Substance Use and Harm Reduction Resource Stigma Among Undergraduate Students

Abstract

Amid the overdose crisis in British Columbia (B.C.), the stigma surrounding substance use and harm reduction resources may discourage people from seeking health and social services. Using data collected from a survey and naloxone training event from undergraduate business students (n = 380), this article examines whether solidarity and legalization video messages reduce stigma and improve the sign-up and completion of harm reduction training. We investigate public, associative, institutional, and self-stigma among students towards non-prescribed drug use and harm reduction resources. Additionally, we attempt to gauge student awareness of substance use and of the B.C. decriminalization law passed in 2023. In our results, we find modest stigma around harm reduction resources across all types of stigma. We demonstrate that solidarity messages have a significant effect on increasing harm reduction engagement levels compared to the control condition. However, overall, the solidarity and legalization video messages did not lead to 1) a significant reduction in public associative, institutional, and self-stigma, nor 2) an increase in sign-ups or training completion. Furthermore, the region (domestic Canadian versus international) where students spent the majority of their life was not a significant moderator for differences in stigma levels. Lastly, a significant but weak (r = - .17) correlation was found between stigma level and knowledge of harm reduction and discrimination laws. We conclude that to bolster anti-overdose efforts, students must overcome an intention-behavior gap. Although some students are interested in harm reduction resources, a lack of intimate understanding of the overdose crisis and of personal relevance can lead to indifference. Using 30-second video clips to destigmatize the issue is insufficient for initiating behavior change, especially in the context of internalized stigma. Future research could focus on understanding the implications of specific subtypes of stigma and exploring better alternatives, such as prolonged in-person interventions, which may be better suited for reducing stigma and increasing the uptake of harm reduction resources. 

Keywords: Harm Reduction, Opioids, People Who Use Drugs (PWUD), Solidarity, Legalization, Decriminalization, University Students