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Drawing on Wellcome Trust qualitative research using in-depth, semi-structured interview data ( N = 24) with people who use heroin, crack cocaine, spice and amphetamine, this article firstly provides insight into how stigma is operationalised relationally between people via a lens of class talk and drug use predicated on normative ideas of \u2018valued personhood\u2019. Secondly, it turns to how stigma is weaponised in social relations to keep people \u2018down\u2019, and thirdly, it shows how stigma is internalised as blame and shame and felt deeply \u2018under the skin\u2019 as \u2018ugly feelings\u2019. Findings from the study show that stigma harms mental health, inhibits access to services, increases feelings of isolation, and corrodes a person\u2019s sense of self-worth as a valued human being. These relentless negotiations of stigma are painful, exhausting and damaging for PWUD, culminating in, as I argue, everyday acts of social harm that come to be normalised.<\/jats:p>","DOI":"10.1177\/00380261221150080","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T06:52:17Z","timestamp":1679295137000},"page":"296-314","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":43,"title":["Framing stigma as an avoidable social harm that widens inequality"],"prefix":"10.1177","volume":"71","author":[{"given":"Michelle","family":"Addison","sequence":"first","affiliation":[{"name":"Durham University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"bibr1-00380261221150080","doi-asserted-by":"publisher","DOI":"10.1057\/978-1-137-51803-3"},{"key":"bibr2-00380261221150080","doi-asserted-by":"publisher","DOI":"10.1016\/j.emospa.2017.01.003"},{"key":"bibr3-00380261221150080","doi-asserted-by":"publisher","DOI":"10.1080\/14461242.2020.1811747"},{"key":"bibr4-00380261221150080","doi-asserted-by":"crossref","unstructured":"Addison M., Lhussier M., Bambra C. 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