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      Applying a ‘harm to others’ research framework to illicit drugs: political discourses and ambiguous policy implications

      1 , 1

      Addiction

      Wiley

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          Most cited references 55

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          Stigma and the ethics of public health: not can we but should we.

           Ronald Bayer (2008)
          In the closing decades of the 20th century, a broadly shared view took hold that the stigmatization of those who were already vulnerable provided the context within which diseases spread, exacerbating morbidity and mortality by erecting barriers between caregivers and those who were sick and by imposing obstacles upon those who would intervene to contain the spread of illness. In this view, it was the responsibility of public health officials to counteract stigma if they were to fulfill their mission to protect the communal health. Furthermore, because stigma imposed unfair burdens on those who were already at social disadvantage, the process of stigmatization implicated the human right to dignity. Hence, to the instrumental reason for seeking to extirpate stigma, was added a moral concern. But is it true that stigmatization always represents a threat to public health? Are there occasions when the mobilization of stigma may effectively reduce the prevalence of behaviors linked to disease and death? And if so, how ought we to think about the human rights issues that are involved?
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            The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis

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              Stigma, social inequality and alcohol and drug use.

               Robin Room (2005)
              A heavy load of symbolism surrounds psychoactive substance use, for reasons which are discussed. Psychoactive substances can be prestige commodities, but one or another aspect of their use seems to attract near--universal stigma and marginalization. Processes of stigmatization include intimate process of social control among family and friends; decisions by social and health agencies; and governmental policy decisions. What is negatively moralized commonly includes incurring health, casualty or social problems, derogated even by other heavy users; intoxication itself; addiction or dependence, and the loss of control such terms describe; and in some circumstances use per se. Two independent literatures on stigma operate on different premises: studies oriented to mental illness and disability consider the negative effects of stigma on the stigmatized, and how stigma may be neutralized, while studies of crime generally view stigma more benignly, as a form of social control. The alcohol and drug literature overlap both topical areas, and includes examples of both orientations. Whole poverty and heavy substance use are not necessary related, poverty often increases the harm for a given level of use. Marginalization and stigma commonly add to this effect. Those in treatment for alcohol or drug problems are frequently and disproportionately marginalized. Studies of social inequality and substance use problems need to pay attention also to processes of stigmatization and marginalization and their effect on adverse outcomes.
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                Addiction
                Addiction
                Wiley
                0965-2140
                1360-0443
                August 2021
                October 2020
                August 2021
                : 116
                : 8
                : 1941-1946
                Affiliations
                [1 ]Drug Policy Modelling Program, Social Policy Research Centre University of New South Wales Sydney 2052 Australia
                Article
                10.1111/add.15243
                © 2021

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