On International Overdose Awareness Day 2021, the Women and Harm Reduction International Network (WHRIN) calls attention to the gender specific needs of women who use drugs and the need for immediate responses to address the ever rising number of drug overdoses.

Women who use drugs face unique challenges to prevent and manage overdose. This includes accessing lifesaving information, support to develop personal prevention strategies and the tools to effectively manage overdose.

Where harm reduction services exist, they are generally established without a gender lens and cater best for male clients. These services lack relevance and are not freely accessed by women and gender non-conforming people. This is accentuated for those with children, who have been subject to violence and for sex workers. Women with children, especially single mothers, are often reluctant to attend drug services for fear of being identified as a drug user and losing child custody. As a result of this women may use drugs secretly and alone, compounding the risk of fatal outcomes. Studies suggest that older women (45-64 years) are at particular risk of overdose, requiring targeted attention from harm reduction providers.

The COVID 19 pandemic has disproportionately affected women and gender non-conforming people who use drugs. Prevention of drug overdose — particularly through harm reduction services and commodities (including naloxone) as well as in-person peer support — has been restricted. Gender based violence (GBV) has increased. Demonstrated linkages between overdose and intimate partner violence indicate the urgent need for integration of GBV and harm reduction services. Fortunately, there is some progress, such as the gender sensitive service, Sisterspace, a women-only safe injecting facility in Vancouver. However, such services are exceptional and in no way proportionate to the scale of need.

To reduce these preventable deaths, it is vital that women who use drugs are meaningfully engaged in planning and delivering harm reduction and other lifesaving services. Peer to peer naloxone distribution, safe injecting spaces and overdose management training must become a feature of harm reduction services and other organisations engaging with women who use drugs. In addition, providers should make all efforts to reach women with low threshold approaches, particularly given COVID19 lockdown measures (where peer support and linkages, including through virtual means, are critical). Womensensitive harm reduction services must be urgently expanded.

On Overdose Awareness Day, WHRIN grieves for the women who have lost their lives to this war on drug users. The losses are harder to bear given the preventability and injustice surrounding the murderous failure of prohibition. The damaging ideology attached to the war on drugs acts as a core barrier to preventing and managing overdose - it is killing people and must end.