Background: Public health guidelines designed to reduce the transmission of COVID-19 (eg: social distancing) directly contradicted guidance developed in response to the ongoing overdose crisis (eg: never use drugs alone), exacerbating harms associated with reliance on the unregulated drug supply and criminalization of people who use drugs. While existing literature outlines the evolving risk environment associated with consuming unregulated drugs during COVID-19, less is known about the impact on women. Objectives: We explored the perspectives of women (cis-gender, transgender, gender-diverse) who use drugs on how the COVID-19 environment shaped their overdose risk in British Columbia, Canada. Methods: We conducted semi-structured interviews remotely with 45 women who use unregulated drugs between May 2020 and September 2021, and analyzed the data thematically. Results: ‘Social distancing’ guidelines, administered via guest restrictions in housing and reduced capacity in harm reduction services, resulted in more women using drugs alone with less chance of timely intervention in the case of overdose. This risk was exacerbated by changes in the unregulated drug supply, including increased toxicity and unpredictability of available drugs. Participants identified practices they applied to mitigate harms associated with these conflicting guidelines, with a particular emphasis on acts of caregiving they engaged in to support other women in their community (eg: establishing informal networks that regularly check on each other). Implications: Women who use drugs experience harms associated with oppressive social and structural environments, which are further intensified by policies that are developed without consideration of their unique circumstances.