For all the general talk about destigmatizing opioid use, it’s mostly related to one particular sub-set of users.
It’s the ordinary citizen — working taxpayers who are using quietly and surreptitiously. The worry is that fear of charges by police and incurring revulsion from their family stops them from admitting their problem. So when they overdose in crisis, that shame stops them from calling for help. So they die from trying to avoid humiliation, as much as toxic drugs.
Decriminalization arose from the view that destigmatizing was essential. But the NDP government was forced to abandon it by the much more obvious cohort of people with addictions. It consists of those so entrenched in addiction they are inhaling dangerous drugs in restaurants, parks and on public transit, sometimes oblivious to their surroundings. (Officials have been stressing permanent brain damage lately as another side-effect of the increasing toxicity.)
“We had some unintended consequences,” Premier David Eby said this week, discussing the difference in the two types of users.
With decriminalization now abandoned, it makes you wonder if the principle behind it is up for discussion.
The Michael Smith Foundation for Health Research commissioned a research paper three years ago on “de-stigmatizing language around substance use and harm reduction.”
It blames the media for “a damaging discourse that substance use is a public burden driven by crime and deviance, rather than a public health concern.”
The study recommended against media focusing on addiction as “a matter of morality” and “be wary of reporting on anything that may cause unnecessary harm to people with lived experience of substance abuse.”
“Avoid using stigmatizing imagery, exaggerated violence, criminalization, and overdose-related mortality. Media should not pathologize drug use, and instead, should incorporate the faces and stories of people who use drugs to communicate their real-world experiences.”
Some of the advice is ludicrous, given that the government released overdose death tallies every month and officials talk about it constantly. But the overall thrust is reflected in government messaging on the opioid crisis.
Public awareness campaigns acknowledge the danger: “Street drugs kill more people than cars.” “A lethal dose of fentanyl can be the size of a few grains of salt.” There is also a “Stories of Support” campaign telling about individuals succeeding in recovery.
There are no scare campaigns dwelling on the horrifying effects or warning about the rampant criminality associated with opioids. Those are considered leftovers from the “war on drugs,” which made next-to-no progress over its half-century run.
The most incongruous thing about decriminalization was that in many situations, there were no penalties for using a lethally addictive drug in a public spot, but people smoking cigarettes were subject to fines and tickets.
That’s because of the anti-smoking campaign, which is one of the most successful public health campaigns in history and involved a fair amount of stigmatizing.
There’s an argument that opioids are different from smoking, that the instant lethality and the more severe addiction mean they can’t be compared.
The late Barbara McLintock, a widely respected Victoria reporter, wrote a book — Smoke Free — about the Capital Regional District’s ground-breaking bylaw in the 1990s that banned smoking in indoor public places.
It detailed how the local government, at public health officer Dr. Richard Stanwick’s direction, committed to the clean air campaign and spent years seeing it through. Fanatically opposed critics eventually flipped and conceded it was a good idea, but it took a lot of determination to impose a law that drove smokers out of bars.
Anti-tobacco crusader Jeffrey Wigand wrote in a foreword that “denormalizing” smoking was (is) a key part of the on-going crusade. Which raises the question: Does destigmatizing opioid use constitute normalizing it?
On a side note, a U.S. researcher who advocates for restigmatizing drug use was cited in the legislature two weeks ago because provincial health officer Dr. Bonnie Henry commissioned a study from him.
Dr. Jonathan Caulkins co-wrote a piece for the Atlantic last winter headed: “Destigmatizing drug use has been a profound mistake.”
It said in part: “Efforts to destigmatize drug use may … draw out the epidemic, invite new cohorts to try hard drugs and create more addicted people.”
His report is not public, but Henry told the Vancouver Sun it was on a different topic — analysis of how safe supply should be monitored — and his views on stigmatizing don’t reflect those of her office.
It’s hard to see what comes next in year eight of the public health emergency, but the options are becoming more limited.
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