The peer-based organization’s remit is “to promote the health and defend the human rights of people who use drugs globally by challenging and exposing stigma, discrimination and the negative impacts of criminalization on peers and communities.”

During Chang’s tenure, INPUD has expanded from a predominantly Global-North membership to incorporate regional networks covering Africa, Asia and Latin America. 

January is her last month in the role; she’ll soon be taking a position at another human rights organization. So it’s a moment to reflect on both her achievements and the renewed attacks on harm reduction from right-wing populists worldwide.

Born in Salt Lake City, Chang grew up in Sydney, Australia, in a “first-generation Chinese immigrant family.” She started using drugs as a teenager—she continues to identify as a woman who uses drugs—and has been an anti-racist and feminist activist since university. 

In the following years, she worked in the HIV and community health fields, focusing primarily on harm reduction and drug policy advocacy from 2015. She has worked with communities in China, India and Thailand, and was based in Milan, Italy, until a recent move to London.

Chang is also a narcofeminist activist. She has written defining texts on narcofeminism—a term coined in 2018 by women using drugs in Eastern Europe and Central Asia—which she’s described as “a rallying principle for women who use drugs to establish links between feminist organizing and drug user activism.” Chang has worked with peers to have women and drugs recognized as a feminist issue.

As Chang steps down from INPUD—amid global threats that carry particular dangers for INPUD’s core membership of people who use opioids and inject drugs—she spoke with Filter about her life’s work, her conception of feminism and the challenges ahead. 

“This person stuck their neck out to connect me to this harm reduction clinic in the informal settlements of Kolkata.”

Carrie Lou Hamilton: How did your personal journey lead to your involvement in the global movement of people who use drugs?

Judy Chang: What planted the seed was a sense that something is wrong with the world, that many people have it harder due to structural issues. I started identifying as a feminist from my mid-teen years. I really got into social justice from my uni years. I was ethnocultural officer and [on] the women’s collective. I always wanted to do international development, but it didn’t take long to be disillusioned with the whole NGO-industrial complex—this real distance between the development worker and the people you’re supposed to be working on behalf of. 

Also, I’ve been a woman who uses drugs from my teen years. I had no idea there was this drug-user rights movement until I was volunteering in Kolkata while studying for my Masters in Melbourne. [I was] on methadone for heroin dependency, but only buprenorphine is available in India. 

This person stuck their neck out to connect me to this harm reduction clinic in the informal settlements of Kolkata. A project manager, who was also a peer, was able to get the doctor to prescribe me buprenorphine. This person [didn’t] know me but [was] helping me because he was [a] long-term drug-user advocate. Being a person who uses drugs and on opioid agonist treatment—there’s not many people that really understand the struggles. 

Then I joined the Asian Network of People Who Use Drugs, because I was based in Australia, and connected to INPUD, started going to conferences, became a board member and stepped into the ED role. INPUD brought my personal experience, that belief in people power, [together] with what I was professionally interested in, marrying the two. 

“One exciting project is getting user voices in research at a global level.”

CLH: What INPUD initiatives are you particularly proud of?

JC: [Since] I first arrived 10 years ago, we’ve seen the regional networks from the Global South come into their own. INPUD’s a much broader and diverse collective of voices and leaders scattered all over the world. It’s been amazing to see the growth and development of the networks, including women-led networks. 

There’s a lot more collaboration. For example, how to change the opiate agonist treatment landscape. Without coming together, there’s a sense that it’s worse in Georgia, or nowhere can be as bad as in South Africa, or wherever. But when we’re together [we see that] everywhere is controlling.

One exciting project is getting user voices in research at a global level. We’re working on a project funded under Unitaid, looking at introducing innovative tools and technologies such as low dead-space needles and syringes, and long-acting depot buprenorphine. 

There’s always been this tension between what service providers think versus [what’s] suitable to the lives of people who use drugs. We brought together this Global Community Advisory Board with diverse gender representation to inform World Health Organization research protocols on these two technologies across 10 low- and middle-income countries. 

