Exploring the early impacts of drug decriminalization on harm reduction and opioid agonist treatment service operations and delivery in British Columbia: insights from key informant interviews

TL;DR

This study explores how drug decriminalization and its reversal affected harm reduction and opioid treatment services in British Columbia from service providers' perspectives.

Contribution

The study provides new insights into the operational impacts of drug decriminalization and policy reversals on service delivery in public health.

Findings

Decriminalization led to few operational changes in harm reduction and opioid treatment services.

Service providers faced ongoing staffing and resource shortages despite policy changes.

Systemic issues like toxic drug supply and homelessness had a greater impact than the policy itself.

Abstract

On January 31, 2023, Health Canada granted British Columbia (BC) a three-year (2023–2026) exemption under the Controlled Drugs and Substances Act (CDSA), decriminalizing the personal possession of up to 2.5 g of certain unregulated drugs among adults (18+) without arrest, seizure of drugs, or criminal penalty. A key objective was to increase awareness, engagement, and retention in harm reduction (HR) and opioid agonist treatment (OAT) services by reducing stigma and enhancing service access. In May 2024, however, the policy was amended to re-criminalize drug use and possession in public spaces. This study examines how decriminalization and its subsequent amendment affected HR and OAT service operations from the perspective of service providers across BC.

Between October 23rd, 2024 and January 29th, 2025, 18 semi-structured virtual key informant interviews were conducted with HR and OAT service providers across BC. The interviews examined participants’ experiences with decriminalization and its amendment, and how these policy changes impacted service operations and delivery. Thematic analysis was used to identify patterns across interview data.

Key informants reported few operational changes following decriminalization, with no major adjustments to service delivery. Despite expectations of increased client engagement, sites received no additional funding and faced ongoing staffing and resource shortages. Informants emphasized that systemic issues—such as the toxic drug supply and rising homelessness—had a greater impact on service use than the policy itself. A lack of clear communication and site-specific training resulted in uncertainty and confusion, further limiting frontline staff’s ability to respond effectively to policy changes.

Key informants perceived that decriminalization did not lead to immediate changes in HR and OAT site operations. Longstanding systemic barriers continued to limit service capacity and policy impact. Providers highlighted the need for sustained investment in housing, staffing, and supervised spaces to support meaningful engagement and reduce stigma. Addressing these foundational issues was seen as essential for realizing the policy’s intended public health objectives.

The online version contains supplementary material available at 10.1186/s12889-025-25479-x.