In many ways, ours is harsh, moralistic, and punitive society. One need only look at our world-leading incarceration rate to see the evidence. We like to punish wrongdoers, and our conception of wrongdoers often includes those who are doing no direct wrong to others, but who are doing things of which we don't approve.

[image:1 align:left]We label those people of whom we don't approve. When it comes to drugs and drug use, the labels are all too familiar: Heroin users are "fucking junkies;" alcohol abusers are "worthless drunks;" cocaine smokers are "crack heads;" stimulant users are "tweakers;" people with prescription drug habits are "pill poppers." The disdain and the labeling even extends to the use of drugs on the cusp of mainstream acceptance. Marijuana users are "stoners" or "pot heads" or "couch potatoes."

Such labeling -- or stigmatizing -- defines those people as different, not like us, capital-O Other. It dehumanizes the targeted population. And that makes it more socially and politically feasible to define them as threats to the rest of us and take harsh actions against them. It's a pattern that we've seen repeatedly in the drug panics that sweep the nation on a regular basis. Drug users are likened to disease vectors or dangerous vermin that must be repressed, eradicated, wiped out to protect the rest of us.

(It is interesting in this regard to ponder the response to the most recent wave of opiate addiction, where, for the first time, users are being seen as "our sons and daughters," not debauched decadents or scary people of color who live in inner cities. Yes, the impulse to punish still exists, but it is now attenuated, if not superseded, by calls for access to treatment.)

Never mind that such attitudes can be counterproductive. Criminalizing and punishing injection drug use has not, for example, slowed the spread of blood-borne infectious diseases such as HIV and hepatitis C. To the contrary, it has only contributed to the spread of those diseases. Likewise, criminalizing drug possession does not prevent drug overdoses, but it may well prevent an overdose victim's friends or acquaintances from seeking life-saving medical attention for him.

A recent survey from the National Council on Alcoholism and Drug Dependence reinforces the view that we tend to stigmatize drug users as morally decrepit. That survey found that Americans are significantly more likely to have negative attitudes about drug addiction and addicts than about mental illness.

Only one out of five said they would be willing to work closely on the job with a person addicted to drugs (as compared to 62% for mental illness), and nearly two-thirds said employers should be able to deny a job to someone with an addiction issue (as compared to 25% for mental illness). And 43% said drug addicts should be denied health insurance benefits available to the public at large.

"While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition," said study leader Colleen L. Barry, Ph.D. of the Johns Hopkins Bloomberg School of Public Health. "In recent years, it has become more socially acceptable to talk publicly about one's struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal."

"The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need," study coauthor Beth McGinty, Ph.D. said in a news release. "If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction."

As the survey suggests, the process of stigmatization is an impediment to smart, evidence-based approaches to dealing with problematic drug use. Now, the Denver-based Harm Reduction Action Center is trying to do something about it.

[image:2 align:right]In the last few days, it has rolled out a new anti-stigmatization campaign featuring the faces of injection drug users, the locations where they overdosed or suffered other bad consequences, and their individual stories in brief.

"My name is Alan," says a middle-aged man with a brushy mustache. "I overdosed on heroin. Right there in that parking lot in that picture. I know the risks of doing heroin, but drug dependency is strong."

The second part of Alan's message is repeated with each drug user pictured: "There are 11,500 injection drug users like me in Metro Denver. 73% of us carry Hepatitis C. 14% of us have HIV. The transmission of bloodborne diseases and drug overdoses are nearly 100% preventable. Support the Harm Reduction Action Center. Learn more about how our public health strategies keep you, and the people you know, safe."

"My name is Andrew," says a dreadlocked and pierced young man whose image is coupled with a photo of an empty apartment. "After a decade living as a homeless youth, the most traumatic thing that happened to me didn't happen to me at all. It happened to my best friend Val. She died of a heroin overdose. Right here in this picture. She was my friend. She was someone's daughter. Sobriety has taught me a lot about the thin line that separates us all. Val was someone you knew. She probably served you coffee. She probably even greeted you with a friendly smile."

"My name is Joanna," says a woman whose image is paired with a photo of a car parked beneath a highway overpass. "When I was diagnosed with lymphoma, I was prescribed a heavy dose of pain killers. Cancer hurts, but with treatment, it went away. My dependency on opioids did not. Two years later, this is where I live; in a car, under the interstate. I did not choose to get cancer. I did not choose to get dependent on opioids."

The images and the messages are strong and direct. That's the idea, explained HRAC executive director Lisa Raville.

[image:3 align:left]"This campaign is about bringing awareness of our work in the community, focusing on the common sense approach championed by harm reduction," she said. "Stigma, of course, is one of the biggest stumbling blocks, preventing otherwise reasonable conversation on the matter of communicable diseases and accidental overdoses. This campaign sets the scene that harm reduction is a valid and evidence-based approach to public health. Access to clean syringes, proper syringe disposal, and naloxone are key components to a comprehensive public health strategy that curbs the spread of HIV, HVC, and reduces the rate of otherwise fatal overdoses."

It's a message directed at the general public even more than drug users themselves, Raville said.

"One of the fundamental problems faced by health care advocates working with injection drug users is a generalized, public perception that the issue is isolated to people and places outside of the normal social sphere. Generally speaking, our tendency is to dissociate our ordinary experiences -- the people we know and the places we go -- from things that we consider dangerous, dark, or forbidden," she said.

"In the arena of injection drug use, the consequence of this mode of thinking has been historically devastating," she continued. "Instead of crafting public policy that works to minimize the harm caused by addiction, our trajectory tends towards amplifying consequences for anyone that wanders outside of the wire and into these foreign spaces. Rather than treating addiction as a disease, we treat it as something that is volitional and deserving of its consequences. Accordingly, our policies view the contraction of blood-borne pathogens and the risk of overdose as deterrents to the act of injecting drugs."

That cold-blooded attitude may make some people feel better about themselves and their policy prescriptions, but it hasn't proven useful in reducing deaths, disease, or other harms resulting from injection drug use. Instead, it tends to increase them.

"These 'consequences,' of course, have little impact on rates of addiction," Raville argued. "They do, however, all but ensure the continued spread of HIV and hepatitis C. Moreover, possession and distribution of naloxone, a drug that counters the effects of otherwise fatal opiate overdoses, remains criminal in many areas throughout the world."

At bottom, the campaign is not just about drug users but about better public health.

"As our campaign points out, when we drive things underground, we make them truly dangerous," Raville said. "Harm reduction is predicated on the fact that people use drugs. Those who inject drugs are among the most insular and at-risk for contracting HIV, HCV or dying of an overdose. Like a stone that falls in the water, these acute health-related events have ripples which touch all of us, regardless of whether or not we use drugs. HIV infects those who inject the same as those who do not; the best way to prevent its spread is to prevent its spread across all populations of people, not just those deemed more socially 'worthy.' By facing stigma head-on and by humanizing the people in our community who we serve, the Harm Reduction Action Center hopes to normalize the issue and bring the conversation about drug use and healthcare to a more practical level. As a public health agency that serves people who inject, we could get so much more done in our community without stigma."