Opioid Harm Reduction: See the person, stop the stigma

By: Jennifer Barnable, senior digital writer
 
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For people who use opioids, a major obstacle on the road to recovery is the harmful stigma they face around them.

According to the Canadian Centre on Substance Use and Addiction, one in 10 Canadians currently experience substance use problems and a further eight in 10 people with substance use disorder report facing barriers to recovery, including stigma.

Statistics Canada reports that almost half of Canadians who are in recovery from an active addiction will face social stigma in society, from the healthcare system to loved ones. This creates significant barriers to accessing treatment and support services that every Canadian has a right to.

In this blog, two Canadian Red Cross experts weigh in, challenging us to see the person and resist stigma. We’ll also highlight ways to de-stigmatize the language we use when talking about substance use disorder and opioid poisoning.

“We all need to understand that substance use disorder is a medical condition – not a choice.” - Jeannene Crosby, Canadian Red Cross Prevention and Safety Coordinator

Red Cross Opioid Harm Reduction program

Physicians often prescribe opioids like as morphine, hydrocodone, codeine, and fentanyl to relieve serious pain caused from things like dental surgery, injuries, chronic pain and cancer. People may have trouble managing or using opioids that have been prescribed to them. In fact, many who experience opioid poisoning are first-time or occasional users.  

Jeannene Crosby, Prevention and Safety Coordinator at the Canadian Red Cross, explains, “Part of the Canadian Red Cross’ focus is to raise awareness and help people to better understand the risks, and misconceptions, of opioid poisoning. Ending harmful social stigma related to substance use disorder begins with focusing on caring about the human being first, rather than passing judgment. We all need to understand that substance use disorder is a medical condition – not a choice.”

The Red Cross has launched a new, national Opioid Harm Reduction program, aiming to build a future where no one in Canada will experience an opioid poisoning without someone being there who can help.

“We’re committed to helping communities reduce opioid-related deaths by increasing access to first aid response training and naloxone, which is fast-acting medication that temporarily reverses the life-threatening effects of opioid poisoning,” says Jeannene.

“At the Red Cross, we also recognize that when it comes to opioid use, collectively, all Canadians can benefit from actively working against stigma. Recovery from substance use disorder is a long process, and it really is possible – but first we need to change attitudes and avoid judgment of people who are struggling. Otherwise, people will continue to experience barriers to accessing essential care and supports in our communities.”
 
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Painful realities of opioid poisoning


“Opioid harm touches many people, including those who care about them,” shares Red Cross Opioid Harm Reduction Advisory Council volunteer Jessica Farmer.

“I was personally impacted by the loss of my 23-year-old nephew, Dylan, who passed away from an unintentional carfentanil poisoning in 2017.”

“Losing Dylan made my family and I realize how much stigma existed in our community around substance use disorder and opioid poisoning deaths – and the lack of understanding about opioids in general,” she adds. “We now see how few resources are available to someone struggling with substance use disorder. More definitely needs to be done to prevent the loss of more lives.” 

A year after their tragic loss, Jessica and her family founded the Dylan’s Hope Foundation, determined to bring public awareness and education about opioid poisoning and substance use disorder. 

“Stigma is everywhere within our communities. The level of judgment is huge. Every person is valuable. Everyone is important to someone. Nobody grows up expecting to one day become a person with a substance use disorder,” she reminds. “Unfortunately, opioid use can change a person who may be trying to cope with physical pain, trauma or other life-changing experiences. It changes the way they think, their drive and what they need to survive – but the person we know and love is still there. People can and do recover with the proper supports.”

“Losing Dylan made my family and I realize how much stigma existed in our community around substance use disorder and opioid poisoning deaths – and the lack of understanding about opioids in general.” – Jessica Farmer, Canadian Red Cross Opioid Harm Reduction Advisory Council

Ways stigmatizing language causes harm

 
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Words are powerful. They can help or harm, offer safety or judgment. International studies by the World Health Organization (WHO) confirm that stigmatizing language negatively impacts people’s overall health and wellbeing.

Stigmatizing language:
  • dehumanizes a person
  • suggests a person’s entire identity is “addiction”
  • discourages a person from seeking help (“I don’t deserve help”)
  • increases a person’s sense of shame or worthlessness (“I don’t matter”)
  • alienates people from the support systems and vital services they need
  • marginalizes people into a place of invisibility, loneliness and despair
“Stigma embedded in our language and in media can deeply affect the way people see themselves, including how they are treated by society,” Jeannene notes. “Not only is stigma hurtful and inaccurate, it can also prevent people getting much-needed support.”  
 

Changing how we talk about substance use disorder


Here are six practical tips for how to de-stigmatize your language, starting today:

1. Use person-first language, not dehumanizing labels like “addict” / “junkie” / “druggie”
A person is a human being first. They are not defined by their illness or health condition, just as they are not their appearance or attributes. Try saying “Jared is a person with substance use disorder” – not “Jared is an addict.” Slang is loaded with judgment, discrimination and insults that can cause real harm.

