Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
Department of Psychiatry, University of Toronto, Toronto, Canada.
Subst Abuse Treat Prev Policy. 2020 Aug 3;15(1):54. doi: 10.1186/s13011-020-00294-2.
Canada has been home to a longstanding public health crisis related to opioids, including an extensive mortality and morbidity toll in the face of substantive intervention gaps. Recently (2019), two extensive reports from preeminent federal authorities - the Chief Public Health Officer and the Mental Health Commission of Canada - have been tabled with detailed, core focus on the phenomenon of 'stigma' and its impacts on substance/opioid use and harms. The reports present extensive descriptions of the nature and effects, as well as a multitude of prescriptions for remedial measures and actions to "stop the cycle of stigma". Closer reading of the documents, however, suggests substantial conceptual and empirical limitations in the characterization of the - multi-faceted and challenging - nature and workings of 'stigma' as a socio-political, structural or individual process or force, specifically as it applies to and negatively affects substance use and related outcomes, primarily the wellbeing of substance users. Concretely, it is unclear how the remedial actions proposed will materially alleviate stigma process and impacts, especially given apparent gaps in the issues examined, including essential strategies - for example, reform of drug user criminalization as a fundamental element and driver of structural stigma - for action that directly relate to the jurisdictions and privileged mandates of the report sources themselves as health and policy leaders. The commentary provides some concrete while subjective notes and observations on the dynamics of stigma as applies to and framed for substance/opioid use, as well as strategies and measures necessary to both tangibly address the material health and wellbeing of substance users, and related forces of stigma, in the distinct context of the opioid crisis in Canada.
加拿大一直存在与阿片类药物相关的长期公共卫生危机，包括在实质性干预差距面前广泛的死亡率和发病率。最近（2019 年），两位杰出的联邦权威人士——首席公共卫生官和加拿大精神健康委员会——提交了两份广泛的报告，详细、核心地关注“污名化”现象及其对物质/阿片类药物使用和危害的影响。这些报告广泛描述了污名的性质和影响，以及大量补救措施和行动的处方，以“打破污名化的循环”。然而，仔细阅读这些文件表明，在将污名化描述为社会政治、结构或个人过程或力量的性质和运作时，存在实质性的概念和经验限制，特别是将其应用于并对物质使用和相关结果（主要是物质使用者的健康）产生负面影响时。具体来说，不清楚拟议的补救行动将如何实质性地减轻污名化过程和影响，特别是考虑到所审查问题中明显存在差距，包括必要的策略——例如，将吸毒者刑事定罪改革作为结构污名的基本要素和驱动因素——作为与报告来源自身作为卫生和政策领导者的管辖权和特权任务直接相关的行动。该评论就污名化的动态提供了一些具体而主观的说明和观察，适用于物质/阿片类药物使用，并就解决物质使用者的实际健康和福祉以及与污名化相关的力量所需的战略和措施提供了一些说明和观察，在加拿大阿片类药物危机的独特背景下。
