The aim of the paper is to understand how people who use drugs (PWUD) experience stigma. To examine this issue, this paper draws on Bourdieu's logic of practice to understand how social harm emerges relationally between people via ‘mechanisms of stigma’. This paper draws on 24 qualitative semi-structured interviews with people who use drugs (heroin, crack/cocaine, amphetamine, ecstasy; 11 men/12 women/1 transgender) living in the northeast of England. 

Highlights:

• Stigma done by others, and internalised by participants, meant that PWUD experience harms to mental and physical health.
• Stigma should be considered a social determinant of health because social relations structure an ‘invisible reality’.
• Stigma, impacts a person's physical and mental health and is a pernicious problem that exacerbates health inequalities.
• Social relations acting in synergy with psycho-social and material determinants of health is an under-researched area.