Frequently asked questions (FAQ): gender and drugs in Europe

Aim and objectives

The aim of the FAQs is to address a knowledge gap at the European level by providing experts, practitioners and policymakers with resources on the links between gender and drugs. The FAQs also support the systematic inclusion of a gender perspective in drug research, monitoring, policies and interventions.

What this page contains

These pages define key concepts related to gender and drugs. They present the most recent epidemiological data on gender and drugs, as well as information on gender-responsive interventions that address drug use and harms in Europe. Finally, they list the key European policy priorities in this area.

The pages also provide background information on the methodology used, the sources of information and their limitations, as well as key references and links to resources.

Questions

Key concepts on gender and drugs

Why is it important to consider a gender perspective in the drugs field?

Given the significant differences by gender in drug use, its consequences and related interventions, there is a growing recognition of the need to integrate gender mainstreaming into the field of drugs (Montanari, 2024). Gender mainstreaming is defined by the European Institute for Gender Equality (EIGE) as the systematic consideration of the differences between the conditions, situations and needs of women and men in all policies and actions for the benefit of women and men.

Effective interventions in the drugs field must take account of the differences between women and men in all their diversity, in order to provide an accurate understanding of their needs, and on this basis develop sound drug policies and interventions. Only by looking at gender differences and discrimination, it is possible to work towards gender equality, which is a key principle of the European Union.

What do the EU policy documents say about gender equality?

The European Commission has been committed to implementing gender mainstreaming as a crucial activity to reach gender equality for 30 years. Gender mainstreaming should be implemented across the design, implementation, monitoring and evaluation of policies, including drug policies (European Commission, 1996). This long-standing commitment is reflected in the EU Gender Equality Strategy 2020-2025, which is in line with the call for data and research to inform evidence-based policy decisions within the EU institutions and Member States. The EU treaties establish equality between women and men as a core value of the European Union and recognise it as a fundamental human right, obliging the European Union to combat gender inequalities in all its activities.

Several European and international organisations, including the United Nations, the World Health Organization, the European Commission and the European Institute for Gender Equality (EIGE), have emphasised the importance of achieving gender equality by systematically including gender considerations in all areas and at all stages of policy-making and project/programme development.

What are the main health and social differences between women and men in drug use and related problems?

Although there are similarities between women and men regarding drug use, differences are found concerning the different phases of drug use, from drug use initiation to problem drug use, and in the consequences of drug use (Buccelli et al., 2016). The studies mainly refer to females and males according to their sex at birth. Little is known on intersex individuals, non-binary people and other groups identified by gender or sexual orientation. Research and the literature identify key gender differences in three areas.

• Drug use initiation
  • Women and men both tend to start their drug use during adolescence, with girls generally starting later than boys (McHugh et al., 2018).
  • Boys are more likely to use substances, including illicit drugs, in social contexts, whereas girls are using more likely to use substances in private. In recent years, however, girls are also increasingly using substances in social contexts, although they are expected to exercise more discretion than boys due to social gender norms (Romo-Avilés and Lopez-Lopez, 2023).
  • A number of risk factors for developing high-risk drug use are common to both girls and boys, including mental health problems, social vulnerability and adverse childhood experiences. Adverse childhood experiences, especially sexual abuse, occur in both genders, but they are substantially more frequent among girls than boys (Baglivio et al., 2014; Dierkhising et al., 2019; Felitti et al., 1998). Adverse childhood experiences represent an important risk factor for developing drug-related problems, including high-risk drug use and exhibiting deviant behaviours (Jones et al., 2018; Martin et al., 2003; Winstanley et al., 2020).
• Drug use
  • More men than women use substances, especially illicit substances.
  • Men tend to use a greater variety of drugs than women.
  • The difference in the proportion of men and women change by drug and depending of the indicator used (see data later).
  • The use of medicinal products without medical guidance is greater among women compared with men in some countries (Clarke, 2015).
  • Transgender people report a heightened risk of drug use disorders compared with the general population (Johns et al., 2019; Reisner et al., 2015; Yi et al., 2017). They are more likely to experience physical or psychological violence, which may be risk factors for developing drug risk behaviours; negative emotions and social and relational anxiety related to gender identity may contribute to increased substance use.
  • The gender differences between women and men vary by country, by type of drug, and by frequency and intensity of drug use.
  • The proportion of women using illicit drugs is generally lower in countries in the south of Europe, compared with those in the north of Europe.
  • The gender gap increases for the most intensive and problematic forms of drug use, for example, with a higher proportion of men using drugs frequently (McHugh et al., 2020).
  • The gender gap seems to be narrowing among the youngest generation (ESPAD Group, 2025).
• Consequences of drug use
  • Women and men report differences in the social consequences of drug use.
  • Men are more likely to spend time in prison because they commit more crimes than women in general and, when they are sentenced to prison, they tend to have a longer duration of incarceration compared with women (Carlen and Worrall, 2004; Chesney-Lind and Shelden, 2013).
  • The majority of women who spend time in prison are sentenced for drug-related crimes, with the recent increase of the number of women incarcerated at the global level mainly attributable to such crimes. This increase, however, has not been reported in Europe (EMCDDA, 2021a; UNODC, 2018).
  • Compared with men, women face higher levels of gender-based violence, including drug-facilitated sexual assaults (DFSA) (EMCDDA, 2008).
  • Women also face higher levels of social disapproval, stigma and unemployment as a consequence of high-risk drug use (EMCDDA, 2021a; EMCDDA, 2023; McHugh et al., 2020; Tuchman, 2010).
  • Among people reporting high-risk drug use, women report higher rates of psychiatric comorbidity than men do (Torrens et al., 2011).
  • Studies carried out more than 10 years ago among people who inject drugs found higher rates of HIV infection among women than men in eastern Europe (33.0 % vs 27.9 %), western Europe (42.8 % vs 40.3 %), Latin America (38.5 % vs 34.6 %) and North America (34.5 % vs 31.3 %) (Azim T. et al., 2015). However, recent data from European countries do not confirm this difference.
  • Men are more likely than women to die from a drug overdose (EMCDDA, 2024). However, data suggest that among people dying from a drug overdose, suicidal intent is more common among women.
  • Compared with men, women tend to have fewer economic resources, as they generally have lower employment and income levels, while they are more likely to be caregivers (Samtleben and Müller, 2022). They may also have less access to social services than men who use drugs (Molina-Fernández et al., 2024).

