European cities are at the frontline of drug policy and harm reduction. With rising urban populations and rapidly changing drug trends, municipalities face unique challenges, from chronic underfunding and service gaps to stigma, political resistance, and the spread of new psychoactive substances. At the same time, cities are proving to be laboratories of innovation, developing pragmatic, rights-based approaches that save lives and strengthen communities. This report brings together insights from city consultations across Europe. It highlights shared challenges, showcases pioneering practices from cities like Zurich, Vienna, Amsterdam, and Glasgow, and outlines concrete recommendations for municipalities, national governments, and EU institutions.

By bridging local realities with broader policy frameworks, the report underlines the crucial role of municipal leadership, cross-sectoral cooperation, and community engagement in building resilient harm reduction responses. It advocates for sustainable funding, inclusive access for marginalized populations, and stronger communication strategies to counter stigma and misinformation. Developed under the European City Initiative on Drug Policy (ECIDP), this publication offers evidence-based strategies to inspire and guide policymakers, service providers, and communities. Its goal is clear: empower cities to respond effectively to emerging drug trends and safeguard public health, dignity, and human rights.