One of our major priorities is decriminalization. We’re working with UNAIDS, Release and the University of Essex to develop the first decrim guidance for low- and middle-income countries. If you’re working in different contexts, you have to look at cultural adaptation. The networks interested in adapting narcofeminism campaigning are led by women, such as WRADAR, a sub-regional network across Kenya, Uganda and Tanzania. And Scotland has just released their Charter of Human Rights for People Who Use Drugs. Can we adapt that to other countries? 

We did the Values and Preferences Study on WHO Consolidated Guidelines on Key Populations. That was the first time we were able to shape WHO recommendations. Seeing that link between people on the ground and big institutions like WHO, seeing it determined as best practice recommendations and taken up at country level, then funded through the Global Fund, has been amazing.

“Drug use was not seen as a valid choice—which is ironic, because the women’s rights movement has always been about bodily choice and autonomy.” 

CLH: You’re at the forefront of the new narcofeminist movement. How would you define narcofeminism?

JC: Narcofeminism is about recognizing the structural inequalities facing women who use drugs. A more expansive view of drug use, seeing it as an act of empowerment, recognizing there are beneficial aspects to women taking drugs. It’s also calling out feminism that hasn’t really recognized [the] links between prohibition and patriarchy. It’s very much linked to intersectionality, but the intersectionality of drug use. Bring[ing] together women in all our diversity, visibilizing women who use drugs and whose lives have been impacted by drug policies. Because we’ve been made so invisible. It’s a way for us to come out.

CLH: Why has mainstream feminism largely ignored women who use drugs? 

JC: [It’s] twofold. There’s the invisibility, linked to prohibition and criminalization. There’s real costs to coming out. And from the mainstream feminist side, [they say], “That’s criminal” or, if you were more generous, “Women who use drugs are victims.” Drug use was not seen as a valid choice—which is ironic, because the women’s rights movement has always been about bodily choice and autonomy. 

Feminism [has] always shut its doors, then been forced to include women from different classes, women of color, transgender women and sex workers. Women who use drugs and formerly incarcerated women were the last groups to truly be accepted. But I’ve seen changes. 

When I went to the AWID [Association for Women’s Rights in Development] conference in Brazil in 2016, people were like, “Oh, what can we do to help women who use drugs? To help them get off?” The opposite of what feminism should be. 

[Then, in] December, a whole delegation of us—30, 40 women who use drugs, formerly incarcerated women, women involved in the drug trade, women working in drug policy, harm reduction—turn up to AWID. We were visible, interacting with people, explaining about the war on drugs and why drug policy is a feminist issue. That was a huge moment for us, as a mass, to really enter into the feminist space.

“Trying drugs, and pursuing pleasure and different experiences that come from drugs is a feminist act, a form of rebellion.”

CLH: How can other feminists work in solidarity with women who use drugs?

JC: A lot is the underlying work of changing narratives and perspectives, campaigning on anti-stigma. That huge paradigm shift has to extend to the harm reduction industry. We still see a lot of inequities in data on gender, engagement, retainment and services. There are particular reasons women don’t feel comfortable within treatment settings. The medical establishment can be very patriarchal. 

There’s this very paternalistic treatment of [women who use drugs] as harm reduction has become more medicalized. There’s always a critique [that] when it started it was very grassroots, peer-to-peer. But over time, control around all the regulated substances, fear about diversion, linked with the stigma of drug use, creates settings that women don’t necessarily want to engage in. They [say], “I’d rather have my freedom than rely on this medical establishment. From one day to the next, I could be thrown off treatment. So I’d rather have that control and be out of the system.” 

Something as simple as take-home [methadone] doses. Nobody wants to travel every day to pick up their medication, but because of clinics’ fear of diversion it’s mandatory [for the first period] of treatment. There was so much rigidness. Then COVID happened, and suddenly a lot of centers had to give longer take-home doses and showed this is possible. 

