Over the past few years, Youth RISE facilitated two international working groups, one with young sex workers who use drugs, and another with young people who use opioids. Both groups were built on non-hierarchical, participatory, and collaborative processes where members were co-creators rather than mere participants, and also compensated for their expertise. Each group produced a published report: “Young Sex Workers Who Use Drugs: Issues and Recommendations, Narrative Report” and “Catalyst for Change: Youth-Driven Insights in Opioid Harm Reduction”.

These reports later became the basis for the elaboration of two commentaries, “What we need, not what we’re given,“ and “Centering the voices of young people who use opioids,”  published in the first half of 2026 in the Harm Reduction Journal. Despite each focusing on the different issues faced by different communities of young people who use drugs, both carry a message that policymakers, funders, and service providers must acknowledge that young people who use drugs are the main experts of their own lives, and they are already building the present and future of harm reduction for their communities. 

Moreover, both commentaries have a shared message that criminalization and paternalism have failed young people. These two commentaries point out the same structural problem. Young people who use drugs, and especially those who also engage in sex work, are at the intersection of multiple criminalized and stigmatized identities, magnified by their age. The result is a triple stigma; as drug users, as sex workers, and as young people who are perceived as incapable of making decisions about their own lives.

Laws designed to protect young people often end up stripping their agency and deterring health care providers from offering services, as they fear they will be punished for encouraging them or because they stigmatize these young people. Abstinence-only approaches, age limits on services, stigma, and the constant threat of police detention push young people away from the very services meant to support them, and further underground, where the risks of overdose, violence, and isolation are present.

When systems fail, young people show up for each other. Mutual care, informal safety networks, sharing harm reduction strategies and supplies, and warning each other about danger, have become central to their survival. 

The recommendations shared in both commentaries are:

  • Full decriminalization of sex work and the legal regulation of drugs to end punitive frameworks that promote violence and block access to care services.
  • Provide and fund youth-tailored and low-barrier services. 
  • Apply “nothing about us without us.” Young people must take an important role in the design of programs, policies, strategies, and research that shape their lives.
  • Educate health care providers, police, policy makers, and the public on a comprehensive, evidence-based, and stigma-free drug education.

Read the articles: