Ignored inequities: Critical analysis of the pre-launch development of British Columbia's "Stop Overdose" campaign

Substance use stigma has been positioned as a major driver of drug toxicity mortality. In response, governmental and public health organizations across Canada have invested significant resources into mass media campaigns that target stigma. Many of these campaigns feature images or stories about people who use drugs (PWUD). Although stigma and drug toxicity death disproportionately impact racially and economically marginalized PWUD, these campaigns often over-represent White, middle-class individuals. This effectively ignores intersecting roles of racism and classism in the experience of stigma and drug toxicity mortality.

To investigate how this pattern of representation might occur, we examined the development process of the British Columbia (BC) Government's "Stop Overdose" anti-stigma campaign launched in 2018. We aimed to identify strategic goals, decisions, and underlying ideas that could help explain the campaign's eventual focus on White, middle-class PWUD. Through a Freedom of Information request we obtained 320 pages of documents from the BC Government outlining the real-time development, testing, and evaluation of the first wave of the campaign. We analyzed these documents using reflexive thematic analysis.

We identified that campaign developers had a marked focus on challenging stereotypes about PWUD and humanizing PWUD, while ensuring the campaign was relevant to BC residents. To achieve these goals, campaign developers ultimately avoided images of what they deemed the inaccurately "stereotypical" marginalized drug user. Instead, they featured PWUD in more privileged social positions. By attaching labels like "co-worker" to this imagery, developers felt mainstream BC residents could relate to and have more empathy for these PWUD compared to marginalized PWUD.

In effect, these strategies perpetuated the exclusion and dehumanization of marginalized PWUD facing disproportionate harms of the drug toxicity crisis. Since anti-stigma campaigns remain a common intervention, we highlight a need for strategic approaches informed by more critical perspectives on substance use stigma.