What are the differences in drug treatment access between women and men?

Compared with men, women have fewer economic resources, which may pose an obstacle to accessing drug treatment, as the cost of treatment may be a barrier if services are not provided by the state or there is no insurance coverage. Transportation costs may pose an additional barrier that women experience more often than men (Huhn and Dunn, 2020; Rahimi et al., 2018).

Furthermore, among people entering treatment for drug-related problems, women are more likely than men to live with and take care of children. The absence of childcare options can pose a significant barrier to accessing services for women. This may be due with a fear of losing custody of their children if their drug use becomes known (Canfield et al., 2017).

Also, women, more frequently than men, have a partner who uses drugs, although some changes are observed more recently (Perrin et al., 2021). This may represent an obstacle to seeking treatment for various reasons. Substance-using men may sometimes be unsupportive of their partners seeking treatment. Women may fear losing the relationship if they engage with such services. Furthermore, women may fear their partner, given that most gender-based violence occurs in the context of intimate partner violence (Polenick et al., 2021).

Another reason women are less likely than men to access treatment may be sexual exploitation. In some cases, women may be undocumented migrants in the country where they live and may fear the legal consequences derived from their status. They may also be misinformed about existing services and about their conditions. For example, they may think that using the services would incur high costs. These women may delay or avoid seeking maternity care, as they may face additional risks during pregnancy, if access to maternity care is controlled by their trafficker (Bick et al., 2017; EIGE, 2018; Willis et al., 2016).

Does stigma affect women and men in different ways?

Stigma refers to negative attitudes, beliefs and stereotypes that society holds towards particular groups or towards individuals. It often results in the discrimination and marginalisation of stigmatised people, which can lead to social, economic and psychological harm (Link and Phelan, 2001).

Although drug use disorders affect both men and women (COPOLAD, 2019), women may face greater stigmatism for using drugs because it is perceived as conflicting with their roles as citizens, women and, particularly, mothers (Meyers et al., 2021).

Women are reported to internalise stigma to a greater degree than men. This can exacerbate their feelings of guilt and shame, preventing them from seeking treatment. Discriminatory and gender-neutral services may also deter women from seeking help (Stone et al., 2020).

Finally, more women than men are involved in sex work, often as a means to sustain their drug use. They may use sex to fund their drug use, but they may also use drugs to help them cope psychologically with their sex work (Iversen et al., 2021).

What is the link between gender-based violence and drug use?

Gender-based violence can manifest in many different ways, ranging from intimate partner violence, the most widespread form, to violence by strangers in different contexts, and including acts of online violence. EIGE recognises the four forms of gender-based violence: physical, sexual, psychological and economic violence.

Both women and men experience gender-based violence, but the majority of victims are women and girls (Gajos et al., 2023). Women who use drugs, particularly those who engage in high-risk drug use, are more vulnerable to gender-based violence than men who use drugs. The prevalence of gender-based violence among women who use drugs is two to five times that among women who do not use drugs (Arpa, 2017).

A recent EU-funded project, Interleave analysed the gender-based violence experienced by female drug users, as well as best practices in the field of prevention and intervention. The goal was to develop a toolkit for professionals working in this area. The study found that most women engaging in high-risk drug use who were involved in the study and were attending drug treatment services had experienced gender-based violence, whether psychological or physical. Nearly half of them had been subjected to sexual violence in adulthood, and one quarter of them had experienced it in childhood (Plaza-Hernandes et al., 2023). Furthermore, cases of institutional psychological and physical violence perpetrated by law enforcement and social and healthcare staff were also reported. The project highlighted the need to improve intervention strategies in both mainstream and specialised services for women who use drugs.

Gender-based violence can be a risk factor, a consequence or a correlate of drug use. Many women who engage in high-risk patterns of drug use have experienced gender-based violence, often repeatedly and at various points in their lives. Such experiences have a cumulative negative impact on their mental health. These women may use substances as a form of self-medication to enable them to cope with and alleviate the trauma caused by violence (Haro et al., 2023; Ogden et al., 2022).

In the context of drug use, particularly recreational drug use, women may be victims of drug-facilitated sexual assault (DFSA). DFSA is defined as ‘all forms of non-consensual penetrative sexual activity whether it involves the forcible or covert administration of an incapacitating or disinhibiting substance by an assailant [‘proactive DFSA’], for the purposes of serious sexual assault; as well as sexual activity by an assailant with a victim who is profoundly intoxicated by his or her own actions [‘opportunistic DFSA’] to the point of near or actual unconsciousness’ (ACMD, 2007; EMCDDA, 2008; Folch et al., 2020).

