While the case study presented in “An inside look at BC’s illicit drug market during the COVID-19 pandemic” [BCMJ 2021;63:9-13,19] may provide physicians who have limited knowledge of the illicit drug trade information about substance use, there are multiple problematic depictions of persons who use drugs (PWUD). The images included, a dark silhouette of a hooded figure and a person lying on the sidewalk in front of a graffitied wall, depict stereotype images of substance users, namely that they are troubled, shady, decrepit, and pitiful. The narrative presented further substantiates stigma and stereotypes, conflating substance use with addiction and poverty. John Doe is an almost contextless individual, chosen as the standard of the illicit drug trade, but why, without evidence of consultation or input from other drug user sources? Organizations like the Vancouver Area Network of Drug Users (VANDU) and the Canadian Association of People who Use Drugs (CAPUD) are instrumental in changing stereotypes of PWUD and engaging people with lived experience in the process of research and policy development.
Given that John Doe was incarcerated and undergoing psychiatric assessment at the time of the interview, was consent informed? Further, description was provided that John Doe was admitted to the forensic psychiatric service because of evaluation following conviction for distribution of illegal substances, but what qualified him as a reliable source? Was there a pre-existing relationship between the interviewer and the interviewee? The assumption that his response was coercion-free is problematic because of the nature of the inherent power imbalance. We must question the ethics of asking people who are accessing health care services for more information in an assessment interview as a teaching tool or population insight. Vicarious information collection, potentially traumatizing the individual, may have benefit to the greater good, but does that mean clinicians should engage in this process at risk to the individual?
The images that accompanied the article were chosen by the editorial team, not the authors. Images are open to interpretation, and we appreciate you sending us yours. —ED.
This letter was submitted in response to “An inside look at BC’s illicit drug market during the COVID-19 pandemic.”
Read the authors’ response in “Re: An inside look at BC’s illicit drug market. Authors reply.”
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