Understanding how cities keep their people healthy, working, and connected is increasingly important across the world. This is particularly important in Europe, where about 76% of its citizens live in urban areas. This concentration also impacts drug markets, consumption patterns and what’s in circulation. It’s more important than ever to ensure that cities have the resources and support needed to create drug policies that fit their people’s needs and habits.
A new report by Correlation – European Harm Reduction Network (C-EHRN) through the European City Initiative on Drug Policy (ECIDP) highlights the challenges that 15 European cities – from Athens to Zurich – currently face in dealing with drugs and harm reduction. Consulting with local city partners, the report highlighted that while many nations have deprioritised harm reduction, urban municipalities continue to respond to emerging drug issues with pragmatic, innovative, and evidence-based approaches that keep people safe and healthy.
The legal, financial, and drug market challenges
Europe’s drug markets are changing rapidly – and cities were the first to feel it. C-EHRN’s report identifies several emerging trends and challenges that are changing local harm reduction needs. This includes working within financial and legal constraints, fragmented governance and cooperation, limited access to services for marginalised populations, changing drug markets, and persistent political and public stigma against drug use and harm reduction.
In almost every city consulted, chronic underfunding of harm reduction has been reported across all sectors and levels. Existing services are financially insecure and unable to meet growing demand. NGOs and civil society are left competing for increasingly limited, short-term project funding, and any continuity and long-term planning of drug-related health policies and initiatives seem to be out of reach.
In Italy, national recognition of harm reduction as an essential service has not translated into sustained funding. In Prague, harm reduction projects depend heavily on short-term and unstable municipal funding, leaving essential services consistently scrambling for funds, ultimately putting access and delivery of care at risk. Even the Netherlands, once considered a harm reduction pioneer, has had its national drug budgets slashed, with cities expected to cover these funding gaps. This is repeated across many European countries. Limited funding is hampered by irregular cooperation between municipalities and regions, usually due to a general lack of consensus on how to approach drug-related issues.
Legal and administrative barriers further strain the situation. In many countries and cities, drug consumption rooms (DCRs) and drug checking services continue to be under a “legal grey zone”; even when implemented or tolerated, they operate without clear legal protection. In Glasgow, the new DCR (The Thistle) took nearly a decade of negotiation before opening – and still only operates under a temporary policy arrangement. In Greece, administrative centralisation has slowed down municipal decision-making and local responses. Meanwhile in Slovakia, restrictive legislation such as the new “foreign agent” rule introduced in 2024 has limited NGO activity and discouraged drug-related innovation.
Changing drug markets
Across Europe, there’s a considerable growth in cocaine and crack use, while New Psychoactive Substances (NPS), especially synthetic cannabinoids, cathinones and synthetic opioids, are increasingly prevalent in street supplies, either as stand-alone products or found contaminating other drug supplies. Cities and countries are generally unprepared for these changes and lack the political power to quickly adapt their drug services to these market changes.
Since the COVID-19 pandemic, European cities have reported dramatic increases in drug use by young people who experiment with NPS, online-sourced drugs, and new routes of use – including drug injecting. Poly-substance use is increasingly common, raising both the difficulties and the need for adapted treatment plans and health responses that are critically lacking.
One barrier that harm reduction continues to face and has grown is stigma. Politicians and the media continue to frame problematic drug use as a moral failing and criminal activity, rather than a public health issue. With European politics shifting to the right, public drug use and harm reduction are being used by politicians as a weapon to advocate for enhanced security and law enforcement measures. This is not only harmful to people who use drugs, but also continues to undermine public health and weaken trust in institutions and services.
Cities still innovating on the ground
Despite the challenges they face, some European cities have carried on with pragmatic, compassionate, and innovative policies. Zurich and Vienna continue to exemplify the “four-pillar model”, increasingly adopted across European cities, of prevention, treatment, harm reduction, and law enforcement. These cities demonstrate how harm reduction can be integrated within public health systems, encouraging collaboration between various sectors, yet prioritised as a key pillar of drug responses, independent of changing political mandates.
Glasgow has also led the way within the UK and Europe, by placing lived experience at the core of its drug policy. The city’s WAND program (Wound Care, Assessment of Injecting, Naloxone, and Dry blood-spot testing) is the first example of an incentivised harm reduction approach. The program uses a £20 voucher to re-engage people who inject drugs, building trust and encouraging constructive conversations, particularly with individuals who have previously had negative experiences and associations with state provided services. By involving service users in service design, Glasgow is actively countering stigma and ensuring programs respond to real needs.
To complement this work, Scotland’s police have implemented their own harm reduction strategy, together with a trauma-informed approach that recognises impact of trauma on individuals. This approach ensures that people are treated with compassion, safeguarded from further harm, and supported in their recovery through better interactions with law enforcement and other points of the criminal justice system.
Cities cannot stand alone
The report has a clear message: even though cities are at the frontline addressing urban drug use and emerging trends, they cannot resolve these challenges by themselves. National governments and European institutions must support municipalities and sustain harm reduction interventions.
To ensure that local innovation is translated into sustainable, system-wide progress, the report outlines recommendations for cities, national governments, and EU level institutions to match this commitment:
For cities:
- Strengthen municipal leadership through coordinated, city-led structures embedding the four-pillar model;
- Systematically integrate lived experience of people who use drugs into service design and evaluation;
- Expand access and hours of low-threshold facilities such as DCRs, mobile outreach, and drop-in centres;
- Normalise drug checking in DCRs and nightlife settings;
- Invest in workforce sustainability and support;
- Prioritise housing approaches linked with harm reduction to address homelessness and open drug scenes;
- Secure sustainable, long-term funding for harm reduction by integrating it in municipal and national budgets, and establish systems for continuous monitoring of emerging drug trends through civil society partnerships;
- Improve community communication to counter stigma and Not in My Backyard (NIMBY) resistance.
For national governments:
- Removing regulatory barriers to key harm reduction services such as DCRs, drug checking, and naloxone distribution;
- Translate national recognition of harm reduction into enforceable local obligations to guarantee equal access across regions;
- Secure sustainable, multi-year financing through increased national and municipal budgets;
- Integrate harm reduction into healthcare systems and strengthening addiction treatment;
- Establish cross-sectoral consulting platforms linking health, justice, social, and policing sectors;
- Foster structural support for vulnerable populations by expanding access to housing, healthcare, shelters, and harm reduction to migrants, women, youth, LGBTQIA+ people, etc.
For EU institutions:
- Establish clear, EU-wide guidance and minimum standards for harm reduction including access to DCRs, drug checking, naloxone, and substitution treatment;
- Strengthen rapid responses to emerging drug trends by enhancing the EU Early Warning System and investing in rapid on-site testing for NPS and synthetic opioids;
- Ensure funding sustainability through long-term EU financing for harm reduction, city networks, NGOs and civil society;
- Promote city-to-city knowledge exchange to scale proven models such as the four-pillar approach;
- Monitor national implementation of standards to guarantee equitable access and accountability across member states;
- Launch an EU-wide public awareness campaign to reframe harm reduction as a health and human rights measure to combat stigma and build support.
“At a time where right-wing and populist governments are on the rise, effective policy making feels out of reach. Cities have the power to drive innovation and need to be given more opportunities to start the change needed at the local level”, said Katrin Schiffer, Director of Correlation, to Talking Drugs.
You can read C-EHRN’s full report here.