Furthermore, women, and to a lesser extent men, who have drug problems may experience gender-based violence in the context of sex work. This issue is believed to affect the LGBTQIA+ community in particular, although data are scarce and more evidence is needed (Cafferky et al., 2018; Iversen et al., 2021).

Despite the relevance and the seriousness of this issue, there is a lack of systematic data on gender-based violence in the context of drug use at the European level. The EUDA is working to address this (EMCDDA, 2023).

Gender and drugs in Europe: data overview

This section explores the role of sex/gender in the use of substances, both licit and illicit. Alcohol and tobacco are included here as they are the most commonly used psychoactive substances in Europe. They provide a backdrop against which gender differences in illicit drug use can be viewed. Moreover, illicit drugs are often used in combination with tobacco, alcohol or both.

Key figures on the use of alcohol, tobacco and illicit drugs by sex/gender are provided in this section. It must be considered that most data sources only include information on biological sex at birth, as most data collection tools do not distinguish between sex and gender. In addition, data on gender identity in this context is very scarce.

The EUDA data described below are therefore mainly referring to sex at birth, except for the web survey’s data, where information on gender identity is also collected.

As explained in the key concepts, the two dimensions – sex and gender – are interlinked and important to the analysis of the drug issue from a gender perspective.

What are the main gender differences in the prevalence of use of alcohol and tobacco in European countries?

According to the latest Eurostat (2022) data on the use of tobacco, 27 % of males and 18 % of females aged 15-64 years in the European Union smoked cigarettes daily in 2019 (Figure 2).

 

 

According to Eurostat (2021), the percentage of males aged 15-64 consuming alcohol daily was 10 % in 2019, while 3 % of females aged 15-64 consumed alcohol daily. Males (22 %) were more likely than females (12 %) to report at least one ‘episode of heavy drinking’, corresponding to 60 grams of pure ethanol or six standard drinks on one occasion, in the last month in 2019 (Figure 3).

 

Note: An ‘episode of heavy drinking’ corresponds to the consumption of 60 grams of pure ethanol, equivalent to six standard drinks on one occasion.

What are the main gender differences in the rates of illicit drug use in the European countries?

Based on the latest available general population survey data (mostly from 2023) and population data, around 53 million males and 36 million females aged 15-64 in the European Union have tried any illicit drug at least once in their life. for the main illicit drugs covered by our general population survey indicator (cannabis, cocaine, amphetamines, ecstasy) is higher among males than females in all countries for all reported main illicit drugs (Figure 4).

Figure 4. Prevalence of use by substance among males and females in Europe

• Cannabis
• Cocaine
• Amphetamines
• Ecstasy

What are the main gender differences among adolescents in substance use prevalence?

Our best window on substance use behaviour among adolescents is provided by the European Survey Project on Alcohol and other Drugs (ESPAD), which has been gathering comparable information on substance use among 15- to 16-year-old school students across Europe for 30 years. The most recent round of the survey, carried out in 2024, found that the gender gap in the use of legal substances, namely of alcohol and cigarettes (more recently including e-cigarettes), has gradually narrowed over time and, for certain patterns of use, girls have even surpassed boys (Figure 5).

When it comes to illicit substances, boys consistently reported higher consumption rates than girls. Lifetime use of illicit drugs was reported by 12 % of girls and 14 % of boys. Notable exceptions include Malta, where 15 % of girls and around 9 % of boys reported lifetime cannabis use, and some countries such as Cyprus, Czechia, Latvia, Slovakia and Slovenia, where the use of new psychoactive substances (NPS) was higher among girls.

In contrast, inhalant use in 2024 was higher among girls on average (7.9 % among girls versus 6.7 % among boys) and exceeded that of boys in 25 out of 37 ESPAD countries. A broadly similar pattern is observed for the use of pharmaceuticals for non-medical purposes, where girls reported a higher lifetime prevalence than boys in most countries and overall (16 % versus 11 %).

In 2024, ESPAD included for the first time the WHO-5 Well-being Index (WHO, 2024), a validated measure of mental state based on recent life experiences. Overall, 59 % of students overall reported a good level of well-being. Boys, however, tended to report higher levels of well-being than girls, both on average (69 % versus 49 %) and across all ESPAD countries, highlighting a persistent and concerning pattern. The gender gap is particularly wide in Italy, Poland and Sweden, where the difference was approximately 30 percentage points. These findings suggest the need for gender-responsive approaches in adolescent mental health prevention and support strategies.

Figure 5. Prevalence of use by among 15-16 year old school-going students in Europe (ESPAD)

• Alcohol use
• Illicit drug use

What are the main differences by sex and gender identity among respondents to the 2024 European Web Survey?

The European Web Survey on Drugs is a voluntary, anonymous online survey of people who use drugs, carried out in EU and other countries. In 2024, the majority of the over-66 000 participants identified as men (58 %), followed by women (39 %), with a small number identifying as transgender or non-binary individuals (2 %) and 1 % preferring not to answer the question on gender identity. Regarding sex, 59 % of respondents reported being male, 40 % female and 0.2 % intersex – 1 % declined to answer this question.

The most commonly reported reasons for using drugs were ‘to get “high”/for fun’, ‘to reduce stress/relax’ and ‘to stay awake’. Among respondents, the motivations for using drugs varied by gender identity and type of drug. Some useful insights are provided by looking at the most prevalent drugs: cannabis, cocaine and amphetamines.

