Upvoting stigma? Analyzing themes in substance use stigma within Canadian subreddits.

Résumé

BACKGROUND: Public perceptions of substance use are important drivers of drug policy, resource allocation, and stigma worldwide. Despite increasing adoption of public health-oriented approaches in some countries, stigma remains a pervasive barrier to harm reduction and treatment engagement. This study examines themes and prevalence of stigmatizing substance use discourse from Canadian city subreddits, providing insights relevant to countries considering policy reform and stigma reduction strategies.METHODS: We collected illicit substance-related posts and comments from major Canadian city subreddits (e.g. r/Toronto, r/Winnipeg). A zero-shot learning approach, utilizing the BART-large model, classified posts as stigmatizing or non-stigmatizing. Posts meeting a ≥ 90 % confidence threshold for stigma underwent qualitative thematic analysis to identify narratives shaping stigmatizing discussions of illicit substance use.RESULTS: Of the substance-related posts analyzed, 14.4 % contained stigma (with ≥90 % confidence). Stigma was most frequently associated with crack (18 %), cocaine (18 %), opioids (15 %), and methamphetamine (14 %). The thematic analysis identified four dominant narratives: Perceived Enabling versus Effective Care in the Evaluation of Harm Reduction (37.5 %), Punitive Criminalization and Law Enforcement (23.2 %), Exclusion in the Name of Community Safety (22.5 %), and Taxpayer Resentment and Public Spending (18.6 %).DISCUSSION: Findings highlight the prevalence and themes of illicit substance use stigma within discussions on Canadian city subreddits on Reddit. Stigmatizing language and attitudes may contribute to resistance against harm reduction measures and punitive policy shifts. Addressing these narratives through public education, evidence-based policy reform, and stigma reduction initiatives is essential for fostering a more inclusive approach to substance use health.