Erasing the Stain: Working together to challenge stigma towards people who use drugs and opioid substitution treatment in Bristol

1 January 2023

What interventions can be developed to reduce stigma towards people who use drugs and OST? How can a story-sharing workshop shed light on drug stigma and the necessary policy to prevent it?

Ideas Exchange 2022/2023

Stigma is a major barrier to people being retained in opioid substitution treatment (OST) and recovering from opioid dependency; people who use OST are often stigmatised both for their drug use, as well as the medications they receive (for instance in healthcare settings). People who use crack cocaine and heroin are especially stigmatised and Bristol has a particularly high incidence of people who use both substances concurrently.

To experience stigma is inherently de-humanising; it further marginalises people, disconnects them from their communities, and severely limits their wellbeing and life chances.

What will the project involve?

This project is focused on the development of interventions to reduce stigma towards people who use drugs and receive OST in the city. It seeks to utilise the primary investigator’s (Victoria Carlisle) background in permaculture design to combine skills and knowledge of natural systems and academic research to improve the lives of people who use drugs and OST in Bristol.

This will involve a full-day participatory workshop with stakeholders using ‘The Art of Hosting’ participatory leadership practices. This draws on the collective wisdom and self-organising capacity of groups to address complex challenges. The project intends to work in the ‘chaordic’ (chaos/order) space – this acknowledges and actively harnesses the emergent properties of complex and unpredictable systems, whilst attempting to bring form and order to the process. Central to this process will be the sharing of stories by people with lived/living experience of drug use and stigma. The project will then use a technique known as ‘World Café’, gathering in groups of 4 or 5 conversing about the issues raised. After a time, one person will remain at the table as ‘host’ whilst the others move to another group, carrying the thread of their story with them. The aim is for the threads of these conversations to be woven together to enable a rich understanding of the ideas that are discovered and developed as a group.

The project will work closely with Mat Southwell (International Network of People Who Use Drugs) and BPD (Bristol Drugs Project) to recruit up to 15 people to attend the workshop with lived and living experience of drug use/OST and stigma who will be compensated for their time. The workshops will be co-facillitated by Victoria Carlisle and José Barco (Community CoLab). Representatives from the following organisations will also attend on the day: Bristol Drugs Project (BDP), Bristol City Council, Avon and Somerset Police, the Integrated Care Board (formerly CCG), OHID (formerly Public Health England), a local GP, a local pharmacist, a local housing charity (ARA) and Transform Drugs. There will also be academics from the University of Bristol in attendance, from Population Health Sciences, Policy Studies, and Psychological Science.

Who are the team and what do they bring?

Victoria Carlisle (Population Health Sciences, Bristol Medical School) is a researcher who has previously explored multi-level influences on recovery within opioid subsitution treatment (OST). She is interested in public health, addiction, opioids, trauma, stigma, intervention development & evaluation, qualitative research methods and evidence synthesis.
José Barco (Community CoLab) is an experienced community organiser and Art of Hosting facilitator. He is passionate about people power, social change and social justice, creating spaces for meaningful participation and collaboration at an organisational and grassroots level. He is also a founding director of Community Organisers Ltd, a national body supporting the training and development of community organisers in England.
Mat Southwell (International Network of People Who Use Drugs) is a technical advisor in HIV, drug use and harm reduction with more than 30 years of experience. Mat founded the Healthy Options Team (HOT) a pioneering partnership between traditional health professionals and the drug using community. Mat went on to be Professional Head of Service for East London and City NHS Drug Services. He trained as and is an experienced general and project manager.

What is to come?

It is hoped that the workshop will have several ‘harvests’ (outcomes). Firstly, the researchers hope that by bringing together people with lived/living experience of drug use and OST in a formalised way, they will be able to facilitate the development of a local network of people who use drugs – something that The International Network of People Who Use Drugs has indicated is currently lacking in Bristol. Moreover, the researchers intend for everyone else to leave the workshop understanding the impacts of stigma and feeling empowered to be able to make changes within their organisations to reduce stigma towards people who use drugs and OST.

Importantly, the project intends to identify potential targets for developing interventions to reduce stigma towards people who use drugs and OST in different settings so that this work can be continued. Through this workshop, Victoria Carlisle hopes to identify partners who are interested in developing the work through applications for further funding.