Among those who have used cannabis in the last 12 months, a higher proportion of men reported using the drug to ‘get “high”/have fun’, compared with women and transgender respondents (Figure 6b). A higher proportion of women reported using the drug to ‘reduce stress/relax’, compared with men and transgender persons. A higher proportion of transgender respondents reported using the drug ‘due to dependence’, compared with men and women.

 

 

Term	Coord
Female	0
Male	1
Intersex	2
I prefer not to answer	3

Term	Coord
Woman	0
Man	1
Transgender or non-binary	2
I prefer not to answer	3

What are the gender differences in people who use drugs attending hospital for acute drug toxicity?

Data on acute drug-related hospital emergencies are collected by the Euro-DEN Plus project, a network of sentinel hospital emergency departments across Europe and neighbouring regions. In 2024, three quarters of the acute drug toxicity presentations reported to Euro-Den Plus were among males. The proportion of females varied by centre (Figure 7) and substance. Among the most commonly reported illicit drugs, the highest proportions of females were for hospital presentations for the use of MDMA. No specific geographical patterns are observed in the proportion of females.

The median age of people presenting with acute drug toxicity was 32 years (30 years among females and 33 years among males), with a significant difference between males and females.

Cocaine was the most commonly reported substance, mentioned in 26 % of presentations. Cannabis (24 %) and amphetamine (14 %) were the second and third most commonly reported substances. Heroin and methadone were the most commonly reported opioids in most centres. However, potent synthetic opioids such as fentanyl and fentanyl derivatives, and nitazenes were reported in some centres.

 

What are the main gender differences among people entering drug treatment?

In 2023, more than 210 000 males and around 52 000 females entered treatment for problems relating to their drug use in the 27 EU Member States, Norway and Türkiye. This equates to approximately 75 % males and 25 % females.

The higher proportion of males among treatment entrants is due primarily to the higher prevalence of illicit drug use among males. In addition, women often face greater barriers to accessing treatment. The relative proportions of males and females entering treatment vary by substance and country, with the highest proportions of males found among treatment entrants who report cocaine or cannabis as their main problem drug (both with around 80 % males), and the lowest among those whose main problem drug is a non-cocaine stimulant (e.g. 74 % males for amphetamines).

Regarding geographical differences across Europe, in general, southern countries report a higher proportion of males among treatment entrants than northern countries. Geographical variations may be related to several factors, including country differences in the prevalence and patterns of substance use, treatment organisation and/or provision, treatment access, data collection methodology and other social factors varying by social context.

The geographical variations observed here may be partially explained by the overall differences in social contexts between European countries. Countries in the north of Europe generally report a higher level of gender equality, including in drug-use behaviours and treatment access, than countries in the south of Europe. These gender inequalities mirror, to some extent, those reported in the 2024 EIGE gender equality index 2024 (EIGE, 2024b). Social norms and expectations play an important role in influencing behaviours in general and deviant behaviours such as illicit drug use in particular.

Figure 8. Gender distribution of people entering drug treatment in Europe

• All substances
• Amphetamines
• Cannabis
• Cocaine
• Ecstasy
• Opioids

 

 

 

 

 

 

Are there gender differences in HIV and HCV prevalence among people who inject drugs?

Understanding the prevalence of drug-related infectious diseases at national level is challenging as recent data are not available for many counties. The latest available studies, conducted in 12 EU countries between 2019 and 2023, estimated the prevalence of HIV among people who inject drugs to be between 0 % and around 33 %. Due to differences in national surveillance capacities, caution is recommended when making comparisons between countries.

The prevalence of HIV among males ranges from 0 % in Luxembourg (out of 35 tested), Malta (66 tested) and Slovenia (21 tested) to 35 % in Italy (78 tested). HIV prevalence among females it ranges from 0 % in Cyprus (17 tested), Luxembourg (10 tested) and Malta (20 tested) to 33 % in Spain (314 tested) (Figure 9).

In the latest available studies, from 11 countries covering the years 2018-2023, the prevalence of HCV among males ranges from a minimum of 14 % in Czechia (out of 2 063 tested) to 73 % in Portugal (out of 310 tested). HCV prevalence among females ranges from 14 % in Czechia (1 241 tested) to 86 % in Lithuania (out of 72 tested) (Figure 9).

Figure 9. Gender differences in HIV and HCV prevalence among people who inject drugs

• HIV
• HCV

 

 

What are the main gender differences in drug-induced deaths?

Almost 7 500 drug-induced deaths were reported to the EUDA in 2023, the most recent reporting year. Males represent 78 % of the reported deaths and females 22 % (see the 2025 European Drug Report). Although these percentages vary between countries (Figure 10) and over time, in general the majority of drug-induced deaths occur among males, overall and in all EU countries.

 

The distribution of drug-induced deaths between males and females shows a higher proportion of male deaths in the south and east of Europe, compared with the north and west of Europe.

Overdose mortality rates are higher among people who use drugs than in the general population for both males and females (adults aged 15-64 years). Mortality rates due to overdose among males are typically 3 to 4 times those among females. The highest mortality rates among males are seen among those aged 40-44, while for females, the highest rates are found among those aged 65 and over (see the 2025 European Drug Report).

