This report presents findings from consultations held across 15 European cities on local harm reduction responses and emerging drug trends. Cities reported growing challenges, including underfunding, staff shortages, limited availability of drug consumption rooms and checking services, and persistent stigma. Rapid changes in drug markets—marked by rising use of cocaine, new psychoactive substances, and synthetic opioids—have increased overdose risks and exposed gaps in preparedness. Despite these pressures, cities are advancing innovative, rights-based approaches through integrated services, peer-led initiatives, and cross-sectoral cooperation, demonstrating the importance of sustained investment and local leadership in effective harm reduction strategies.