Ending stigma for whom? A critical community-based participatory research project to examine Canadian substance use-focused anti-stigma campaigns

In the escalating crisis of drug toxicity deaths in Canada, reducing stigma towards people who use drugs (PWUD) has emerged as a priority, and mass media substance use-focused anti-stigma campaigns have become a popular intervention; however, the harms experienced by PWUD are distributed inequitably and shaped by structural stigma (e.g., racism, classism). So, who are these anti-stigma campaigns really for? Drawing on critical theorizations of stigma, this dissertation utilizes a community-based participatory research approach to examine how PWUD are represented in Canadian substance use-focused anti-stigma campaigns, as well as the potential implications for marginalized PWUD. Study one examined the prevalence, timing, and location of substance use-focused anti-stigma campaigns across Canada and tracked patterns in how PWUD were represented. A comprehensive review identified 134 Canadian substance use-focused anti-stigma campaigns from 2009-2020. Systematic visual and textual analysis of these campaigns found that they tended to centre White-appearing, middle-upper class PWUD and frequently included concepts of stigma and anti-stigma strategies (e.g., "addiction does not discriminate") that individualized the problem of stigma and obscured the structural inequities (and intersecting systems of oppression) that shape substance use-related harms. Study two critically examined the potential implications for marginalized PWUD of anti-stigma campaigns that centre White, middle-class PWUD. Eight focus groups were conducted with marginalized PWUD (e.g., Indigenous, poor) who analyzed two examples of mainstream anti-stigma campaigns (Stop Overdose BC, End Stigma). Reflexive thematic analysis revealed how some participants hoped the campaign message that "anybody" could be a PWUD might benefit them by addressing the stereotypes associating substance use with their other marginalized social identities (e.g., Indigenous, poor). However, participants also critiqued the campaigns for purposely excluding representations of PWUD like them and ignoring the forms of stigma that PWUD like them faced. Participants worried that campaigns like these could exacerbate the stigma and exclusion they face by negatively contrasting marginalized PWUD like them with the privileged PWUD represented in the campaigns. This dissertation recommends that anti-stigma interventions more deeply reckon with how substance use stigma intersects with other systems of oppression and work towards addressing structural inequities at the heart of the drug toxicity crisis.