Stigma by Association Is Driving Workers Out of Harm Reduction

A new article in drug policy and harm reduction magazine Filter has been published featuring research from the Tackling Stigma team.

Written by our Communications Manager, Brooke Nolan, the article explores stigma by association, a form of stigma experienced by people who work in harm reduction and drug user health settings.

Article excerpt

Everyone knows about the stigma faced by people who use drugs. What’s far less visible is the stigma experienced by the people who support them: the harm reduction workers, counselors, outreach staff, nurses and peer workers who show up every day in a landscape still steeped in social judgment.

This is contributing to burnout, chronic stress, social distress and the loss of skilled staff from a sector that simply cannot afford to lose them.

Two recent Australian studies—published in Drug and Alcohol Review in 2024, and the International Journal of Drug Policy this September—examined how negative societal beliefs about people who use drugs spill over onto harm reduction workers, or “stigma by association.”

“Respondents characterized stigma as a pervasive social devaluation that shaped how workers were treated and how services were funded and supported,” said Dr. Theresa Caruana, a research associate and post-doctoral fellow at the Centre for Social Research in Health at UNSW Sydney, and part of the new Tackling Stigma in Healthcare network established there.

One worker who participated in the 2025 study, which Caruana co-authored, described it simply: “When the clients I work with are stigmatized, the work they do to better themselves is stigmatized. That includes the work that I do with them.”

“Workers who reported experiencing more of this stigma by association had poorer workplace wellbeing, greater levels of burnout and stronger intentions to leave.”

Harm reduction workers see this stigma play out in health care settings, including through reluctance to provide care, or provision of care that is impersonal or inadequate. Some study participants spoke about needing to accompany clients to hospital to prevent mistreatment, which increased their own emotional strain and workload.

Stigma also shapes how services are positioned within the health care system. Harm reduction workers reported that people who inject drugs were often viewed as “problematic” or a “safety risk.” That contributes to harm reduction services being kept separate from mainstream health care, making them harder to resource or improve. Which again, adds to the strain and workload. 

“Workers who reported experiencing more of this stigma by association had poorer workplace wellbeing, greater levels of burnout and stronger intentions to leave the sector,” Caruana told Filter.