Many overdose deaths are reported as accidental, and others have an undetermined intent. Some countries have access to more detailed information on intentionality. Among these countries, a sizeable proportion of reported overdose deaths (around 17 %) were classified as intentional, which implies a suicidal intent. In all countries where data on intentionality were available, the proportion of overdose deaths with a suicidal intent was higher among females than among males (Figure 11). In a small number of countries, more than a third of the reported overdose deaths among females were classified as having a suicidal intent.

 

Most drug-induced deaths involve more than one substance (polysubstance use), with opioids involved in the majority of the deaths. An increase in drug-related deaths overall has been reported in the last decade in some countries. This is reported for both sexes and is mainly linked to an ageing population of people who engage in high-risk drug use, also partly due to some drug-induced deaths involving prescription opioids and other medicines. The number of overdose deaths reported among those aged 50-64 increased by 134 % between 2013 and 2023 (by 76 % among females and by 159 % among males). In 2023, the mean age of those who died of a drug overdose was 44 years for females and 42 years for males (EUDA, 2025).

Is the gender gap in drug use narrowing?

When looking at trends in the proportions of females and males in different epidemiological indicators (drug use in the general population, among school students and among people entering drug treatment), the gender gap appears to be rather stable over the years.

However, when looking at trends in the use and patterns of licit substances (e.g. alcohol and heavy episodic drinking), the sex differences have decreased in more recent years. This is particularly striking among school students, with the latest ESPAD survey reporting that girls are reaching the same levels of tobacco and alcohol use as boys, or even exceeding boys on some measures. However, this seems to be mainly related to a decrease in use among boys. Some countries also report a narrowing gender gap in illicit drug use behaviours among the adult population, although it varies by country.

These trends may reflect an increased similarity in risk behaviours between females and males over time and particularly among younger generations. The narrowing gender gap in substance use prevalence is likely to be due to an increased similarity in social behaviours between girls and boys; those similarities are greater for licit behaviours, which are considered more socially acceptable for women and girls.

A gender perspective in drug policy and interventions

What is a gender-responsive health intervention?

Gender-responsive interventions aim at gender equality and take into consideration women and men in all their diverse and specific needs, including gender identity and sexual orientation.

The WHO (2011) offers a gender-responsive assessment (GRA) scale to evaluate the inclusion of a gender perspective in health interventions, with the aim of promoting gender equality. The scale can be used in various fields, including the drugs field, to understand the extent to which the needs of different genders are addressed and effective responses are implemented. This is crucial if interventions are to be appropriate and effective, as the drugs phenomenon is highly differentiated by gender. Appropriate and effective responses should address these differences.

Show a text version of the above graphic

• Level 1
  •  Gender unequal: perpetuates inequalities
• Level 2
  •  Gender blind: ignores gender norms
• Level 3
  •  Gender sensitive: Acknowledges but does not address inequalities
• Level 4
  •  Gender specific: Considers women's and men's specific needs
• Level 5
  • Gender transformative: Aims at transforming harmful gender norms, roles and relations

Gender-responsive policy: considers genders, norms, roles and relations; takes active measures to reduce harmful effects.

The WHO GRA scale is a 5-level framework that defines interventions according to their level of gender responsiveness, ranging from level 1 (gender unequal) to level 5 (gender transformative) (Figure 12).

What has been done in European countries to include a gender perspective in the drugs field?

Our understanding of the main approaches to drug treatment and gender in Europe is based on routine reporting to the EUDA by 29 countries (27 EU Member States, Norway and Türkiye). The majority of countries reported specific interventions available at local or regional level, mainly targeting women and three countries reported no provision of gender-responsive services; and four countries provided no data on this point. Only one country, Spain, had conducted a comprehensive national-level mapping of gender-responsive interventions. 

In 22 out of the 29 countries, specific interventions, mainly targeting women, are reported. These include programmes within mainstream drug services, sometimes with dedicated opening hours for women, as well as specialised services or treatment centres for women, or a combination of both. Specifically, 21 countries have dedicated services for women, including pregnant women and mothers, while two countries reported only services for pregnant women or mothers with young children.

Services for LGBTQIA+ individuals who use drugs are reported to be less widely available, except for some harm reduction services aimed at people engaging in chemsex, or occasional examples of inclusive harm reduction services tailored to the needs of LGBTQIA+ individuals. Peer to peer interventions are rare, but good practice examples are reported in some countries. 

Very few services address the specific needs of men as parents or behaviours related to gender roles and norms expected of men, such as risk-taking, dominance and misogyny. Services addressing men who use drugs as perpetrators of gender-based violence are poorly documented and are reported to be rare (Gilchrist et al., 2022).

The primary approach of all these services is inclusive, as they aim to facilitate access to drug treatment to all women and men, gender identities and sexual orientations, as treatment access is reported to be more difficult for women and transgender persons. 

Common characteristics of drug services with a gender perspective are also their multisectorality and multidisciplinarity, as they must address not only drug-related needs, but also gender-specific needs, including mental and physical health, gender-based violence, social needs, parenthood and childcare.

What are the key policy documents and guidelines on gender and drugs?

A series of institutional documents exists regarding the relationship between gender and drugs, which highlight the importance of considering a gender perspective in the drugs field.

The UN Commission on Narcotic Drugs has specific resolutions that encourage the mainstreaming of gender perspectives and/or supporting services for women including:

• CND Resolution 55/5 – promoting strategies and measures addressing specific needs of women in the context of comprehensive and integrated drug demand reduction programmes and strategies (United Nations, 2012);
• CND Resolution 59/5 – mainstreaming a gender perspective in drug-related policies and programmes (United Nations, 2016).

