Evaluation of the British Columbia Exemption to Allow for Personal Possession of Small Amounts of Illegal Drugs: Semi-annual Meeting
What We Heard Report

This sub-study is using quantitative analyses and qualitative interviews to examine health impacts and experiences with decriminalization among people who use drugs (PWUD).

Qualitative Sub-Study

PWUD perceptions on decriminalization prior to the policy coming into effect

Between June and October 2022, 45 PWUD from across B.C. were interviewed regarding their perceptions on decriminalization. The results of this study were published in the journal Substance Abuse Treatment, Prevention and Policy in June 2023^{Footnote 1}. A research snapshot summarizing the study can be found online here.

Key findings can be summarized under two main themes:

Implications of threshold on substance use behaviours and purchasing patterns:

• PWUD indicated that the 2.5g threshold is too low and is unreflective of their substance use patterns. Although some people indicated that the policy wouldn’t impact their purchasing patterns because they are unable to purchase large amounts at a time, others suggested it may force them to seek out substances more frequently, which could increase their risk of harms.
• PWUD felt the 2.5g threshold should be non-cumulative or substance specific. Individuals purchase and consume different amounts for different substances, so the threshold may not be relevant for all substances.
• Buying in bulk may be more economical, particularly for PWUD residing in remote communities. It is common practice to purchase in bulk and split or share among peers.

Implications of threshold on police enforcement, use of discretion, and jurisdictional discrepancies

• PWUD have a long history of negative experiences with police. There are concerns about disparities in police enforcement, including geographical discrepancies with rural/remote communities and marginalized communities at greater risk of arrest.
• PWUD are worried that their trusted suppliers may be targeted or arrested, disrupting their drug supply and increasing their risk by forcing them to obtain substances from unfamiliar sources.

Summary

• Differences in PWUD purchasing and consumption patterns and frequency of use need to be considered as part of this policy, particularly in relation to the threshold, and its evaluation. In some cases, PWUD purchase in bulk to reduce costs and ensure a safe/available supply. The police play an important role in enforcing the policy and determining possession or trafficking.
• It is important to monitor the impacts of the 2.5g threshold to determine if it is undermining the goals of the policy.

PWUD perceptions on decriminalization after the policy came into effect

Interviews with PWUD began in October 2023 and are ongoing, with 55 completed at the time of this update. The goal of this part of the study is to gain an in-depth understanding of PWUD experiences with decriminalization. Four total assessments are planned over five years, with new cohorts of PWUD recruited from across the province and with attempts for equal representation from each of the five provincial health authorities.

Preliminary themes that have emerged to date:

• Most PWUD are aware of the policy but many of the specifics around threshold amount and substances that are included are unknown. Some PWUD are unaware of the policy altogether.
• PWUD are less concerned about being arrested and feel more comfortable carrying substances they need.
• The threshold of 2.5g is too low and is unreflective of PWUD substance use and purchasing patterns.
• PWUD report that police have not distributed resource cards, nor any verbal information, about health and treatment services in the community.

Quantitative Sub-Study

Quantitative data will be analyzed from a variety of sources (i.e., Statistics Canada, the BC Centres for Disease Control (BCCDC), and the Canadian Institutes for Health Information (CIHI.)) from 2013 to 2027 to examine the impacts of decriminalization on the health of PWUD pre- and post-policy implementation. Indicators will include opioid agonist treatment (OAT) prescriptions, overdose prevention services utilization, hospitalizations due to illicit drug overdoses, paramedic-attended illicit drug overdoses, overdose deaths, and load per capita of drugs in wastewater. Data analysis is expected to begin in mid-2024.

Summary of quantitative results to date:

• Both paramedic-attended opioid poisonings and illegal drug-related poisoning deaths in BC have been increasing prior to decriminalization.

This sub-study will use quantitative analyses and qualitative interviews to examine criminal justice impacts and experiences with decriminalization among the police and criminal justice system.

Qualitative Sub-Study

Qualitative interviews with police will be conducted over five years with new cohorts of police recruited from across the province to gain an in-depth understanding of police experiences with decriminalization. Data collection began in November 2023, but results are not yet available.

Quantitative Sub-Study

Quantitative data will be analyzed from Statistics Canada (i.e., the Uniform Crime Reporting Survey (UCRS) and the Integrated Criminal Court Survey (ICCS)) from 2013 to 2027 to examine the impacts of decriminalization on police and criminal justice system-related indicators pre- and post-policy implementation. Indicators will include police-reported illegal drug-related offenses and illegal drug-related criminal charges. Data analysis is expected to begin in mid-2024.

Summary of quantitative results to date:

• Police-reported incidents involving possession of illegal drugs in BC have been decreasing for most substances prior to decriminalization, though methamphetamine has been increasing more recently.

This sub-study will evaluate the impact of decriminalization policy on the public through public opinion surveys distributed to a representative sample of adults in B.C. Surveys are expected to begin in January 2024.

This sub-study will examine the impacts of decriminalization on harm reduction and opioid agonist therapy (OAT) services by collecting province-wide survey data on harm reduction and OAT service operations (e.g., service utilization, clientele socio-demographics, referral pathways, funding, etc.). Surveys will be completed by service representatives. In-depth follow-up interviews will also be conducted with a subset of participants. It is expected that the survey will launch in January 2024.

This sub-study will evaluate the economic impact of decriminalization. This includes estimating the economic burden of drug use in B.C., and the cost and impacts of interventions. Comparing the costs pre- and post-decriminalization will allow the researchers to calculate the return on investment for the decriminalization policy. Although final results won’t be available until the end of the five-year study, the researchers hope to provide some information throughout the study to inform potential cost-saving decision making.

This sub-study will comprise two projects:

• Analyses focusing on the impact of public consumption legislation (i.e., Bill C34, “Restricting Public Consumption of Illegal Substances Act”) as well as jurisdictional bylaws (related to public consumption as well as other drug-adjacent bylaws) will be undertaken to understand the potential impact of these on the policy’s implementation including any differences between communities. An initial search of existing bylaws and a manuscript draft has begun.
• Focus groups of key stakeholders to elicit feedback on data gathered from each of the sub-studies, consisting of individuals from each of the main stakeholder groups: PWUD, public, police, criminal justice representatives, and harm reduction and OAT providers. These focus groups will not commence until approximately year four of the study.