Research has shown that members of communities that face racism are disproportionately affected by the harms associated with substance use, including criminal justice involvement, morbidity, and mortality.59 This disparity in health and social outcomes can be directly attributed to institutional racism.59-61 For example, although available evidence suggests similar rates of unregulated substance use among black and white individuals, black individuals are dramatically more likely to be arrested and incarcerated for drug-related charges.59 Individuals who face racism also face more barriers to substance use treatment access, lower retention, and reduced satisfaction compared to their white counterparts, due to the experience of discrimination within the health care system.59-61 

The implementation of an anti-racist framework for substance use care can help improve care engagement and health outcomes for populations that experience racism and other forms of marginalization.62 By definition, anti-racism is a process of confronting and interrogating racist structures which persist within current sociocultural institutions, including the health care system.62,63 Anti-racist practices require individuals to build awareness of their own position and role within these oppressive constructs, critically revising their own values, and actively challenging norms, policies, and practices that marginalize specific communities on the basis of race.62,63 

Some examples of inclusive, anti-racist policies and program development considerations include:64

• Seek pre-implementation consultation from members of racially and ethnically diverse communities that the program serves
• Prioritize racial and ethnic diversity and equity in employee hiring and retention practices
• Mandate anti-racism training among all staff
• Build partnerships with community organizations that support members of communities that face racism

Some day-to-day service elements that support members of communities that face racism may include: 64,65

• Provide interpretation and translation services to clients for whom language is a barrier to equitable program participation
• Ensure that patient-facing materials are written in the client’s language, and at an appropriately accessible reading level 
• Include a strong outreach component, as people who are new to Canada, or to a given province or territory, may be unaware of the types of substance use support services available or how to access them
• Provide space and other necessities for religious or cultural practices
• Establish a confidential and clearly-defined and communicated procedure for clients and employees to safely report racial discrimination