Douglas Todd: How drug user anti-stigma campaign mostly misses the point

Analysis: One problem with the campaign against stigmatizing those who use drugs is it’s ‘reassuringly vague,’ says an SFU psychologist. It might not be accomplishing much

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The campaign against stigmatizing drug users seems to make sense, at least on the surface.

Its easy appeal helps explains why it’s become the go-to mantra today for so many public-health officials and politicians.

But is the public battle against stigmatizing those who use drugs and, relatedly, those who struggle with mental health, that simple? Or effective?

Could the campaign distract us from the real solutions to curbing the outrageously high number of opioid deaths in Canada? In B.C. alone, five years after a public health emergency was declared, five people each day, the vast majority male, continue to die from overdosing.

Meanwhile, the anti-stigma rhetoric coming out of B.C. remains persistent. It recurs in announcements from officials, the B.C. Coroners Service, Dr. Bonnie Henry, activists, civic-minded corporations and especially politicians.

“We all play a part in ending stigma,” B.C. Minister of Mental Health and Addictions Sheila Malcolmson, Education Minister Jennifer and Minister of Children and Family Development Mitzi Dean wrote this month in The Vancouver Sun.

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“Stigma around drug use” is the key reason people experiencing addiction don’t access services, said Malcolmson. “Stigma and criminalization are driving people to use (drugs) alone,” she added. Most such anti-stigma statements include a call for the decriminalization of simple drug possession to reduce drug-related deaths.

The combination of moralizing and libertarianism in the anti-stigma mantra makes it awkward to argue against — and unravel. There is some validity to the idea certain segments of the population are stigmatized, which contributes to them having worse health outcomes. But that effect might not occur in quite the way politicians declare.

The opioid crisis requires nuance to understand. In the past there have been many North American public-health campaigns that definitely have stigmatized people who use drugs, says Judy Graves, who was the City of Vancouver’s homeless advocate for two decades.

Previous public health and school programs featured authorities preaching “zero tolerance.” But their efforts mostly “left generations with a contempt for drug users,” Graves said. “And the campaigns were not successful: People still use drugs.”

Things are not so either/or in this era, when the stigma against drug users is not as strong, since we reside in a country where most pride themselves on their live-and-let-live philosophy.

But one of the many troubles with the current campaign, Graves said, is “it’s not possible to simply ‘Stop Stigmatizing.’ ”

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Simon Fraser University professor Julian Somers, a clinical psychologist and leading researcher in substance use and mental health, carries a similar wariness.

“Stigma is a problematic construct, because it is reassuringly vague,” Somers said this week.

“In a political setting you can say you’re opposed to stigma and then everyone will nod and agree.”

“In a political setting you can say you’re opposed to stigma and then everyone will nod and agree,” says SFU clinical psychologist Julian Somers (pictured in 2017), an expert in addictions. (Mark van Manen PNG files)
“In a political setting you can say you’re opposed to stigma and then everyone will nod and agree,” says SFU clinical psychologist Julian Somers (pictured in 2017), an expert in addictions. (Mark van Manen PNG files) Photo by Mark van Manen /PNG

Anti-stigma campaigns frame the opioid crisis in “an attractive and potentially elusive way,” said Somers. When people hear about it they say to themselves: “ ‘I’m opposed to stigma. Of course we’re going to reduce stigma. Yes, let’s do that.’ ”

Such campaigns might lead to “a rousing discussion and pleasing-sounding commitments,” Somers said, but then some will stop and ask themselves, “ ‘What did we talk about? What exactly was that about?’ ”

Both Somers and Graves suggested, however, there is at least one undeniable stigma in society: People who descend into debilitating addictions are not given equal access to quality programs, which could help them overcome their addiction and their sense of exclusion and devaluation.

Somers said Indigenous people, young people, homeless people, poor people and those experiencing mental illness who are dying from opioid overdose deaths at the highest rates.

The real stigma, he said, lies in how governments are not willing to provide proper psychological treatment for all drug users, including those in such groups. They are not provided the same kind of programs well-off people can access privately.

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“People in valued positions, like physicians, public servants, lawyers, et cetera, receive intensive forms of support that retain them in their social and professional roles,” said Somers.

“For them we interpret addiction as a sign that we must re-engage a person through social processes and without drugs. Success for these individuals means recovery and wellness.”

In contrast, Somers said, people with addictions who can’t afford full-scale private psychotherapy and comprehensive treatment programs are often just given more drugs, albeit ones considered “safe” or untainted with fentanyl.

“About 75 per cent of those who receive methadone and similar opioids are unemployed. And typically these patients must obtain methadone each day, ostensibly because they can’t be trusted with more.”

There is no way, Somers said, that a physician, for instance, would be treated that way. “No physician experiencing addiction is offered ‘safe supply’ as a way of retaining their job and their position in society.”

In her decades on the front lines, Graves said she has seen “little public health information that is honest and useful. As well, anyone who spends time connecting with addiction and mental health resources knows there is little resource available, and even less quality resource.”

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While the B.C. government announced in May it would support the hiring of 350 full-time mental health and addictions staff over the next three years, there are questions about how effective the treatment they offer will be, particularly since B.C.’s medical services plan doesn’t cover psychological therapy.

Generally, Somers sees value in the innovative model used in Portugal, which has had publicly funded, compulsory treatment for two decades. Although it decriminalizes all drugs for personal use, people found with small amounts are sent to the Commission for the Dissuasion of Drug Use.

They are then interviewed by social workers, psychologists and lawyers who help determine a treatment plan that could include up to three years in a therapeutic community, out-patient counselling, a referral for housing, a prescription for methadone or job retraining.

That’s much different from simply asking everyone not to stigmatize drug users. It’s also more expensive, at least upfront. But there are more than a few informed people who say such comprehensive programs offer a payoff, financially and socially, in the long run.

Instead of nodding our heads about the need to avoiding stigmatization, wouldn’t we be further ahead discussing how to move more people into effective treatment programs, so they can lead lives they find fulfilling?

dtodd@postmedia.com

twitter.com/douglastodd


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