I Dare You to Drink the Vinegar

In this third article of Seeing Beyond the Stigma: Nursing Practice at the Margins, the story no longer begins with “What is stigma?” or “Who are Alex and Sharna?” We have already explored those questions (if you haven’t, go read articles 1 and 2 of this series). Their missed doses, late arrivals, and visible distress are now understood as part of lives shaped by poverty, trauma, and structural inequity, not as simple “noncompliance.” The work at this stage is different: it is about what nurses do with that knowledge in the flow of everyday practice, especially in the moments when documentation, policy, and split‑second judgments either deepen exclusion or open the door to more just and inclusive care. From Recognition to Responsibility  In the earlier posts, stigma was named as more than a personal attitude: it was framed as a social process in which people are labelled, stereotyped, separated, and pushed into lower status in ways reinforced by power. Link and Phelan’s description...

In the first article of this series, the focus was on how stigma, social exclusion, and documentation practices can subtly shape the care people receive, especially in settings like methadone clinics. That piece invited us to look at policies, electronic health records, and institutional routines. This second article turns the lens even closer: toward the stories we tell ourselves as nurses when we encounter people whose lives are deeply affected by structural inequity, substance use, and trauma.  Nurses encounter many people whose lives are shaped by complex intersections of health, identity, trauma, and structural inequity, including those who move in and out of substance use over time. For someone like Alex or Sharna, years of navigating a relationship with opioids can include periods of reduced use, times of not using at all, and ongoing efforts to stay safe, connected, and housed. Despite this resilience, the ways their lives show up in care, for example missed appointments, o...