Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic




Bowles, Jeanette M.
Kolla, Gillian
Smith, Laramie R.
Scheim, Ayden
Dodd, Zoe
Werb, Dan

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Drug and Alcohol Dependence Reports


Background: Stigma overwhelmingly affects people who inject drugs. The COVID-19 pandemic posed unique challenges for people who inject drugs, who are already stigmatized as being “dangerous and spreading disease.” The present study explored ways in which stigma was experienced by a sample of people who inject drugs in Toronto, Canada following COVID-related public health precaution measures. Methods: Qualitative interviews were conducted with people who inject drugs (n = 24) recruited from supervised consumption sites in Toronto, Canada. The semi-structured interview guide focused on the impact of COVID-19 on participants’ health and social well-being. Interviews took place six-months after initial COVID-19 precautions (September-October 2020). We used thematic analysis to examine findings, with stigma being an emergent theme. Results: Participants described heightened acts of stigma after COVID-19 restrictions were implemented, including feeling treated as “diseased” and the cause of COVID-19′s spread. They reported being less likely to receive emergency care during events such as overdoses. Participants perceived increased disease-related stigma evident through actions of stigma, including amplified dehumanization by the public, others avoiding all contact with them, and more discrimination by police and hospital systems. Conclusion: Participants provided specific examples of how stigmatizing behaviors harmed them after COVID-19 precautions began. It is plausible that stigma contributed to the dramatic increase in fatal overdoses, difficulty accessing housing, and further difficulty accessing needed healthcare in our setting. Integrating evidence-based harm reduction approaches in areas where stigma is evident might offset harms stemming from disease-related stigma and mitigate these harms during future public health emergencies.



People who inject drugs, Disease-related stigma, Harm reduction, Supervised consumption sites


Bowles, J. M., Kolla, G., Smith, L. R., Scheim, A., Dodd, Z., & Werb, D. (2023). Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic. Drug and Alcohol Dependence Reports, 7, 100167. https://doi.org/10.1016/j.dadr.2023.100167