Stigma and the Opioid Crisis: Full Report

Purpose

Canada is in the midst of an opioid crisis. Yet, while broad agreement exists that the stigma surrounding opioid use is both significant and consequential, several questions remain before we can have a comprehensive understanding of how it affects persons with opioid use problems:

• What does opioid-related stigma look like?
• Where does it come from?
• How is it expressed?
• How might it interfere with seeking or accessing help?
• How might it affect the quality of care and the availability of services?
• How might it be successfully combated?

Since answering these questions is essential for delivering effective interventions to improve the quality of first response services, the Mental Health Commission of Canada (MHCC) undertook an 18-month
research project (funded by Health Canada) under its Opening Minds anti-stigma initiative. The project had three main objectives:

1. Develop a better understanding of the role of stigma in opioid (and other substance) use problems to assist governments (and others) with service delivery and policy decisions.
2. Identify learning needs among first responders (e.g., emergency department staff, fire and police services, paramedics, and outreach workers or other front-line service staff) regarding stigmatization to help create appropriate and effective interventions.
3. Establish a measure for evaluating anti-stigma initiatives that are directed toward first responders on the front lines of Canada’s opioid crisis.

Methodology

The project included a scoping literature review as well as key informant interviews and focus groups involving first responders, persons with lived experience of substance and/or opioid use, policy makers, and other service providers. The group meetings were held in each of Canada’s five regionsto ensure they included sites with particularly high rates of opioid-related deaths or hospitalizations and had a broad representation of opinions, perspectives, and experiences. From these activities, we developed and tested a new scale for assessing opioid stigma interventions among first responder groups.

Key Findings

Heather Stuart, PhD, from Queen’s University completed the scoping review in March 2018. In January 2019, she published an invited article based on its findings in Healthcare Management Forum, called “Managing the Stigma of Opioid Use.”