 In Europe, around 37 million women have used an illicit drug at least once in their lifetime. Around 100,000 women enter drug treatment every year. Nearly 2,000 die from drug overdose. Over the last decade, the gender gap has been narrowing among young school students who use drugs. Women represent only a fifth of clients in specialized drug treatment, but their problems are often more complex than for men. They tend to progress faster towards addiction, a phenomenon known as telescoping. They go through more severe withdrawal symptoms and report higher levels of depression and anxiety. Women often start using drugs through a drug-using male partner, and are more likely to share needles and other equipment with their partner. In general, women are likely to have fewer socioeconomic resources. This is even more the case for women who use drugs. They experience most stigma because they may be perceived as contravening their roles as mother and caregiver. Some groups of women have specific needs, such as pregnant and parenting women, women from ethnic minorities, women in prison and those involved in sex work. A specific drug-related issue for women is intimate violence and drug-facilitated sexual assaults, which has serious psychological and social consequences. Services for women with drug use problems need to address these unique concerns. They need to be welcoming, non-judgmental, supportive and physically and emotionally safe. To achieve this, women who use drugs need to be fully involved in the planning and development of policies and services. The staff recruited in drug services need to have appropriate attitudes, knowledge and skills. Services need to be well coordinated and integrated to address different issues, such as mental health, pregnancy and childcare. And monitoring and research needs to consider this gender dimension to optimise effective responses for women with drug-related problems.