Stigma may be the biggest threat to solving the opioid crisis

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  • Brian Paolino says:


    Why are providers not working with people like myself?

    I have been free from OUD for a decade and am on SUBOXONE. I went back to college and graduated as an addiction counsellor. Now, I’m almost done my Honours in PSYC.

    The reason I opened up was to help others. Not just those with SUD’s, but the doctors who had provided me the crazy amounts of narcotics. I think I had enough for an oral equivalence of 600 mg of MOP a day!

    I have advice, I know all the tricks and you would be shocked by how much doctors do not know about opioids.


    There are practical, easy ways to ensure that narcotics are used for pain and not being diverted or over consumed.

    Only one provider ever asked me for my thoughts!?!

  • Susan McPherson says:

    I also have a special interest in the intersection of infectious diseases and social determinants of health. I hadn’t considered the relationship between the opioid crisis and HIV/AIDS before. But living in a city in Ontario where the emphasis of the Health Unit, in particular its medical officer of health, is mainly on the opioid crisis, and seeing so many people who are not HIV positive needing opioids or narcotics, at a moderate level – say, Tylenol 2 or 3, leaves me feeling that the needs of some people are being disregarded in favour of those addicted to opioids due to HIV or AIDS.

    I also see that perhaps in part because of this “crisis” in sw Ontario, that the Health Unit is not paying enough attention to other aspects of its mandate when it comes to infectious diseases, such as Tuberculosis. I was let down last year when I was falsely suspected of having TB, due to inaccurate clinical symptoms being put on the form someone filled out about me. No one caught the error, No one could be bothered. What would happen if that happened to someone with HIV or AIDS? They would probably start a “healthy debate” about it. As someone with emphysema, and not with symptoms of TB, born in England, attended private school, had caring parents who enjoyed nutritious food served at the table, later emigrating to Canada, marrying, giving birth to 2 children (pregnant 2.1 times), having that end, moved to attend university, moved again to attend university, still no career, ended up in the first university city unknown, uncared for, replaceable. Now a senior, thrown to the wolves, no one caring enough (about me, or the work they do) to do it right. And now, no one taking responsibility. I no longer have a prescription any more for Tylenol 2 or 3, that I had at one time for a broken ankle before I moved to this city, and now with a healed broken femur but left with a bad knee and other chronic conditions, I am required to make do with Tylenol 1. Yes, I have an interest, too, in the intersection of infectious diseases (or being suspected of having one) and the social determinants of health as seen by narrow-minded health professionals judging me by how I ended up.

  • Mat Rose says:

    Thanks for this thoughtful piece about bias. I believe it speaks to a fundamental flaw in the philosophy of medical care: if you don’t have the “answer” for a successful treatment outcome, you have “failed”. Medical training indoctrinates us to avoid failure; therefore, we find ways to avoid patients whose conditions we are ill-prepared to help with. We end up blaming the patient, moralizing the conditions, and finding quick but ultimately ineffective “solutions” that solve our problems but not the patients’, such as early discharge, thoughtlessly increasing doses of opioids, setting patients up so their behaviours become intolerable enough that we can fire them. This was the case when HIV was new. This is the case with addiction. This is the case with chronic pain. I think it speaks to the necessity of upping our compassion quotient, particularly when faced with a lack of “answers”. And, of course, educating ourselves appropriately where there are effective means of providing good care to complex conditions. Like addiction. Like chronic pain.

  • Dr. Gaylord Wardell says:

    It seems you are a hypocrite. Addicts are, and rightly so, treated as people with an illness. That aside, chronic pain patients on opioids are stigmatized by nurses, pharmacists, doctors and medical regulators as addicts.

  • Kinnon Ross says:

    So great to see you sharing your experiences at SPH, Thomas! Hope to see you there in the future.

  • Helen says:

    Wonderfully written, compassionate and important


Thomas Dashwood


Thomas Dashwood is a third-year internal medicine resident at the University of Toronto. He has a special interest in the intersection of infectious diseases and social determinants of health.

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