The harms of stigma
Ninety-one percent of people who die from opioid overdoses die using alone. Stigma causes people to hide their addiction and prevents them from seeking help.
My friend, Kelley, injects fentanyl and cocaine. I urged her to go to the hospital to get treatment for her skin abscesses, get into rehab again or get on Suboxone or methadone. She won’t go. “They treated me like shit the time I overdosed. I will never go back.” Veronica, another user I know, told me a paramedic said to her, “I’m tired of scraping your ass off the pavement.” EMS and the ED are not welcoming places for them. They feel judged there, and so they avoid going there. I was thrilled when the local harm reduction group opened up a drop-in center and staffed it with a nurse who I could send them to see.
Stigma means stain. When we stigmatize someone, we put a stain on them. It suggests not just moral judgment against a person, but it also inspires fear in others, works to isolate people, and criminalizes their behavior. The user becomes a stereotype and not a person. A “dope fiend” is not someone considered capable of positive human interaction.
The World Health Organization (WHO) studied stigma in 14 countries to determine what conditions (homeless, AIDS, obesity, mental disorders, alcoholism, criminal record for burglary, etc.) were most likely to be stigmatized. Drug use was number one.
On TV and on the news, the visuals and images that accompany stories on the drug crisis often show people living in squalor, rooting through garbage cans, and trying to inject their necks or feet. Their drug use is portrayed as a crime not the result of a disease and social situation.
Stereotypes produce negative judgments and negative judgments lead to discrimination. Would you give a job or rent an apartment or even give a dollar to a “drug abuser?”
Language affects how people feel about people who use drugs; it also affects how people who use drugs feel about themselves. Steven Biko, the great South African human rights leader, said, “The most potent weapon of the oppressor is the mind of the oppressed.” If you can destroy a man’s self-worth, you can cripple his ability to stand up.
A first responder stands over you and barks, “What’s wrong with you? You’re going to kill yourself. Think of your family. Get some self-respect. I’m being honest with you bro, keeping it real. You’re a mess. Look in the mirror. You’re at rock bottom.”
Do you want to be in this person’s care? Do you want to go to the hospital and be lectured at by people with similar views who think you are a scumbag? An abuser?A junkie? The triage nurse scolding you has a coffee mug that says “The tears of my drug-seekers.” How does that make you feel? Everyone looks down on you. You just want to crawl back into your own hole. You want to forget. Even if someone was there to help you, you would likely just mess it up again. With no one else to turn to, you turn back to the needle. The damage is done. We need to help people, not shame them.
Science has shown that social pain is felt in the same area of the brain as physical pain and thus responds to pain medicine in the same way physical pain responds. In an opinion piece in the New England Journal of Medicine, Dr. Nora Volkow cites a study in which lab rats chose interacting with other lab rats over self-administering drugs, but when they were punished with electrical shocks for their social interactions, they reverted to drug use. She concludes that stigma “spurs further drug taking.”
People who use drugs hide their use for fear of being stigmatized. They are worried they will lose the respect of others as well as cost themselves economically. It is hard to seek treatment for a problem that you don’t want the world to see.
Ending stigma could change the course of this epidemic. People who use drugs are human beings knocked off course by a larger epidemic not of their making. None of them set out to become addicted to drugs, to become homeless, lose their families or their lives. An addictive gene, an accident, a doctor’s prescription, an innocent experimentation, a history of sexual abuse or mental health problems, diagnosed or undiagnosed, so many factors were behind their use. We must stop driving people into the shadows or locking them up because we don’t like their disease. Drug treatment, housing, health care, job support, human empathy and love will go farther than hurtful words and prison bars. As humans, we all belong to each other.
ABOUT THE AUTHOR
Peter Canning, the EMS coordinator at UConn John Dempsey Hospital, has worked for more than thirty years as a 911 paramedic. He is the author of Killing Season: A Paramedic’s Dispatches from the Front Lines of the Opioid Epidemic and Paramedic: On the Front Lines of Medicine.
