The drug treatment and support needs of black and minority ethnic populations have been a policy concern for more than 10 years in England. This paper considers how these needs are currently understood, addressing four particular issues. First, it considers the ways in which ‘diversity’ and ‘difference’ are conceptualized and operationalized in research, practice and policy decisions. Second, it offers a critical oversight of the epistemological and methodological limitations of the current knowledge base. Third, it addresses the differences and tensions between the priorities and agendas of policymakers and academic researchers. These are seen as central because policymakers are not merely consumers of research, rather their potential to influence the knowledge base manifests in their role as commissioners and publishers of research evidence. Finally it makes recommendations about how these issues might be overcome in future research, including advocating the value of psycho-social approaches and situated understandings.