“Criminalization Causes the Stigma”: Perspectives From People Who Use Drugs

Abstract

Introduction In light of North America's persisting drug toxicity crisis, alternative drug policy approaches such as decriminalization, legalization, regulation, and safer supply have increasingly come to the forefront of drug policy discourse. The views of people who use drugs toward drug policy and drug law reform in the Canadian context are essential, yet largely missing from the conversation. The aim of this study was to capture the opinions, ideas, and attitudes of people who use drugs toward Canadian drug laws and potential future alternatives. Methods This paper was developed as part of the Canadian Drug Laws Project, a cross-jurisdictional qualitative study conducted in British Columbia, Canada between July and September 2020. The qualitative data are from 24 semi-structured interviews with a diverse sample of people who use illegal drugs. Interviews were recorded, transcribed, coded, and analyzed thematically by the research team. Results Two main themes and corresponding sub-themes are presented: (1) The experience of stigma as a consequence of criminalization; (2) The perceived benefits of drug law reform. Participants spoke in-depth about their experiences living within a criminalized drug policy context and offered suggestions for new pathways forward. Their perspectives illuminate how Canada's drug laws may shape public attitudes toward people who use drugs and the consequent manifestations of structural, social, and self-stigma experienced by people who use drugs. Conclusion Participants openly and profoundly believed that current drug laws produced and propagated the public attitudes and structural inequities experienced by people who use drugs in Canada. This matters, not only because our findings highlight the fact that people who use drugs experience stigma in tangible and clearly impactful ways, but it also suggests that the criminlilization of drugs shapes the experience of structural, social, and self stigma. Finally, participants believed that efforts to destigmatize people who use drugs would be ineffectual without the enactment of more robust forms of drug law reform such as the decriminalization of illegal drugs.

High-dose naloxone formulations are not as essential as we thought

“…This biased depiction results in an altered portrayal of the effects and risks associated with recreational drug use [ 18 ] and provides opportunities for reinforcing racial, gender, and class stereotypes pertaining to drug users [ 18 , 19 ]. Misunderstandings and socially reinforced biases result in misunderstandings of and opposition towards harm reduction strategies [ 20 , 21 ]. In the context of naloxone, the misunderstandings can be seen in the altered portrayal of the effects and risks associated with naloxone use for overdose reversal [ 21 – 23 ].…”

Commentary on Brothers et al.: The role of safer environment interventions in addressing injecting‐related bacterial and fungal infections

“…Decriminalization is discussed as a promising macro-level structural SEI to reform prohibitionist frameworks criminalizing people who inject drugs (PWID) [1], which are implicated in the proliferation of injecting-related harm [2,3]. Potential public health benefits of decriminalization (resulting from prioritizing public health over criminal justice system responses) include reductions in drug-related harm and increased access to risk-reduction programs and healthcare among PWID [4], partially through reduced stigma and discrimination within healthcare [5]. Healthcare access barriers critically shape suboptimal management of injecting-related infections [1], and this would facilitate improved treatment and reduce reluctance to seek care, which negatively impacts the progression of infections [6].…”

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

“…Some suggest that strict laws and social deterrents against substance use will effectively limit use, while others debate this (Caulkins et al, 2014;Hughes et al, 2018;McKeganey, 2011). Critics to strict approaches also highlight the potential of these strategies to compound harms for those involved in substance use (Caulkins et al, 2014;Scher et al, 2023;Wakeman & Rich, 2018). Most INTRODUCTION 14 "drug policies" (i.e.…”

“…Framing of drugs as criminal, dangerous, and deviant then carries on to the people who use them, and vice versa. In a society in which drug use is highly criminalized, PWUD then become labeled themselves, as criminals, deviants, and a danger to society (Becker, 1963;Scher et al, 2023). And, as stated, this process can also occur in reverse, in that drugs become deviant in their association with certain groups (Edman & Olsson, 2014), then leading to a reinforcing cycle.…”

“…Social control and resulting exclusion disproportionately affect those already in difficult positions, compounding issues (Anderson, 1998). There is evidence which suggests that for individuals with addictions, the negative outcomes of criminalization and stigma intensify the harms of drug use itself Bonn et al, 2020;Scher et al, 2023). Instead of negatively framing drug use itself (and the people engaging in it), focusing on negative outcomes, such as death from overdose, may be more fortuitous.…”