The aim of this research is to explore what type of support is available to women who use drugs in Britain, their experiences of treatment and ultimately, how services can be improved to support these women. The research was split into two parts, a quantitative section scoping the level of mainstream versus specialist women-only support and treatment at a local level, and picking up trends from the response to surveys conducted with third-sector organisations. The qualitative part of this research focused on 1 on 1 interviews, roundtables, surveys and literature reviews.

Our quantitative research found there was a wide variation in what services local authorities provided for women who use drugs. Some areas reported an extensive and comprehensive list of interventions catering to different demographics of women, in a variety of community and clinical settings. Other local authorities had very little special provisions to engage women who use drugs. Our qualitative research which focused on engaging women with lived experience and staff that worked with them, heard many key issues and themes repeatedly raised. We heard how women use drugs differently to men. While trauma is a big factor in both male and female substance use, relationships with a partner play a much larger role in women’s drug use. Women were more likely to be introduced to drugs by a partner, while men were more likely to be introduced by a friend.

Women’s use often began out of “necessity”, as a coping mechanism, whereas we know men are more likely to first use drugs recreationally. We also heard how women were more likely to progress from first use to problematic use more quickly, a process known as ‘telescoping’. Though women make up a much higher proportion of front-line staff working at drug services, women who use these services are underrepresented in data and research around drug use and drug treatment populations. Drug use and problems unique to women have received insufficient attention in research. We also heard how treatment services can be a daunting prospect for many women. For women with experience of domestic abuse, male-dominated services were often intimidating. Men are nearly twice as likely as women to have used drugs, and make up around three quarters of the drug treatment population in England.

With much of the treatment system taken up by male long-term opiate users, the capacity to develop expertise and services to meet the needs of women, and the diversity of needs within the female population is limited. Drug using communities are often small and it is common for women to have been in group settings with a former partner or abuser. Women who have experienced domestic abuse are eight times more likely to develop an issue with drugs than those who haven’t. The impact of long-term disinvestment on how women engage with services was made clear. Where some authorities have the resources to provide a whole range of services for women who use drugs, others do not have the capacity. It is clear that treatment providers having to prioritise the needs of the long-term heroin using population has meant more specialist services have had less investment. However, though investment is vital, it is not the only way to address this issue and there are practical steps that require little funding but which have the potential to improve women’s engagement in treatment. The recommendations from our research are set out.