and nonbinary people are often excluded from services ,’ said Aura Roig Forteza . ‘ When they go to other services , such as mental health , they ’ re not allowed in because they ’ re using drugs .’ She went on to describe her experience in her home country , Spain . In the late ’ 80s , Spain had the highest rates of HIV in Europe . Her service , Metzineres , was responsive – an innovative , daring , non-profit cooperative , providing a sheltered environment exclusively for women . ‘ It covers the full spectrum of harm reduction approaches ,’ she said .

Being effective meant breaking protocols . The Metzineres model provided consistency while being reliable , pragmatic and cost effective . Above all , it welcomed all women with compassionate responses . ‘ We try to empower the women and respect their goal ,’ she said .

FLIP THE NARRATIVE ‘ I used drugs since I was 13 and was only ever treated punitively ,’

said Anna Millington , explaining why she set up the support group , Mother2Mother . When her daughter was taken off her for two years , she realised how hard it was to move on from a negative stance .

‘ We ’ re told “ don ’ t fear us , you can come into services ” – but it ’ s a lie ,’ she said . ‘ Mothers are told they have choices and options – but they haven ’ t .’ Experiencing attitudes that they shouldn ’ t be taking drugs , mothers were hiding from treatment services and afraid of social services . ‘ But they ’ re not the expert – you are ,’ she would tell them . Generational trauma was all too frequent , but ‘ if you ’ ve been taken off your mother , you ’ re even less likely to trust services .’ Her mission was ‘ changing things from hidden and seedy to public and positive ’, as ‘ if people feel so badly about it , they don ’ t want to talk about it .’

‘ Do you consider mothers who use drugs in your service ?’ she would ask services , But she soon realised that acknowledging the question implied having to do something about it – a slow process . So she launched a campaign to collect positive and negative stories and create

materials for mothers , based on what they actually wanted .

‘ I ’ m angry that I ’ m watching mothers and children being ripped apart ,’ she said . ‘ It ’ s time to flip the narrative .’

‘ Drug use doesn ’ t happen in a vacuum – the lives we live impact on how we use drugs .’

AILISH BRENNAN

EXPERT OPINION ‘ Drug use doesn ’ t happen in a vacuum – the lives we live impact on how we use drugs ,’ said Ailish Brennan of the Women and Harm Reduction International Network . Her journey as a transwoman had combined joy and acceptance with traumatising experiences , and as a result she was passionate about designing gender-sensitive services .

‘ Self-medicating was the only outlet I had ,’ she said . ‘ Trans people are generally very

demotivated to access services – it ’ s very low down on the list of things we want to do .’ However , accessing treatment had changed the way she used drugs and enabled her to enhance her health and wellbeing , so she wanted services to be more accessible and approachable . Above all , they had to be consultative : ‘ We are all experts on our own existence ,’ she said . ‘ We need to be respected and included .’

OVERDOSE RISK Working at the Academy of Perinatal Harm Reduction had led Joelle Puccio to become passionate about reproductive justice and ‘ the right to control our bodies ’. The argument had come about barriers and oppression , rather than the drugs . In the US , overdose was more common during the year following birth . The body was changing during pregnancy and afterwards , so women needed to know what drugs they were taking and what the likely effects would be . ‘ We need to make the healthy choices the easy choices ,’ she said .

Criminalisation was ‘ ineffective ’ and she was involved in developing a harm reduction