Violence is one of the most underreported issues facing women who use drugs. A major study published in JAMA Network Open in March 2026 shed new light on how widespread and serious this problem is, and why so many women suffer in silence.
The findings are deeply concerning. Yet understanding them is an important step towards building a society that truly protects its most vulnerable members.
What the Research Found About Violence Against Women Who Use Drugs
The study followed 431 women in Melbourne, Australia, over more than a decade. Researchers combined survey responses with hospital, ambulance, and emergency department records. The results paint a stark picture.
By the end of the study period, 82% of women had experienced at least one assault. A further 38% had experienced at least one sexual assault. These rates are roughly double those in the general female population, where around 39% report lifetime violence and 22% report sexual violence.
Almost one in four women (23%) attended an emergency department because of assault. One in five (19%) ended up in hospital. Ambulance callouts for assault reached 17% of the cohort.
Violence was not only common but recurring. At follow-up interviews, 59% of women reported being assaulted since their last interview, roughly within the previous 12 months. The median number of lifetime assaults was five, though many women reported far higher numbers.
Who Was Carrying Out the Violence?
Perpetrators went well beyond intimate partners. Whilst 53% of women named a partner as an assailant, nearly half (43%) also reported attacks by a stranger. That proportion is considerably higher than in the wider population. Friends or other family members were named by 39% of women. Drug dealers or other people who use drugs featured for 30%.
This range of perpetrators matters. Most support services focus on domestic and family violence. When assault also comes from strangers or people connected to drug environments, the gap in available support becomes very clear.
Assault and Drug Use in Women: The Barrier of Stigma
Despite how often violence occurred, only around one in three women sought health care after an assault. That figure alone tells us something has gone seriously wrong.
Qualitative interviews with ten women revealed why so many stay silent. Stigma came up repeatedly. Women felt judged or dismissed by healthcare providers the moment staff learned about their drug use, even when that use was years in the past.
One woman in her 50s put it plainly: some doctors “don’t want to know you” once they discover a history of drug use, regardless of how long ago it was.
Retelling a complex and painful history to every new clinician is exhausting. For women carrying trauma, that prospect alone can stop them from seeking help.
Fear of Losing Children
Fear of child protection involvement stood out as one of the biggest barriers. Several women stayed silent about violence because they feared that speaking up would lead to their children being removed.
Sara described being “too scared” to reach out. She believed she would have opened up had she found someone she trusted, someone who would not immediately involve child protection services.
The numbers tell a similar story. Women with a history of child removal were more than twice as likely to seek health care after assault. Women who reported sexual assault had four times the odds of seeking help. Severity clearly pushes some women to act. But for many others, fear continues to win.
Violence Against Women Who Use Drugs: Practical Obstacles Matter Too
The barriers around assault and drug use in women are not only emotional. Practical challenges block access just as effectively.
Some women could not attend services because they had no transport. Others lacked phone credit to call helplines. Many services required a phone call just to book an appointment, an immediate obstacle for anyone without a working phone.
Eve had been in multiple abusive relationships and never once accessed support. She named transport costs and phone credit among her reasons. She also pointed out that even when a service offered a free number to ring, finding a payphone that could make the call was its own challenge.
The Difference a Trusted Clinician Can Make
The research also captured something genuinely hopeful. When women found a clinician they trusted, that relationship changed everything.
Jane described a maternal child health nurse who noticed signs of abuse across several visits. The nurse reached out consistently, and when the time came, helped Jane access refuge housing with all four of her children. Jane said the team made her feel completely safe and supported her through the whole process.
Mira credited her prescriber with helping her leave an abusive relationship. He asked about her safety at every visit and offered to document her injuries. That steady, non-judgemental concern gave her the confidence to walk away.
Individual clinicians can make an enormous difference. Relationship-based care matters deeply for this group of women.
What This Means for Policy and Prevention
The study’s authors called for women who use drugs to gain formal recognition in Australia’s National Plan to End Violence Against Women and Children. That plan currently acknowledges elevated risk for Aboriginal and Torres Strait Islander women, culturally and linguistically diverse women, LGBTQIA+ people, and women with disabilities. It does not name women who use drugs.
That gap needs addressing. Violence against women who use drugs occurs at rates that exceed even other marginalised groups already recognised in policy. Without targeted support, this population stays excluded from the systems designed to help them.
Violence and substance use are deeply connected. Services need to reflect that reality. Women-centric models, built on trust and staffed by people with relevant lived experience, offer a stronger path forward than approaches that inadvertently penalise women for their circumstances.
Conclusion
Violence is pervasive in the lives of women who use drugs, it is severe, and the systems meant to help them are missing them. Women do not stay silent because they want to. Stigma, fear, and practical barriers push them away. The research community has now documented this clearly. The next step belongs to policymakers, services, and clinicians who have the power to respond.
Recognising this burden is not just a research priority. It is a moral one.
(Source: JAMAnetwork)