prison terms for drug supply, the criminalisation of possession, and a lack of alternatives to incarceration—disproportionately affects people with substance use disorders. As the data show, drug users, especially those with opioid dependence, constitute a significant share of the prison population, while rehabilitation and harm-reduction measures remain limited. The chapter suggests that the persistence of punitive policies is rooted in cultural factors, including stigma towards drug users, conservative societal values, the legacy of Soviet-era legal thinking, and the limited normalisation of drug use compared to Western Europe. These conditions reinforce societal fears, the moralisation of drug use, and reliance on law enforcement. Although recent strategic documents signal a shift toward a more humane, evidence-based model, meaningful reform requires confronting deeply ingrained attitudes towards drug users. The chapter concludes that without the decriminalisation of less serious offences, the expansion of treatment and diversion options, and a reduction of stigma, Lithuania risks further expanding its prison population and exacerbating social exclusion.