The UNODC and the WHO have published International standards for the treatment of drug use disorders, which highlight the need for the provision of evidence-based and gender-sensitive interventions as key principles (WHO and UNODC, 2020). In particular:

• Principle 4 – treatment services should be gender-sensitive and oriented towards the needs of the populations they serve, with due respect for cultural norms and the involvement of patients in the service design, delivery and evaluation;
• Principle 5 – responding to the special treatment and care needs of population groups including gender-specific issues in the treatment of adolescents.

At European level, the EU Drugs Action Plan 2021-2025 (EU Council, 2021) sets the following objectives:

• to enhance treatment options to include gender-specific approaches;
• to identify and reduce barriers to treatment and other service utilisation for women who use drugs;
• to ensure such services are sensitive to the needs of women (e.g. include childcare support);
• to launch outreach efforts to reach women drug users and make them aware of available women-focused treatment.

Finally, several guidance documents and strategic institutional recommendations are available on how to integrate a gender perspective into drug interventions by implementing a gender-responsive approach (Arpa, 2017; EIGE, 2021; Mutatayi, 2022; EMCDDA, 2023).

What are the conclusions of the 2023 Swedish Presidency of the Council of the European Union on gender and drugs? 

In 2023 Sweden had the Presidency of the Council of the European Union and chaired the Horizontal Working Group on Drugs (HDG) indicating as one of their thematic priorities gender and drugs.

The Presidency identified four thematic areas to prioritise when working on gender and drugs, including: access to treatment for women and men with drug use disorders; women in drug supply and organised crime; gender and drug overdose; gender-based violence and drugs.

How can gender-responsive interventions be implemented in the drugs field?

If some policy documents address the needs for a gender perspective in the drugs field, it is necessary to clarify what does gender-responsive interventions mean in practice and how they can be implemented. 

The task of moving from theory to practice and defining a common understanding of what constitutes gender-responsive interventions was at the centre of the Gender and drugs symposium held in Lisbon in 2024. The symposium identified five key areas and proposed 39 actions. 

Area 1 – Drug policies: adopt a gender perspective in drug policies, which is systematic, comprehensive, balanced and human-rights based.

Area 2 – Minimum quality standards: define minimum quality-based standards for gender-responsive practices in the drugs field and share best practices across different countries and contexts.

Area 3 – Implementation of gender-responsive interventions: ensure the implementation of gender-responsive interventions in the drugs field by addressing different and specific gender-related needs.

Area 4 – Gender based violence and drugs: address gender-based violence as a risk factor, correlate or possible consequence of drug use.

Area 5 – Monitoring: systematically include a gender perspective in drug monitoring and research.

What are the key aspects to consider when providing drug-related services for women?

Most available drug interventions incorporating a gender perspective focus primarily on women’s needs. However, further efforts are necessary to address the specific needs of women and men across a spectrum of gender identities and sexual orientations.

The Health and Social Responses Guide (EMCDDA, 2023) includes a number of recommendations for interventions targeting women who use drugs.

• They should heighten awareness of addiction problems among women for professionals and policymakers.
• They should work to reduce stigma, by implementing a non-judgmental and non-moralistic attitude towards women who use drugs. Women suffer a double stigma: the stigma of being a person using drugs and the stigma as women not complying with the gender role – a stigma that can be even higher when women are pregnant and mothers.
• They should address gender-based violence through the establishment of trauma-informed treatment interventions. Psycho-social interventions targeting the trauma caused by gender-based violence should be implemented, paying attention to not retraumatise women, while working on awareness and women’s empowerment and self-confidence.
• They should adopt a multidisciplinary approach, where different types of services (health, social, legal) are integrated, facilitating collaboration between the various sectors.
• They should address the social needs of women who use drugs: from justice to housing, social insurance and benefits.
• They should address gender-based violence, by emphasising the need for integrated services that simultaneously address substance use and gender-based violence and that specialised services for victims of gender-based violence are accessible to women who use drugs.
• They should address parenthood. Women are still the main caregivers of children, although both parents have the same duties, and it would be necessary to address the specific needs of women as mothers, including parental education, childcare and family support, with the proviso that this does not imply excluding fathers from parenthood.
• They should provide services for women who are pregnant. It is important that services for pregnant women address a spectrum of needs including those related to drug use, obstetric and gynaecological care, infectious diseases, mental health.
• They should treat psychiatric comorbidity. People with comorbidities, particularly women have complex needs that should be addressed through an integrated care where substance use and mental health problems interact and should be treated in an integrated way.

Depending on the social or occupational context of women, the Health and Social Responses Guide (EMCDDA, 2023) identifies additional measures that may be necessary.

• Women involved in sex work: Support should be provided to help these women access drug services and overcome the barriers to drug treatment. Measures such as women-only services, mobile outreach services and peer support could be important responses.
• Women in prison with drug-related problems: There is a need for gender-responsive, trauma-informed and integrated interventions that address the multiple issues of women in prison with drug-use problems. These interventions should consider the unique needs of women in detention, in terms of accessibility to services, staffing, methods and materials, and their multiple vulnerabilities.
• Women who use drugs from ethnic minorities/migrants/displaced: Services targeting those women should have a sensitivity towards ethnic and cultural aspects and the possibility of an interpreter when required. They should also consider the intrinsic vulnerability of this population group, where barriers to access treatment may be linked to fear of deportation, language difficulties and cultural differences.
• Older women: As people who use drugs are getting older, substance use disorders are becoming more common in women over 60, with people in long-term opioid treatment having specific needs. Women in treatment suffer from osteoporosis, menopause and other chronic conditions earlier than the general population. In addition, among those dying from a drug overdose, a higher proportion of women than men are reported to have had suicidal intentions.

