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Critical drug studies have developed a significant body of work that illuminates understanding of gender and drug use as well as drug pleasures. However, framing the study of women and their drug pleasures through critical drug studies presents potential limitations. The posthuman turn de-emphasises the primary goal of drug use: a particular subjective experience. Both the language and theoretical frameworks of new materialism potentially distance researchers, as interlocutors, from engaging the human experience of drug pleasures, rendering drug use abstract and unknowable.

In a historical context in which women’s intoxication has invoked shaming and criminalisation, control of their bodies, and silencing of dissent, scholarly activism by and inclusion of women who use drugs should be foundational to critical drug studies. Autoethnography offers a modality by which personal narrative becomes a convention of academic writing. It also presents a way of performing the self critically and authentically within conceptual frameworks that explore the complex, intersectional politics of women’s drug use, ways that are representationally missing in the scholarship. An ethics of care as part of one’s practice of the self proposes a radically different way of framing drug use. The recognition and normalisation of drug pleasures as the complicated, emergent, expressions of ethical self-care that they are for women (and all people who use drugs) promises fertile ground for future scholarly exploration. Research based in the lived experience of women who use drugs will help establish languages that resituate drug use in the phenomenology of their experience.

The Russian Federation has taken a harsh, punitive approach towards drug policy. There are limited health and social services available to people who use drugs and widespread, documented discrimination within the criminal justice system. Amongst those who use drugs, the proportion of women who use injection drugs is estimated to be approximately 30 per cent. While a minority, women who use drugs are often disproportionately impacted by drug policy enforcement and remain underrepresented within research. Moreover, women who use drugs experience specific gender-based forms of discrimination within social, health and criminal justice systems, which result in particular vulnerabilities. This chapter examines policing and sentencing practices within the Russian criminal justice system and their gendered impacts, especially concerning women who use drugs. Human rights reports and court cases as well as interviews from civil society organisation (CSO) workers are analysed in order to understand how gender roles, gender-based discrimination and gender-based violence shape these interactions and result in disproportionate negative impacts on the lives of women who use drugs. This analysis also highlights key areas that need greater involvement and attention from researchers, policymakers and advocates.

Over the past decade, an increase in the numbers of women prosecuted, sentenced and imprisoned for drug-related offences has prompted concern and debate amongst criminal justice practitioners and policymakers. The female prison population in Southeast Asian countries is high compared to other regions. The direction of national drug policies and law enforcement are critical determinants of this situation. This chapter discusses the trends in the illicit drug market, the different types of policy responses, and the impacts on correctional services in the region. It provides an overview of women prisoners’ profiles, their backgrounds and their involvement in drug-related crimes. Key issues relating to the treatment of women in Southeast Asian prisons are analysed and addressed through the lens of the relevant provisions of the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders.

The prevalence of older people who use drugs is increasing in many countries, with evidence that some women continue or begin illicit substance use in midlife and older age. While research on older people who use drugs is limited, evidence of risk behaviours among older women who use drugs is particularly inadequate. Unsafe drug use and sexual practices that are prolonged and sustained over many years increase the possibilities for poorer health, leading to potentially greater morbidity and early mortality among older drug users. This chapter is a timely contribution to the extant literature and explores our current knowledge of the risk behaviours of older women who use drugs.

Although midlife is viewed as a transition period in the life course, the normative role expectations of midlife and older women run parallel to the stereotypes of women who use drugs. Furthermore, drug-using bodies are politically and culturally shaped through control and containment practices centred around notions of difference and risk. Acknowledging the intersection of age, race and gender, this chapter frames its position around the concepts of ‘risk’ and ‘edgework’. Utilising these theoretical concepts, this chapter argues that a shift towards a support-focussed model, rather than control of, older women who use drugs is required. The absence of a focussed, gendered analysis of the lives and experiences of older drug users, and older women who use drugs in particular, limits our understanding. Consequently, the chapter concludes with a call for well-designed studies of this increasing and largely hidden cohort of drug users.

Eastern Europe and Central Asia (EECA) is home to 21% of the world’s population of people who inject drugs and it is the region with the fastest-growing HIV epidemic. HIV prevalence among women who inject drugs is significantly higher than among men in EECA. Even in places with high coverage of needle syringe programmes and HIV testing and treatment, women’s access to opioid substitution treatment is lower than men, and women’s sexual and reproductive health needs remain unaddressed. EECA has a unique system of drug registries that store the personal data of people who use drugs. Registration lowers the chances of employment and access to education and for women and increases the risk of losing custody of their children. The system of drug registries contributes to drug-related stigma. Breaches of confidentiality of drug registry data lead to the further marginalisation of women who use drugs. Criminalisation, past experience of police violence and poverty contribute to healthcare access barriers for women. There is a need for legislative changes to improve personal data protection, decriminalise drug use and reduce police violence. The positive effects of these changes would only be seen in the long term. In the interim, women need special access programmes that are designed specifically to address their needs, that provide free-of-charge services and that ensure the safety and confidentiality of personal data.

Purpose – To examine how drug prices for specific diseases vary across payers in the United States and how insurer and patient out-of-pocket (OOP) costs vary by payer type.

Methodology – This study uses data from the Medical Expenditure Panel Survey (MEPS) from 1996 to 2006. We estimate multivariate price regressions for four major drug product classes (antihypertensive, antidepressant, antiasthma drugs, and non-steroidal anti-inflammatory drugs (NSAIDs)). Separate models are estimated for brand and generic drugs within each of these drug product classes. In addition to estimating overall transaction price equations for brands and generics, the study estimates patient OOP payments and insurer payments for drugs.

