Cities are on the frontline of the worsening global drug crisis and have significant potential to become innovative hubs that shape national and international policy frameworks. In collaboration with the Angie Brooks International Centre for Women’s Empowerment, Leadership Development, International Peace & Security (ABIC), this project explores the role of youth, women, and municipal-level governance as drivers of socially responsive drug reform. Through a comparative thematic analysis of urban drug policy landscapes in Berlin, Geneva, and Monrovia, this research examines how locally grounded initiatives can inform more inclusive and sustainable approaches across diverse political and socioeconomic settings. By distinguishing youth and women as two separate groups, this research also aims to capture their distinct vulnerabilities and the leadership roles they hold in shaping community-driven solutions. Ultimately, this study argues that effective drug interventions must be built from the ground up, informed by the lived realities, capacities, and leadership of local communities.