This article examines how women who use drugs (WWUD) in Central Asia experience layered stigma, shaped by gender norms, punitive drug governance, and the region’s semi-peripheral position. Drawing on regional reports, emerging scholarship, and professional experience in harm reduction, it shows how Soviet narcological legacies and contemporary criminalization embed moralized understandings of drug use in institutional practice. Through mechanisms such as narcological registries, reproductive governance, and everyday institutional and familial control, women’s drug use is treated as a violation of femininity and motherhood rather than a health issue, exposing women to surveillance while limiting access to care. The article also considers how the marginal position of Central Asia in global drug policy debates can make both structural violence and local forms of agency less visible. Finally, it highlights community-based initiatives and narcofeminist organizing as ways in which women seek to reclaim autonomy and dignity.