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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.

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.

Women who use drugs are one of the most maligned, misunderstood and maltreated groups in contemporary culture and society. Despite this, little public outcry nor empathy is given. As a woman who uses drugs, the author examines what lies behind this neglect. A post-structuralist approach is taken in order to examine the categories of meaning assigned to bodies under the twin ruling structures of prohibition and patriarchy. This is done with the intent to better understand and challenge the process of (masculinist) knowledge-making and practices surrounding women who use drugs that treats us as mere objects of knowledge. Furthermore, this chapter draws from feminist auto-ethnography, as the author uses own personal experiences as a woman who uses drugs, a feminist and a drug user advocate as a lens through which to give form to this analysis. Ultimately, the author argue that it is time to let go of outdated, unjust and prejudicial images by challenging established norms and practices, test and apply new theories and negotiate different identities outside of those currently available to women who use drugs. In undertaking this piece, the author hopes that the critical reflections contained within this chapter can ‘cause some trouble’, by being politically useful for the growing movement surrounding women who use drugs.

Global drug policy has undergone significant change over the past decade, especially with the advent of the 2016 UN General Assembly Special Session (UNGASS) on drugs. This was a catalyst moment both in highlighting the need for a gender perspective in drug policy, and in initiating a review of the indicators used to evaluate progress in drug policy.

To date, the UN has not adequately tracked gender-specific data in drug policy. This is symptomatic of the lack of focus granted to the specific vulnerabilities and needs of women in the illicit drug trade. This has resulted in a knowledge and understanding gap in relation to the issues faced by women worldwide.

The importance of quantitative and qualitative data and analysis of how and why women are involved in the illicit drug trade, and how this relates to their age, ethnicity, socio-economic status, family situation and history of trauma, violence and mental illness cannot be understated. Without adequate indicators on the underlying factors of their engagement in the trade, the differentiated impacts that both drugs and drug policies have on their lives, and the vulnerabilities they may face, policy makers will be unable to design and implement drug policies that are truly effective.

This chapter provides a historic overview of how data on women has so far been tracked by the UN. The chapter will then look to the future, focussing on opportunities to identify more meaningful indicators within a revised Annual Reports Questionnaire, and also by leveraging the Sustainable Development Goals, UN human rights mechanisms and civil society research.

The medicalization thesis derives from a classic theme in the field of medical sociology. It addresses the broader issue of the power of medicine – as a culture and as a profession – to define and regulate social behavior. This issue was introduced into sociology 50 years ago by Talcott Parsons (1951) who suggested that medicine was a social institution that regulated the kind of deviance for which the individual was not held morally responsible and for which a medical diagnosis could be found. The agent of social control was the medical profession, an institutionalized structure in society that had been given the mandate to restore the health of the sick so that they could resume their expected role obligations. Inherent in this view of medicine was the functionalist perspective on the workings of society: the basic function of medicine was to maintain the established division of labor, a state that guaranteed the optimum working of society. For 20 years, the Parsonian interpretation of how medicine worked – including sick-role theory and the theory of the profession of medicine – dominated the bourgeoning field of medical sociology.

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.

This chapter examines representations of gender in online modafinil markets. While gender has often been absent from scholarship on online drug markets, our analysis demonstrates the ubiquity of gender in representations of modafinil users and sellers. The analysis draws on visual images, blogs, and marketing emails relating to three websites selling modafinil, discussed pseudonymously. We describe the range of ways that notions of gender are represented in advertising. Although women represent around 40% of that buying modafinil online, websites and communications tended not to feature women. Although sexist stereotypes of women were rarely present (in contrast to direct-to-consumer pharmaceutical advertising), the ways that modafinil was imagined tended to focus narrowly on corporate spheres of work and productivity. We contrast this narrow imaginary with female journalists’ own accounts of using modafinil to manage illness and enhance creativity. Thus, we conclude that the ways that modafinil has been imagined reflects working assumptions as to who is considered the ‘normal’ participant in online modafinil markets.

Sex and gender are regarded as critical structural determinants of mental health and mental illness. Mental illness is a complex phenomenon, and risky behaviour and substance use commonly occur simultaneously or subsequent to one another. A gendered vulnerability in biological, environmental, and behavioural risk factors has been registered in the development and escalation of mental illness. Studies have found that women who use drugs experience greater physical and mental health repercussions than men. Women who use drugs present higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress. This chapter addresses the most common mental illnesses associated with women who use drugs: depression, anxiety, trauma-related disorders, and eating disorders.