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were 5,448 drug related deaths in 2023 – that ’ s 5,448 people who have died .’ As Maddie O ’ Hare reminded delegates at the HIT Hot Topics conference of this stark statistic , she added that policy and practice were not fit for purpose , and that ‘ keeping people alive is the minimum we should do ’.

Fortunately , there was ambition among female leaders to support women facing multiple challenges , making sure they not just survived but went on to thrive , and the conference heard from some of them .

Anna Millington , founder of the M2M harm reduction network , showed a video of her daughter Rain talking a few years ago about how her mother ’ s drug treatment made her feel , the stigma she felt and the difficulties she faced .

There could be overuse of safeguarding by workers ‘ covering their backs ’ and it was essential that organisations had strong , clear policies that protected the mother and allowed workers to make decisions based on their knowledge and relationship with the individual , said Millington ,

who followed up discussion through a workshop .

Drug testing was another issue that caused tension between women and their key workers , with scepticism around the accuracy of the tests . They also used up a lot of the valuable time of an appointment – ‘ If I have 30 minutes with a client , I don ’ t want them spending 20 of it in the loo taking a test ,’ said one participant .

Paula Kearny from the SAOL Project in Dublin told delegates about their work with disadvantaged women whose addiction might be the primary issue but where it was often a symptom of underlying problems relating to poverty , abuse or mental health .

SAOL did not insist on drug-free recovery but focused on helping women find their strengths and what they wanted from life . ‘ When a woman walks through the door they are greeted with tea and chats not judgement and stigma ,’ she said . ‘ Many of the women accessing SAOL have suffered severe trauma and may have controlling partners – the service tries to wrap around them and support them . We need to stop continually punishing women

and making it hard for them .’

This was one of the things that made Stella Kityo tired – tired of working in a system that seemed set up to make people fail , tired of people being re-traumatised , and tired of things not changing . As a women ’ s specialist who had worked in all kinds of environments , she supported and empowered women in diverse circumstances . ‘ Women don ’ t want reducing , they want options , a voice , a time to heal ,’ she said . ‘ There needs to be a collective change .’

Sex workers faced multiple stigma – not least from other women , said Grace Sumner from the Women ’ s Inclusion Health Collective . The criminalisation of sex workers caused problems , with sex workers 12 times more likely to be murdered than women not involved in sex work . ‘ But sex workers are well organised and have strong unions and groups – they don ’ t need to be rescued , she said .

The government ’ s plans to adopt the ‘ Nordic model ’ which criminalises clients rather than workers would push workers in the sex trade to take greater risks and engage in more dangerous situations

to protect their clients , she said . There needed to be more open and honest discussion about practical harm reduction – such as new sex workers understanding the value of mirrors to know what was happening behind them , and the importance of hiding all ID and ways of being identified .

Julie Smedley shared her experience of visiting sex workers as part of an outreach team , which did not initially go the way she expected . ‘ I was naive and thought I would change everything ,’ she said . ‘ Women asked for a script and laughed when I suggested an appointment in two weeks ’ time .’

This doubled her determination to help , and as part of WithYou she set up a service in Liverpool ’ s red light district that aimed to overcome the barriers of location , waiting times , flexibility , and stigma . Taking the service to the women also removed their concerns about meeting any of the ‘ three Ps ’ – punters , pimps and perpetrators – who might be attending a mainstream service . Many of the women who came along wanted a script , and while there was initial scepticism around other support offered this gradually lessened , leading to the IRIS project . Launched in December 2023 , it provided holistic wraparound services where most needed .

The devastating global consequences of the war on drugs and lack of safe supply were illustrated by Lynn Jeffreys from EuroNPUD who showed a slide with 47,162 dots representing drug deaths in her native Canada . ‘ If I was trying to do this for the USA there wouldn ’ t be enough space for all the dots ,’ she said . DDN