["Medical Anthropology Quarterly, EarlyView. ", "\nAbstract\nIncreasing punitive drug regulations in Japan amplify longstanding tensions within psychiatric practice, pushing psychiatrists to balance clinical obligations with complex socio‐legal demands. This article analyzes how psychiatrists specializing in illicit substance use disorders to navigate escalating criminalization by developing diagnostic frameworks such as “carceral harm”—attributing symptoms primarily to policing and incarceration threats—and “future treatability,” wherein addiction is an anticipated, incomplete phenomenon justifying ongoing medical care for patients facing imprisonment. Drawing from ethnographic research at Japan's National Center of Neurology and Psychiatry and semi‐structured interviews with psychiatrists, the study demonstrates how these clinical interventions simultaneously address ethical demands for compassionate care yet risk reinforcing psychiatry's historical associations with repression. The findings reveal psychiatrists' active role in reshaping medico‐legal discourses around addiction, highlighting clinical practice as a site where care and punishment intersect and reconfigure each other in reference to a medico‐legal theory of illicit drug addiction.\n"]