Report highlights the need to clean the conversation around drug use

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Skewed perceptions of drugs and people who use them negatively affect both health and health care by feeding into harmful prohibitionist policies and sometimes directly affecting clinical care, according to a new international report that aims to counter such prejudices.

The report, titled The World Drug PERCEPTION Problem, was released on Tuesday by the Global Commission on Drug Policy. The 25-member delegation includes 12 former heads of states or government, a former secretary general of the United Nations and three Nobel Prize laureates.

Ruth Dreifuss, chair of the commission and former president of Switzerland, said the stigmatization of people who use drugs leads to discrimination and supports "regressive drug laws based on moral judgment."

"Whether you think of someone and refer to them as a person who uses drugs or a 'junkie' makes a huge difference in how you and society will treat them," Ms. Dreifuss said in a statement. "The vicious cycle, which has been fuelled for decades, must be broken."

The report comes as North America grapples with an overdose crisis brought on by illicit fentanyl. Canada's 2017 death toll from opioid-related overdoses is expected to surpass 4,000, with roughly a third of those deaths in British Columbia.

Amid media reports on the escalating crisis and impassioned debates about possible solutions, advocates have cautioned against using language that stigmatizes drug use or portrays people who use drugs as morally flawed or inferior. Rather, language should be "people-first" and reflect the medical nature of substance use. "Person with a substance use disorder" should be used over "addict" or "junkie" for example and "supervised consumption site" over "fix site" or "shooting gallery."

(The American Press Stylebook, a grammar and usage guide for journalists in the United States, last year issued an update recommending against using words such as alcoholic, addict, user and abuser unless they are in quotations. Instead, the new guide recommends phrasing such as "he was addicted," or "people with alcoholism.")

The report noted that stigmatization can have a direct impact on clinical care, citing a U.S. study in which mental-health clinicians were given identical case studies about people in court-ordered drug-treatment programs.

"The individual was either referred to as a 'substance abuser' or 'someone with a substance use disorder,'" the report stated. "The trained mental health professionals who read about an 'abuser' were more likely to believe that the individual in question was personally culpable for their situation and that punitive measures should be taken."

Such negative perceptions of drugs and drug use can also feed into policies such as mandatory minimum sentencing on petty drug crimes and compulsory treatment programs that are not only ineffective but violate human rights, the report stated.

Jane Buxton, harm reduction leader at the BC Centre for Disease control, issued a report last year encouraging the use of non-stigmatizing language when describing substance-use disorders, addiction and people who use drugs.

Her report also highlighted self-stigma – shame, negative self-evaluative thoughts and fear – that can develop when a person who uses drugs identifies with a stigmatized group.

"Those who experience self-stigma are less likely to seek employment, find it difficult to develop intimate contacts and are more likely to avoid treatment," Dr. Buxton's report stated. "When [people who use drugs] adopt [stigmatizing] terms for themselves they are likely to experience self-stigma and 'accept' that they cannot recover."

Karen Ward, a drug-policy advocate and former board member with the Vancouver Area Network of Drug Users, has mulled the effect of language on people's perception of drug use. She has floated the idea of relabeling B.C.'s overdose crisis as a poisoning crisis to reflect the fact that most people are not choosing to use lethal amounts of fentanyl.

"It was something happening to people," Ms. Ward said. "It wasn't a dose that people were doing too much of; it was something that was happening to them and they didn't have any control over it."

The Global Commission's report concludes with six recommendations. They include for policy makers to strive to change perceptions of drugs and people who use them by providing reliable and consistent information; and for United Nations member states to review language while negotiating international political agreements on drug control.