Side event: Addressing stigma: Continuing the discussion

Organized by the Governments of Canada, Estonia, Norway and Uruguay, the United Nations Office on Drugs and Crime, Prevention, Treatment and Rehabilitation Section, and the Civil Society Task Force.

Rite Notarandrea, Canadian Centre on Substance Use and Addiction (CCSA): Stigma is discriminatory behaviour against a group of people. Addiction is not a moral failing, it is not a choice made by bad people, it is a health condition that afflicts millions around the world. Stigma represents human rights violation in some circumstances. Treatment services are not scaled up globally. Illicit substance use disorder is the most stigmatized medical condition in the world. Stigma comes in many forms, like language, attitudes, behaviour, and policies. Perception that people who use drugs have about themselves makes it difficult for them to seek and receive help. Fearful of being met with judgement instead of respect. Stigma causes healthcare professionals to judge and treat people who use drugs differently than other patients. Criminalization and punitive laws are related to stigma and can keep people from accessing health services.

Gord Gardner, Community Addictions Peer Support Association (CAPSA): Wish you all well. Have my best hopes. Whether I agree with you or not, I hope you sleep in safety tonight and awake tomorrow. No worse fate than to sleep with your own disapproval. I hope you never experience self disdain. My opinion of your ideas or actions does not reduce your value as a human being. Let’s not focus on our opinions so much, but the value we hold as human beings. If I am sincere in my wishes, how will I think of you? Based on my opinion or respect for your life? Ask you all to speak of people using drugs with respect and further humanity. Ask you select policies and language that reflect this.

Miwa Kato, Director DO, UNODC: All the discussions and documentation ultimately have to answer this question that has been raised. There are so many people that do not have a safe night’s sleep and are stigmatized every day. Not enough attention to address these issues. Groundbreaking resolution at the last CND on stigma. Spent some time over the last year looking at what stigma means. Over the past nine months at the UNODC, I have been able to relate to many people in different economic, political, and social positions about the question of stigma. People have such stigma already against drug users. We at the UNODC need to be paying more attention to this. Underemphasized in our work currently. Very important for the UNODC to be hearing your experiences and thoughts on how we can make this work and ensure we do not inadvertently reinforce this stigma.

Gilberto Gerra, Chief Drug Prevention and Health Branch, UNODC: People say it is a self-acquired disorder, and ignore the context of vulnerabilities that causes a person to use drugs. If you have mental health issues in combination with substance use disorder, you have no services offered to you, in contrast to someone with just mental health issues. Among doctors, only 22% were prepared to screen for substance use disorder. People do not want to be trained in addiction medicine, as they will then need to work with drug addicts. Leprosy in the past was called the disease of the sinners. We know today this simple infection can be easily treated. Took a long time to overcome the ignorance. Epilepsy was seen as devil possession. We have to dissipate ignorance. Replace moralistic approach with a science-based model.

Diego Olivera, Uruguay: Stereotypes are very strong in our society. Operate among caretakers of people with drug abuse problems. Have had 50 years of fighting against drugs. Us against them mentality. Focused more on substances than individuals. Based on UNGASS implementation, drug policy must be centered on people with a strong focus on human rights and public health. Making the great effort to bring about change is indispensable and we must develop powerful tools to move in that direction. Wording and reframing law. Smart use of terms. In the first article of our cannabis law, language indicates that cannabis regulation is necessary for promoting public health and human rights. Careful about using terms that bring us closer to stigmatization. Information made available for people. Must take into account different socio-economic situations. Necessary to change and increase education on drugs. Provide effective tools to help new generation and reduce damage caused by drug use. Offering training to teachers, teenagers, and children. Every child that entered the public education system receives laptop and information through courses. Radio and TV also used to invite people to have discussions.

Kenneth Arctander, Dianova International: Self-identify as someone who has faced stigma due to substance use disorder. Campaign by Dianova on stigma. In healthcare services, high levels of stigma lead people to fail to receive treatment. Results in some widespread difficulties. Some healthcare providers do not provide medication assisted treatment. Services must provide adequate information, advice, and support. Involve people in all stages of the treatment function. Improve resilience, self confidence, and self-esteem. Work towards increasing social awareness. In workplaces, substance use disorders rarely have corporate policies. Remain silent. Assess the needs of your workplace, such as through a survey or meeting. Develop clear guidelines. Implement an education and awareness program for employees. Train the supervisors. Support your employees. Stigma in the media has a huge impact on public perception. Important to distinguish between substances and their effects, and between use, misuse, dependency, and addiction. Media should convey that problematic use is not always related to criminality or lower socio-economic status. Avoid using an alarming tone. Present the reality of addiction objectively while avoiding moral judgements. Media content should highlight circumstances that can increase vulnerabilities. We need to watch our language. Examine our own potential for stigmatizing others.

Ain Peil, Estonia: Focus on the law enforcement side of things. One of the most important stakeholders that in some cases may be seen as the profession that creates stigma. Police can be involved in reducing stigma. We have fentanyl as the mainly used opioid since early 2000s. High level of overdose deaths and related harms to society. Accompanied by stigma amongst general population and professionals that come into contact with drug users. Police saw that they come into contact with the same people, such as those coming in and out of prison. Lack of referral or existence of health and social services as alternative for punitive sanctions. Police started to advocate for greater availability of these services. Successful as police were effective in public relations. Communication and messages improved when health and police began meeting regularly. All stakeholders involved in discussing problems and solutions. Using the same terminology. Change happened when civil society organizations and drug users got involved in the discussion. Effective when politicians became involved in discussions. Creates empathy which is necessary for reducing stigma. Led to increased information exchange. High level police officials started to advocate for drug users. Still focused on the safety. We still have stigma of course, but we moved forward with involvement of police. Have referral systems and piloting different programs that help drug users get in contact with health and social services instead of sanctions. Recommendation is to get police involved in advocating for problems and solutions. Get people on the same team and include different stakeholders. Share information both ways.

Torbjorn K. Brekke, Norway: As we have negative attitudes towards drugs, we transfer these views to those who use them especially if they use a lot and lose control. We even punish them. Although we do not know anything about them, we label them a drug addict and nothing more. Lowest stage of social ladder. Even within drug users, operate with an us and them mentality. People who use drugs often have been abused or neglected. Over the last years, many countries have included representatives of people who use drugs. They have showed up as well spoken, responsible, and sympathetic. Remind us that there is much more to this than meets the eye. Praise Canada for putting stigma on the agenda. The only one we can change is ourselves. To confront stigma, have to confront myself and my attitudes, and hope others will as well.

Rite Notarandrea, Canadian Centre on Substance Use and Addiction (CCSA): Stigma comes in various forms. We are talking about the human being. The UNODC needs to emphasize this more. Language emphasized. Need for comprehensive efforts to open and have a societal dialogue. Issue belongs to society. Raising awareness and understanding in various settings, such as healthcare, social services, media, and workplace. Stigma ends with me and all of us in the room.

Gord Gardner, Community Addictions Peer Support Association (CAPSA): Invite you to join our exhibit in the rotunda. Please remind me of my commitment to end stigma.

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