Substance use is a reality for many Canadians, whether it involves a glass of wine after work, cannabis use, prescription medications, or illicit drugs. Yet, the way society responds to different substances鈥攁nd the people who use them鈥攊s far from equal.
Legal, healthcare, and social policies often disproportionately impact marginalized populations, reinforcing existing inequities and limiting access to essential services.
New research highlights the urgent need to rethink how substance use is addressed in Canada, moving away from stigmatizing and punitive approaches toward policies rooted in equity and harm reduction.
The unequal burden of substance use policies
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While substance use is widespread, the consequences of legal and social responses are not evenly distributed. A person with financial stability and strong social networks is far more likely to navigate substance use without major repercussions, while someone facing poverty, housing insecurity or who is part of a marginalized group is more likely to come into contact with law enforcement, face criminal charges, or receive inadequate healthcare.
The way we talk about substance use and the policies we create often reflect deep-seated biase
鈥淭he way we talk about substance use and the policies we create often reflect deep-seated biases,鈥� says Dr. Niki Kiepek, a leading expert on substance use and social inequities. 鈥淎lcohol is widely accepted 鈥� even promoted 鈥� despite being one of the most harmful substances, while those who use opioids or other illicit substances are criminalized and dehumanized.鈥�
Dr. Kiepek is an associate professor in the School of Occupational Therapy and a project lead with the MacEachen Institute for Public Policy and Governance. Her current research examines broad representations of substance use across health, law and lived experience.
She says in health-care settings, stigma can prevent people from seeking treatment, leading to worsening health outcomes and increased harm. Many individuals avoid disclosing their substance use to doctors due to fear of judgment or consequences, sometimes leaving hospitals before treatment is complete.
Challenging stigma and misconceptions
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A key part of addressing these disparities is challenging the deeply ingrained stigma surrounding substance use. Traditionally, research has focused on the most extreme cases of addiction, reinforcing the perception that all substance use is inherently harmful. However, emerging studies suggest that many people use substances in moderation and experience benefits, such as stress relief and relaxation.
If we only study the most severe cases, we miss the bigger picture
鈥淯nderstanding the full spectrum of substance use is crucial,鈥� says Dr. Kiepek. 鈥淚f we only study the most severe cases, we miss the bigger picture 鈥� including why people turn to substances in the first place.鈥�
One of the biggest challenges is questioning why certain substances are stigmatized while others are normalized.
- Why is opioid use condemned, while alcohol 鈥� a substance linked to high rates of harm 鈥� is widely accepted?听
- Why are people who sell illicit substances labeled as 鈥減redators鈥� in court decisions, while industries that profit from harmful products, like alcohol or processed foods, are not held to the same moral scrutiny?
鈥淔or instance, people who are living unhoused and don鈥檛 have a lot of money may buy drugs and share it among their friends for reasons of safety. Legally, that鈥檚 considered trafficking but it鈥檚 actually a way of enhancing safety because we have unsafe drug supplies,鈥� she says.
Keri Chambers is the occupational therapy clinical lead, primary care, on the Harm Reduction Team for Newfoundland and Labrador Health Services. She has partnered with Dr. Kiepek on several projects and says her research is critically important in looking at who uses substances, the language used to describe substance use, and how stigma can prevent people from getting equitable care.
"Her work addresses some of the systemic issues in terms of how substance users are seen and receive health care. Addressing and dispelling these misconceptions will result a fairer and more equitable health care system for all."
Rethinking solutions: A path to equity
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To reduce inequities, experts argue that institutional changes are necessary, such as:
- Reframing substance use听鈥� Public education campaigns should move away from moralizing substance use and instead provide accurate, evidence-based information about risks and benefits.
- Addressing institutionalized stigma听鈥� Healthcare and legal professionals need training on how stigma affects their decision-making and patient interactions, ensuring that people who use substances receive fair, unbiased treatment.
- Developing equitable policies听鈥� Laws and healthcare policies should reflect actual drug-related harms, rather than reinforcing punitive measures that disproportionately affect marginalized communities.
- Improving social conditions听鈥� Many people use substances as a coping mechanism for stress, trauma, or economic hardship. Addressing these root causes 鈥� through better mental health services, access to stable housing, and economic support 鈥� can reduce harmful substance use.
The road ahead
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A more equitable approach to substance use isn鈥檛 just about changing laws 鈥� it鈥檚 about shifting mindsets. By acknowledging the social and economic factors that shape substance use, Canada has the opportunity to create policies that support, rather than punish, individuals.
鈥淭here鈥檚 this myth that people have to hit rock bottom before they are able to improve," says Dr. Kiepek. "In my experience of working with clients, it鈥檚 hope and the fact that things are improving that makes them feel like things can get better.
鈥淭here鈥檚 still a long way to go. But the more we challenge outdated assumptions, the closer we get to a society where everyone 鈥� regardless of their substance use鈥� has access to compassionate and equitable care.鈥�
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