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Destigmatizing Substance Use Disorders

What does “PWUD” Mean?

PWUD is an acronym of “People Who Use Drugs.” This term is used in discussions and studies concerning drug use, addiction, and harm reduction. It acknowledges the humanity and complexity of individuals dealing with substance use disorders (SUD) and highlights the need for compassionate approaches to addressing these issues. This term also puts substance users at the centre and forefront of their care, encouraging peer-lead support programs and uplifting first-hand perspectives.

PWUD Perspectives

Studies have been recently done that engage with PWUD directly to change policies and provide better treatment services for substance users. An Ontario study conducted with one-on-one interviews with PWUD in 2021 hopes to inform government policies. One concrete proposal developed in this study is “…the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators” This study notes governmental barriers to treatment including long wait times and limited space in government-funded treatment centres, as well as high price points for private facilities. 

Participants note individuals getting “lost in the system,” indicating: “transitions between services were not seamless, which was especially problematic. Examples included a lack of referral or being referred to the wrong or unhelpful service, a lack of follow-up, and having to go to multiple different services to find assistance.” This leads to individuals giving up on the system, getting the wrong type of care, or long waiting times for treatment arriving too late.

PWUD and Progress

PWUD have always been involved in peer-lead harm reduction services in local organizations. However, these discussions have yet to make meaningful change in the federal government in North America. Stigma and criminalization is a large part of why progress has been stunted. A study conducted in Lethbridge, Alberta demonstrates that the limiting of Supervised Consumption Sites (SCS) to an abstinence based treatment system and installing Overdose Prevention Sites (OPS), which are noted as temporary emergency measures that do not provide the long term support of SCS. The article states: “In fact, harm reduction initiatives, specifically SCS, have long been found to increase treatment program uptake and reduce infectious disease transmission, lethal overdose rates, and public drug use.” By noting the difference in these two treatment models, we can see a clear benefit to destigmatized treatment programs that provide long-term and person-centred care.

Another study based in Victoria, BC is by the University of Victoria, Canadian Institute of Substance Use Research, SOLID Outreach, and Victoria SAFER Institute. Engaging with PWUD around the question “Safer Supply would work well if…,” researchers and local harm reduction workers received six different clusters of statements: “1) Right dose and right drugs for me; 2) Safe, positive and welcoming spaces; 3) Safer supply and other services are accessible to me; 4) I am treated with respect; 5) I can easily get my safer supply; and 6) Helps me function and improves my quality of life (as defined by me).”

The Collaborative Community Laboratory on Substance Use and Harm Reduction (Co/Lab) in Victoria, BC also worked with PWUD to produce a checklist indicating effective elements of a theoretical Safer Supply program. Notable elements from this checklist include “I feel welcome and nurtured.” “There are people you can talk to.” “People believe what you say.” “Options that recreate the ritual. “There are people who know me and understand what I am going through.” “People who are good at communicating and following through.” From these quotes, it is evident that PWUD are not treated with dignity and respect at the current facilities available to them. Communication, care, knowledge, and trust are extremely important in developing plans for PWUD-centred care.

There are extreme mental and physical barriers to treatment for PWUD in the form of stigma and lack of accessibility to essential services. The term “PWUD” encourages the humanization of drug users and promotes a person centred approach. Peer-lead harm reduction treatments have been shown to prevent overdose and prescribed Safer Supply has not contributed to overdose deaths in Canada. Directly engaging with PWUD in policy-making has the potential to save lives and prevent overdoses across Canada and the world.