Abstract: Who Deserves Stigma? A Critical Analysis of a Health Campaign to Address Stigma toward People Who Use Drugs

◆ Rachel Young, University of Iowa

◆ Scott D. Neufeld, Brock University

◆ Tia Greto, Brock University

In the current overdose crisis, antistigma campaigns meant to humanize people who use drugs (PWUD) have spread widely, coupled with a media emphasis on “blameless” drug misuse focused on prescription opioids and the racialization of the crisis as White (Johnston, 2020; Netherland & Hansen, 2016). We conducted a critical analysis of the development and effects of an influential Canadian communication campaign meant to reduce stigma towards PWUD. We find that, despite a campaign development process that acknowledged the importance of including the lived experiences of PWUD, the final campaign photos and tagline shifted attention away from those most affected by the overdose crisis, reinforcing intersectional stigmas. The analysis was based on nearly 400 pages of campaign materials obtained through a Freedom of Information request, including prototype messages, accounts of focus groups for message testing, and evaluation research. The campaign’s initial creative brief emphasizes the desire to show the “human side” of the overdose crisis; encourage “compassionate conversations” from friends, family, and health care providers of PWUD; and reduce interpersonal and self-stigma. A subsequent social marketing proposal mentions the need for engagement with First Nations groups and people with lived experience of substance use in developing campaign strategy and messages. However, focus groups ultimately used for pilot testing campaign messages focused on a “general population” of middle-class adults who mostly lacked personal experience with the overdose crisis; emphasized drug use as a moral failing; and suggested that it was important to shift attention from “street-affected individuals” as PWUD towards middle-class drug users who were perceived as less deserving of stigma. Based on this message testing, campaign developers finalized messages that featured conventionally attractive, White-appearing faces that “quickly conveyed that the opioid crisis affects more than street-affected individuals,” paired with text that read “people who use drugs are real people.” The campaign was extremely well-funded and widely distributed. More than 90% of people in the province reporting having seen the campaign, and its perceived success inspired similar efforts elsewhere. However, evaluation showed no meaningful decreases in stigma despite the campaign’s wide reach. In fact, on many relevant metrics, stigma toward people who use drugs significantly increased over the evaluation period, including the statements “People who use drugs have made poor choices and deserve what they get” and “People who use drugs should have access to the same health care services I do.” Our critical analysis of campaign materials identifies a troubling gap between the intentions motivating an antistigma campaign and the final messages. In depicting PWUD who were more relatable to a privileged, White audience, the campaign ignores how drug use stigma intersects with racism and classism. Extending compassion to more “deserving” PWUD may in fact backfire to reinforce stigma against those most marginalized by emphasizing their perceived otherness. With significant funds being spent on antistigma campaigns for drug use, mental health, and other health issues, additional research is needed to better understand the potential unintended stigmatizing effects of these campaign messages on those who are most harmed by stigma.