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 onl