If you want to look at creating services that suit that person, you have to take people’s actual lives into consideration when you’re designing things. If you look at data on diversion, it’s very, very minimal. It’s a way people freak out, [like] over welfare cheats.

CLH: That’s an excellent comparison. You’ve written that drug use is a feminist act. Please say more about that.  

JC: Narcofeminism is about looking at the alternatives to how we interpret drug use and recognizing that people’s experiences, why they start or continue to take drugs, are diverse. Risk-taking behavior amongst men is always considered more acceptable. Women are expected to be caretakers, put their own needs, their own pursuit of pleasure, in the back seat. When women do pursue their own pleasure, it’s seen as very nonconformist.

So it’s interpreting drug use as okay, challenging that idea that women shouldn’t be allowed to seek their own pleasure, that women shouldn’t be allowed to experiment and take risks. Trying drugs, continu[ing] to take drugs and pursuing pleasure and different experiences that come from drugs is a feminist act, a form of rebellion. A form of being able to control your own emotions and mental states, experimentation [with] your own body. 

“As long as we rely on the trauma trope, you’re going to see women who use drugs as victims. That has real implications for any kind of empowerment.”

CLH: You’ve also warned against assuming women’s drug use is rooted in trauma. Why? 

JC: As long as we rely on the trauma trope, you’re going to see women who use drugs as victims. That has real implications for any kind of empowerment, giving women who use drugs their own decision-making ability over their minds and bodies. 

We know that not all drug experiences are about trauma. A lot of people are going out and taking drugs for fun and experimentation and pleasure. Good things. 

Being in the community, speaking to a lot of women and people who use drugs—and I would say this for myself as well—drug use has [nonetheless] helped overcome some trauma. Those are the narratives we don’t really look at. 

In a lot of ways illicit drug use can be self-medication. People usually say that in a negative way. But sometimes it can be positive. Not all pharmaceutical drugs help people through trauma. There’s so many people seeing psychiatrists, getting antidepressants that don’t work for them, have adverse effects. Some people have actually found using illicit drugs helped them through the worst times of their life.

CLH: What’s next for you? And what are the key challenges and priorities for the movement? 

JC: I’m moving to Open Society Foundations, their local drug policy department. The funding side of things. Drug policy [will] always be close to my heart. I come from the community. It’s important to fund peer-led networks and marry that into broader objectives. 

There’s more challenges to international work than ever. We’ve been so used to having international guidelines, United Nations agencies being the standard bearers and giving recommendations. There’s challenges to the UN system, including human rights. We need to get human rights recognized and respected at regional level. Regional work will be more important as time goes on.

There’s huge disinformation campaigns. People don’t understand what decriminalization means. They expect it to change everything overnight. [They] link decriminalization to the rise of crime or expect decriminalization to fix homelessness. It’s not a panacea. 

“In a lot of meetings, conferences, the most powerful voice is the person who uses drugs who is able to cut through the jargon and the bullshit.”

There’s a lot more work to do around media, getting public support. Parties change, leaders change, and they can reverse things. Sustainable change [is] about changing the hearts and minds of people. The use of data or technical jargon can really put people off. You have to adapt to different audiences, using examples from people’s lives that they can see parallels with. 

INPUD’s all about having people who use drugs at the front lines. The most powerful way to do that is to have people with lived experience. Having voices from the Global South and gender diversity is very, very important. 

In a lot of meetings, conferences, the most powerful voice is the person who uses drugs [who is] able to cut through the jargon and the bullshit. We work so much in silos, preaching to the converted. How do we get the voices that have that legitimacy to speak to the broader public and get people not currently on our side? 

There’s a good foundation. I think the drug-user rights movement has done really amazing things over the last few years. It can go further.

Photograph of Judy Chang, speaking at the AWID conference in December 2024, courtesy of Chang

The Influence Foundation, which operates Filter, has previously received grants from the Open Society Foundations. Filter‘s Editorial Independence Policy applies.

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