How can a gender perspective be applied to interventions for men who use drugs?

Overall, men are the main clients of drug services, as most people who use drugs and develop problems related to their drug use are men (EMCDDA, 2023). Overwhelmingly, research on substance use treatment for men has not critically examined the gender dimension of male-specific issues relating to drug use, including health, psychological and social needs.

Traditional gender roles, gender stereotypes or gender norms are not taken into account in policy design and implementation when addressing the needs of men who use drugs. For example, the influence of different types of masculinities expressed in drug-use behaviours is not considered, nor is men’s trajectories into drug use and addiction: the dimensions of risk-taking behaviours play an important role in men’s drug use as well as in the legal consequences of drug use, where male deviance differs from that of women (Davidson, 2024).

Interventions provided for men are limited to gender-neutral responses, although a better understanding of the role of masculinities in drug-use behaviours may help to improve prevention interventions as well as the planning and implementation of effective interventions for all men, without excluding other genders (Hunt and Antin, 2019).

What should be done to address the needs of LGBTIQA+ people who use drugs?

At present there are few specific interventions aimed at the LGBTQIA+ persons, since the dimensions of gender diversity and sexual orientation are not yet fully integrated into the care of people who use drugs. In addition, the numbers of LGBTQIA+ individuals are relatively low, and they are often less visible.

LGBTQIA+ persons who use drugs have specific needs, and more information and targeted interventions are needed (Ruppert et al., 2021). Transgender and non-binary individuals are known to experience higher risks of developing substance use disorders and mental health problems, including suicidal thoughts.

Transgender people disproportionately face significant adverse health outcomes and greater risk of experiencing gender-based violence (Chibanda et al., 2014; Leventhal et al., 2014; Reisner et al., 2015; Whiteford et al., 2013). However, interventions targeting these populations are scarce. Culturally sensitive responses are needed to meet the needs of these groups (Connolly et al., 2024; Glynn and van den Berg, 2017).

What is chemsex and what responses are available?

Chemsex is the use of drugs in the context of sexual activities, whether alone, with a partner or with a group. The use of drugs during sexual encounters is not a recent phenomenon, and it can occur in various settings. Over the past decade, however, there has been an increase in its prevalence and a concomitant codification of this practice, through organised sex parties or dating apps, primarily among men who have sex with men, and particularly with the use of stimulants (methamphetamine, synthetic cathinones, etc.). The use of drugs prior to or during sexual activity is intended to enhance sexual performance and pleasure. However, there are potential risks involved, including an increased likelihood of contracting sexually transmitted infections and developing drug dependence. Reports of this pattern of behaviour among some groups of men who have sex with men have raised concerns in some countries (Milhet, 2017; Milhet et al., 2019).

There is a substantial prevalence of drug use, particularly stimulant use, among the clientele of sexual health services, and sexual health problems are common among persons treated for drug problems. Links between sexual health and drug problems can arise in a number of ways. Drug use can intoxicate and disinhibit, leading to unintended sexual activities – consensual or not – that result in negative consequences, such as regret, mental distress, sexually transmitted infections, and impact on professional and social life. Some people with drug problems may engage in sex work to fund drug use, increasing their risks of sexually transmitted infections and assault. Drugs may be used to cope with the emotional distress arising from a sexual health problem, such as an HIV diagnosis.

In a recent French study on drug trends in Paris and Île-de-France, people engaging in chemsex were found to be increasingly diverse in their socio-demographic profiles, with greater visibility among those attending drug services of people using new psychoactive stimulants and those with migratory backgrounds (Klingelschmidt et al., 2025).

Interventions targeting chemsex focus on the risks linked to the injection of stimulants. They include harm reduction measures, which are aimed particularly at preventing the transmission of infectious diseases, both through drug injection and unprotected sex (EMCDDA, 2021b).

In Europe, treatment services for drug and sexual health problems are usually funded separately, have different eligibility criteria and are rarely co-located. This makes it challenging to provide ‘joined up’ care for people with both types of problems. Each type of service focuses on providing only one type of care, missing an opportunity to address both sets of problems.

What is the European Drugs and Gender Group and what is its aim?

The European Drugs and Gender Group (EDG) was formed in 2019 in preparation for the 2019 Lisbon Addictions conference. It brings together experts from various organisations with the overall goal of promoting gender mainstreaming in the drugs field. The group aims to strengthen collaboration across countries, organisations and experts, and to enhance the scientific basis for informing research, practice and policies on the need for the systematic inclusion of gender perspectives on the drugs phenomenon.

The group organised side events to the Lisbon Addictions conferences in both 2022 and 2024.

The group is coordinated by the European Union Drugs Agency in collaboration with the Pompidou Group of the Council of Europe (PG-CoE), the United Nations Interregional Crime and Justice Research Institute (UNICRI) and the European Agency on Gender Equality (EIGE). Experts from international organisations, national governmental and non-governmental organisations, various disciplines, academia and people with lived experience of different European countries are part of the group, which is open to new interested experts.

