Smith's extensive career in drug policy reform includes significant contributions to the movement. In 1996, as Associate Director of StopTheDrugWar.org, Adam launched The Week Online, the nation’s first publication providing original coverage of domestic and international drug policy from a reform perspective. Two years later, Smith launched the Higher Education Act Reform Campaign, the first successful effort to roll back federal drug war era legislation. He also laid the groundwork for the founding of Students for Sensible Drug Policy, incubating the group under his direction for nearly two years until SSDP’s launch as a stand-alone organization.

As the founder of the Craft Cannabis Alliance and the Alliance for Sensible Markets, Smith wrote legislation and spearheaded successful efforts to pass the nation’s first three cannabis interstate commerce bills in Oregon, California, and Washington. Smith was also a founding contributor to the "Marijuana Today" and “Marijuana Tomorrow" podcasts, appearing in more than 250 episodes from 2015-2023. He has organized and lobbied on behalf of craft cannabis producers, managed ballot initiatives and candidate campaigns, negotiated collective bargaining agreements for Oregon nurses, and built and served in coalitions driving legislative action on issues ranging from labor rights to election reform.