Instead, use a more respectful – and accurate – expression like “a person who uses substances” or “a person with a substance use disorder.” Similarly, avoid asking if a person is “using” and instead ask if they have “taken” any substances. Remember, people with this health condition often don’t seek out help because they fear being labelled by words like these. They may also be frustrated by discrimination they’ve faced or resigned to expecting to be met with harmful biases in society, like in health care settings where they may be turned away, not taken seriously, or treated as a second-class patient.  

2. Use the term “opioid poisoning” not “overdose”
According to Jeannene, “The word ‘overdose’ technically means to give too much medicine. This suggests that a person knows what the medication does and chooses to take too much of it. It creates a false implication of personal responsibility, which can increase stigma. We already know that the majority of opioid-related deaths are accidental. At the Red Cross, we intentionally chose the term ‘poisoning’ and avoid incorrect terms like ‘overdose.’ We know that language matters. We are training people to know what to do when opioid poisoning occurs, and we work to promote accurate, non-stigmatizing language.”

3. Avoid using the label “clean”
While a person is in recovery, don’t say “They have been clean for 10 months.” Instead, refer to the person’s recovery process by saying “They haven’t taken any substances in 10 months.” Similarly, don’t ask a person if they are “clean” – this suggests moral judgment, labelling someone as either “good/clean/pure” or “bad/dirty/impure”. It also invades their privacy – substance use disorder is a medical condition. This outdated and dehumanizing use of “clean” or “dirty” language continues stigma and erodes self esteem and dignity. Let’s leave this judgmental label behind when speaking with and about people with substance use disorder.

4. Don’t use the term “substance abuse”
The word “abuse” is heavily charged and suggests criminal activity. Instead, use “substance use” or “substance use disorder” – these are the correct terms for this health condition. Opioids are powerful and highly addictive for a person who uses them, and often this begins with a doctor’s prescription for a condition.
 
5. Avoid failure-based words like “relapse”
This negative word refers to failure and is loaded with judgement. When a person struggles with their condition and recovery journey, the word “relapse” reduces all their efforts, as they face an overwhelming challenge. Don’t discourage people or minimize their recovery efforts. Resist the use of the word “relapse” in mainstream slang when talking about trivial matters or in jokes. Substance use disorder is a medical condition, not a choice and recovery is a process. Don’t belittle the efforts of people who are working hard toward their recovery. Remember, it takes courage and strength to recover – especially when faced with stigma that impacts access to necessary supports.

6. Don’t use ableist language
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The stigma surrounding mental health and addictions typically come from discrimination, lack of knowledge, stereotyping and prejudice. When speaking about substance use disorder, it’s important to avoid ableist, dramatic language like “suffering from.” Instead, try using “experiencing” or “struggling with.” Ableism discriminates against people with disabilities, which also includes people who live with illnesses and conditions like substance use disorder and mental health disability. Ableist expressions include saying things like “She doesn’t look like an addict” or “They don’t act like they’re on oxy” or “He doesn’t seem disabled to me.” All are unacceptable and discriminate against the more than six million Canadians who live with disability, as well as people who are struggling with substance use disorder.

If you’d like to learn more about ways to change your language, The Canadian Centre on Substance Use and Addiction (CCSA), with support from the Community Addictions Peer Support Association (CAPSA), has developed “Overcoming Stigma Through Language: A Primer” as an easy-to-use community resource we highly recommend.
 

See the person, stop the stigma

Jessica urges Canadians to challenge themselves on common misconceptions about people like her late nephew Dylan.
 
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"The opioid crisis is not limited to big cities, or found only among young people and those who are homeless,” she reminds. “Yet most of the time, communities pass judgement on those who die from opioid poisoning or other substance use disorder. People are simply not sympathetic to them.”

The impact can mean the difference between life and death, Jessica insists.

“Discrimination and stigma often result in people who use substances not seeking help, using substances alone – often resulting in poisoning – and not getting the supports they need for recovery.”  She strongly believes we can each change that, starting with how we speak about substance use disorder.

“Just starting a new conversation makes a difference,“ she urges. “When talking with family, friends, coworkers or neighbours about substance use disorder, we can all make the effort to be more sensitive and self aware about the language we use. By changing how we speak about opioids, we can help stop stigma, one conversation at a time. Let’s help those who are struggling feel safer to reach out and receive the care and dignity that all people deserve.”

The Canadian Red Cross invites you to take another step toward effecting change, by participating in our free, 30-minute online course, “Becoming an Opioid Harm Reduction Champion.” Designed to increase knowledge about how harm reduction works, it also teaches how to help during an opioid poisoning emergency, and how to reduce stigma and change attitudes towards opioid use. Will you become a champion who helps reduce opioid harm and stigma, in your community?

Learn more about OHR with Canadian Red Cross resources at redcross.ca/OHR. You can sign up for a First Aid and CPR course that contains a module on how to help someone who is experiencing an opioid poisoning.

This initiative was funded by a contribution from Health Canada’s Substance Use and Addictions Program (SUAP). The views expressed herein do not necessarily represent the views of Health Canada.


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