also been designated as a crime. This criminalization exacerbates stigma and produces exclusionary processes that deepen the marginalization of people who use illegal substances. Therefore, the social processes and institutions created to control substance use may actuality contribute to its continuation.31 An article proposing to frame the opioid epidemic as a public health issue states that: The national dialogue around opioids has been dominated by several approaches that on their own are inadequate or harmful. “War on drugs” approaches that would increase arrests and incarceration to deter drug use and distribution have had long-term scarring effects on many communities, primarily those of color, without measurably reducing access to street drugs. Likewise, defining drug use as an individual’s moral failing that can be remedied through willpower alone is inconsistent with biological triggers that create susceptibility to addiction. The moral failing approach also fails to recognize the role of trauma and adverse childhood experiences in addiction. Most importantly, the willpower approach lacks evidence for efficacy. Likewise, a single-minded focus on abstinence led to opposition from several self-help advocates against highly effective treatments such as methadone, buprenorphine,  and harm reduction. Moving beyond moralized and punitive approaches to addiction could help reduce stigma and increase acceptance of treatment, not only for people who use opioids but also for the safety and wellbeing of society at large.32 Considerable research has found that there are positive effects on recovery from efforts to remove the stigma associated with substance use disorder, both from professional interactions with the patient and self-inflicted stigma.33 Programs aligned with this play will seek to change the culture of interaction with those who have substance use disorders. The specific components include educational programs, small group discussions, seminars and training in specific approaches, and language that professionals – ranging from police to health care providers – should avoid. Rachel Wurzman gives this Ted talk on how social isolation fuels opioid addiction. Changing the cultural view of substance use disorders will require the development of a shared vision between public safety and public health, as well as other stakeholders. Committees or task forces dedicated to just this initiative could be helpful in developing such a vision. Goals and Objectives The goal of this play is to reduce the effect of stigma in interactions between individuals with substance use disorders and the professionals with whom they come into contact, as well as the effect of behaviors related to self-stigma. Creating non-judgmental interaction patterns can increase the probability of recovery and reduce the likelihood of continued disorders. Theory of Change If the environment of interaction by professionals (police, health care providers, etc.) can be become more non- discriminatory and non-judgmental, there is a higher probability that the road to recovery will be shorter and more likely to result in a positive outcome. Example The Toronto Drug Strategy Implementation Panel has published a report on its initiative to deal with the stigma problem. It includes recommendations for program content. Resources SAMSHA has developed a brochure on how to create a stigma-reduction initiative. Ohio created a brochure to describe better language about substance use disorders. The Central East Addiction Technology Transfer Center has published an anti-stigma toolkit that provides a comprehensive set of guidelines for reducing stigma related to substance use disorder. It is available at https:// attcnetwork.org/centers/new-england-attc/coming-light-breaking-stigma-substance-use-disorders Shatterproof has a useful guide on language that should be avoided in dealing with people suffering from substance use disorder. 28