The purpose of this study is to identify the current situation of illegal drug use and abuse among North Koreans and provide suggestions and strategies for South Korea and the international community to counter this issue. The survey was distributed to the 1,467 North Korean defectors during the period of 2014 through 2016 and an in-depth interview was conducted with 18 who had been actually involved in produce, distribution, and use of illegal drug. The survey findings revealed 16.5% had experienced drug use and many of them were aware that the substance they had was illegal drugs such as narcotics. The frequency of drug use was on the rise. At present, drug use in North Korea seems common and popular which anyone can access, regardless of age, gender, or other social background. In-depth interviewees revealed that many drug users have become addicted, and they were aware of the seriousness of this condition. Nonetheless, they informed that there was no treatment or rehabilitation facilities for those drug addicts in North Korea. Although those drug addicts were punished in detention centers or prisons, or even executed in public by the North Korean authorities legal and institutional regulations are not actively enforced. Based on the results, this study points out that North Korea needs to counteract the illegal drug use and abuse among North Korean residents including legal enforcement and professional treatment. Besides, South Korea and the international community should take an initiative to investigate thoroughly the current situation of drug use and abuse in North Korea for properly understanding of the gravity of this problem and seeking appropriate solutions. In the meantime, the government of South Korea needs to change the policy to allow the settlement support for those North Korean defectors that have drug abuse problems in the past when they were in North Korea.