The group recognises that the drugs phenomenon affects women and men in different ways, according to various national and social contexts, and other intersecting factors. It also recognises that gender equality is achieved by consciously identifying those structural social differences and acting on them.

Methodological approach

What are the sources of the data on gender and drugs?

These FAQs are based, in part, on data collected by the EUDA through the Reitox network of national focal points for the following epidemiological indicators:

• Prevalence and patterns of drug use
• Drug-related deaths and mortality
• Drug-related infectious diseases
• Treatment demand indicator.

In addition, data are sourced from:

• the European Survey on Alcohol and Other Drugs (ESPAD)
• the Euro-DEN Plus network of sentinel hospitals

• the European Web Survey on Drugs.

To identify drug treatment interventions that incorporate a gender perspective, the EUDA analysed qualitative information provided by national focal points on the treatment of individuals who use drugs.

What other information sources are used in the FAQs?

The European Institute on Gender Equality (EIGE) website was a major source of the key concepts developed in these FAQs.

Other key information sources were selected studies from the scientific literature and international guidelines on gender equality and on gender and drugs.

Click here to access the list of resources.

What are the main limitations on data on gender and drugs at the EUDA?

These FAQs present several methodological limitations.

• Gender-related data available to the EUDA mainly refer to sex at birth, with the exception of the European Web Survey on Drugs, which also collects data on gender identity.
• Collected data are mostly based on reporting from the national focal points, following an internal data quality assurance procedure.
• Other data sources may also exist but may not be available to the EUDA.
• Most data requested by the EUDA from the European countries include a breakdown by sex (female/male). However, some EUDA data (drug law offences, wastewater analysis, syringe residues) do not include a sex breakdown, either because they refer to episodes and not individuals (e.g. drug law offences) or because estimates cannot be broken down by sex (e.g. wastewater analysis and syringe residues). Work has started to obtain those data whenever possible.
• Most data reported to the EUDA are provided in an aggregated form and not at case level. This limits the possibility for further sex/gender breakdown for the variables not already reported by sex and gender; for that reason the EUDA is working to extend the inclusion of sex and gender in most variables.
• Available information on sexual orientation in the context of drug use mainly refers to chemsex.
• Little information, either qualitative or quantitative, exists on drug-related interventions with a gender perspective. What is reported is not collected in a systematic way. However, efforts are being made to incorporate a gender perspective in this field.

How can a drug monitoring system better include a gender perspective?

A gender perspective is rarely applied in the analysis of the drug situation, interventions and policies and drug monitoring. The European Institute for Gender Equality (2021) recommends a number of actions that should be taken to improve the quality of gender statistics. These can be applied to drug monitoring.

• Awareness on the importance of gender mainstreaming in the area of drugs should be raised.
• The gender dimension must be systematically considered in the collection and analysis of data and the dissemination of findings.
• The two-step approach proposed by EIGE should be used. The first step, sex at birth, as a core variable; the second step, gender identity (self-identified gender), as an additional, intersectional variable(EIGE, 2021, 2024a).
• When choosing gender options , it is important to consider ethics and inclusivity, as well as pragmatism, historical trends, data analysis and sample size.
• Incorporate an intersectional approach in research and monitoring, considering both intersecting inequalities and multiple inequalities, which implies the recognition of multiple discriminations in the analysis of population needs. Those layers vary by location, culture, race, etc. Examples are data collected by sex and age, by ethnic group, level of poverty and other deprivation indicators. Data should be reported not only separately for women and men and for different age groups, but separately for women and men within each age group.
• Introduce instruments (or adapt existing tools) for the assessment of gender-specific needs in order to appropriately respond to gender-specific drug problems.
• Obtain a comprehensive overview of available gender-responsive interventions in Europe, identifying existing gaps and needs for responses to adequately address the different gender categories.
• Consider a gender dimension at institutional level in all strategic documents.
• Identify knowledge gaps at different levels, from policy, to epidemiology, to interventions.

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Yi, S., Peltzer, K., Pengpid, S. and Susilowati, I. H. (2017), ‘Prevalence and associated factors of illicit drug use among university students in the Association of Southeast Asian Nations (ASEAN)’, Substance Abuse Treatment, Prevention, and Policy 12, 9, https://doi.org/10.1186/s13011-017-0096-3.

Source data

The data used to generate data visualisations on this page may be found below, as well as in our Data catalogue. This data set is covered by a Creative Commons Attribution 4.0 International (CC BY 4.0) licence.

Translation table

ID	Term
10	Percent
20	Sex: males (%)
21	Males
50	All drugs
51	Amphetamines
52	Cannabis
53	Cocaine
54	Ecstasy
55	Opioids
100	Female
200	Male
300	Intersex
400	I prefer not to answer
500	Man
600	Woman
700	Transgender or non-binary
800	Gender
850	Share of responses within each gender category (%)
900	Sex
1000	Data: Eurostat | Charting tool: HighCharts
1100	Data: ESPAD | Charting tool: HighCharts
1110	Data: EUDA-Euro-DEN | Charting tool: HighCharts
1150	Data: EUDA | Charting tool: HighCharts
1200	Data: ECDC | Charting tool: HighCharts
2000	Substance
2100	Motivation (displaying results ≥ 5% for each gender category)

About this page 

Recommended citation: European Union Drugs Agency (2026), Frequently asked questions (FAQ): gender and drugs in Europe, https://www.euda.europa.eu/publications/topic-overviews/drug-induced-deaths-faq_en