Findings – We find relatively modest differences among payers in terms of total prices (e.g., insurer plus OOP). The main difference is in terms of how prices were shared between insurers and patients. Medicaid paid significantly more than other payers for each drug class, while Medicaid beneficiaries paid significantly less.

Research implications – Our results shed light on how drug prices vary by different payers and how drug prices are shared by third party payers and patients. The relatively modest differences in total drug prices across payer type suggest that these payers do not differ greatly in terms of their ability to negotiate price concessions from their suppliers. Instead, larger differences emerge in terms of how total costs are shared among the payer and their patients. Understanding the reasons for these variations, and their implications for health outcomes, are important directions for further research.

Women across the world are being incarcerated at an alarming rate. Between 2000 and 2017, the female incarceration rate worldwide increased by 53.3%, whereas the male incarceration rate increased by only 19.6%. In Latin America, drug offences are the first or second cause of female incarceration. The excessive use of pre-trial detention, mandatory minimum sentences, and disproportionate penalties characterise the region’s drug policies. Recent data compiled by the Washington Office on Latin America show that between 35% and 70% of incarcerated women, depending on the country, are behind bars due to a drug offence, while for men the rate is much lower. In other words, harsh drug laws disproportionately impact women.

Qualitative research on female prisoners accused of drug-related offences shows how gender roles, gender-based violence and social exclusion are often triggering factors for women’s participation in the drug trade. Agency and victimisation co-exist in these women’s stories, and while drug trafficking becomes a means to cope with adversity, it also further enhances previous vulnerabilities, and incarceration can have a devastating impact on their families. These women are engaged in high-risk activities but represent a low risk to society. Drug law reforms and the use of alternatives to incarceration could reduce the number of women behind bars for low-level drug offences.

Illicit drug use amongst women in Zimbabwe is increasing. The most common drugs of choice are marijuana and new psychoactive substances like ecstasy, cough syrups with a high content of codeine, and other small intoxicating pills like mangemba (diazepam). The most affected population group are women between the ages of 20 to 40.

In a community engagement undertaken by Zimbabwe Civil Liberties and Drug Network in five of Zimbabwe’s provinces, socio, cultural and economic factors were identified as the drivers of increased engagement with the drug trade. The urge to be independent and the inter-related aspect of sex work were also identified as push factors accounting for the increase in illicit drug usage in the country. The community engagement showed most women use illicit drugs as a way of liberating themselves within a heavily patriarchal society and due to the traumas associated with sex work. Sex work in turn exposes women to opportunistic infections, rape, violence and sexual violence. Women perform different roles in the illicit drug economy. In their role as sellers of controlled drugs, women aimed to support their families, maximising the opportunities presented by life in illicit economies. Whilst advocacy groups are pressing for drug policy reform in Zimbabwe, interventions can be designed to help women extricate themselves from this quagmire through empowering them and having a drug policy that among other facets, strengthens communities.

Parallel with trends in the wider East Africa region, there has been an increase in the number of women involved in drug use, trafficking and drug-related crime in Kenya (Beckerleg, Telfer, & Hundt, 2005 ). Vulnerable populations, such as domestic labourers, ethnic minorities, those living in slums, bar attendants, sex workers and refugees, are recruited into criminal organisations and assigned roles that expose them to negative health outcomes, human rights violations and incarceration (NACADA, 2016 ). In cases where women do not directly participate in drug use or the drug trade, they often are responsible for mitigating the risks arising from drug use by family members and the community. This reflects their triple burden of care and support when family and social life deteriorates (Mburu, Limmer, & Holland 2019).

The Kenya Narcotic Drugs and Psychotropic Substances Control Act of 1994, criminalises possession and trafficking of illicit drugs. The enforcement of this legislation has led to an increase in the number of women incarcerated in Kenya for drug, but also (and mainly) alcohol offences. This goes against the recommendation of the UN Commission on Narcotic Drugs in 2005 that States should adopt innovative measures and policies that prioritise treatment and rehabilitation as opposed to incarceration. In Kenya, prisons have adopted the Mandela and Bangkok Rules, enabling a paradigm shift in the provision of correctional services for women offenders, including remote parenting, family open days and linkages to aftercare services. However, these policies need to be anchored in the legal framework, with adequate resources to hasten the realisation of goals for the care and treatment of female drug and criminal offenders.

As in other parts of the world, the ‘war on drugs’ in West Africa has led to significant focus on criminal justice, compromising public health and human rights without reducing the scale of drug trafficking, production and use. West Africa is not only a transit zone, local production and consumption continue to rise unabated. The Economic Community of West African States has described drug issues as the enemy of the state and the rule of law, and has called on members States to fight the ‘scourge’.

The failure of the current policies has been vividly documented by the West Africa Commission on Drugs through its 2014 report titled ‘‘Not Just in Transit: Drugs, the State and Society in West Africa’’.

In response, civil society organisations and activists have contributed to raising awareness of the harm being caused by the current repressive drug policies in West Africa and engaged their respective national governments in evidence-based drug policy reform.

These engagements culminated in regional consultations that gave birth to the West African Common Position for the 2016 United Nations General Assembly Special Session (UNGASS) with a call for harm reduction and an evidence based drug policy for the region. Unfortunately, the UNGASS outcome was not as revolutionary as expected by the West African progressive voices, who have therefore continued to engage their governments to make the 2019 High Level Ministerial segment a turning point in the global drug debate.