Stigma, Scarcity and the Price of Legitimacy: Chronic Pain Advocacy and the Politics of Pharmaceutical Partnerships in Canada.

This study examines how chronic pain advocates in Canada navigated fraught relationships with pharmaceutical companies amid escalating concerns about the adverse public health impacts of opioids. Drawing on 22 qualitative interviews with professional chronic pain advocates, it examines how advocates navigated their complex relationships with pharmaceutical companies amid structural constraints and limited institutional support. Findings reveal that advocates viewed pharmaceutical funding not primarily as an ethical compromise, but as a pragmatic necessity driven by pervasive stigma, institutional neglect and inadequate public funding. Credibility that advocacy groups once gained through association with opioid manufacturers became a reputational liability as industry involvement in widespread harms came into focus and the field shifted toward pharmacovigilance and accountability. In this way, chronic pain advocacy has become entangled in a process that both legitimises the condition and embeds the institutionalisation of pharmaceutical treatment as its dominant response. By situating advocates' decisions within broader organisational arrangements, this study contributes to sociological understandings of pharmaceuticalisation and disease-based advocacy as processes shaped by strategic action under constraint.