Stable patterns, shifting risks: the impact of British Columbia's decriminalization and recriminalization policies on drug use behaviours.

Background: Canada's historical reliance on criminal justice approaches to drug policy has intensified structural and social stigma, and high-risk behaviours among people who use drugs. In response to pressure from local advocates, British Columbia implemented a pilot decriminalization policy in January 2023, permitting adults to possess up to 2.5 g of specified unregulated substances, cumulatively. While not designed to address the toxic drug supply directly, it aimed to reduce stigma and encourage engagement with health and harm reduction services. In May 2024, however, drug possession in public spaces was recriminalized, raising concerns about a return to punitive environments. To date, little is known about how these policy shifts have been experienced by people who use drugs themselves. We conducted a qualitative study exploring the impacts of British Columbia's decriminalization policy and its subsequent recriminalization amendment on the drug use behaviours of people who use drugs across the province.

Methods: A cross-sectional qualitative study with 75 people who use drugs across British Columbia, including a socio-demographic survey, and semi-structured interviews. Interviews were transcribed verbatim and analyzed using thematic analysis. The codebook was applied across all transcripts using a comparative approach to identify recurring patterns, divergent experiences, and key themes related to drug use behaviours.

Results: Participants reported little to no change in their drug use patterns following either decriminalization or recriminalization, as drug use was primarily driven by dependence, routine, and structural factors. Nonetheless, many described a psychological benefit under decriminalization, including reduced shame, internalized stigma, and fear of criminalization. These gains were largely reversed following the recriminalization amendment, which pushed drug use back into hidden, high-risk environments. Participants also noted destabilizing shifts in the drug supply, including increased potency and a rise in less experienced dealers, linked to the 2.5 g threshold.

Conclusion: Decriminalization did not significantly alter drug use behaviours but offered notable psychological relief for participants. The subsequent recriminalization amendment then reversed these perceived gains, illustrating how this abrupt policy change led to unintended consequences, undermining the original goals of the decriminalization policy. These findings highlight the need for sustained and structurally supported effective policy approaches that center the lived realities of people who use drugs.