A policy of drug decriminalization enacted in British Columbia (BC) between February 2023 and April 2024 resulted in significant reductions in police-recorded drug possession incidents but failed to lower drug toxicity deaths or hospitalizations as BC’s government had hoped.

During the province’s partial recriminalization period, from May 2024 to March 2025, police-recorded drug possession incidents rose again. Declines in drug-related hospitalizations occurred during this period of partial recriminalization, but a comparable decline was also seen across the rest of Canada, suggesting that these reductions resulted from national trends independent of BC’s criminalization policy.

The findings were published on September 14 in CMAJ.

Decrease in Arrests

“British Columbia’s decriminalization pilot represented a drug policy change in North America and was subject to considerable controversy,” senior author Daniel T. Myran, MD, MPH, Gordon F. Cheesbrough Research Chair in the Department of Family and Community Medicine at North York General Hospital in Toronto, told Medscape News Canada. The pilot was subsequently narrowed in scope through partial recriminalization and ultimately not renewed.

“While it was widely promoted as a solution to the current drug crisis, there had been limited evidence on its effects. We were interested in evaluating some of the key stated goals, such as whether decriminalization reduced police arrests and charges for drug possession, and whether it was associated with changes in overdoses,” said Myran.

Using data from Statistics Canada, the Canadian Institute for Health Information, and drug toxicity deaths in BC, Alberta, and Ontario obtained from provincial, publicly available data sources, the researchers found that decriminalization in BC was associated with a 39% reduction in police-recorded incidents. After recriminalization, police-recorded incidents increased by 68%. No significant changes in police-recorded incidents were observed in the rest of Canada, the authors noted.

After decriminalization, BC did not differ significantly from other provinces and territories in changes in opioid-related hospitalizations (ratio of rate ratios [RRR], 0.87), stimulant-related hospitalizations (RRR, 0.77), or deaths from drug toxicity (RRR vs Alberta, 0.83; RRR vs Ontario, 1.07).

After recriminalization in BC, changes remained similar to other provinces and territories for opioid-related hospitalizations (RRR, 1.03) and stimulant-related hospitalizations (RRR, 1.02) and similar to Alberta for deaths from drug toxicity (RRR, 1.14).

Solving the Overdose Crisis

The overdose crisis is a complicated issue that involves much more than the criminal status of drug possession, Myran noted.

“Many of those at greatest risk are also facing unstable housing, poverty, untreated mental illness, chronic pain, and fragmented healthcare. An effective response needs to address multiple factors, including harm reduction measures, evidence-based addiction treatment, mental health care, and investment in social supports, including housing, income, and employment,” he said.

The significant reduction in police-reported drug arrests as a result of BC’s policy aligns with evidence from other jurisdictions, including Oregon, Washington, and Portugal, Alexis Crabtree, MD, PhD, medical lead of Harm Reduction & Substance Use Services at the BC Centre for Disease Control in Vancouver, and Alissa Greer, PhD, associate professor of criminology at the Simon Fraser University in Burnaby, BC, wrote in a related commentary.

“Reduced arrests and charges for possession are more than administrative outcomes — they represent a meaningful change in how people who use drugs experience and interact with the justice system,” they wrote. “Extensive research documents the harms of criminalization, including justice system costs, criminal records and their socioeconomic consequences, and barriers to health and harm-reduction services.”

Drug liberalization policies may be most successful where there is a broad community support, acceptable and accessible health services, and mechanisms to encourage treatment and discourage problematic public consumption.

“The lesson from BC is not that decriminalization is irrelevant, but that such policies must be supported within prepared, trusted, and adequately resourced systems,” they concluded.

Downsides to Decriminalization

“The authors probably had a one-sided interpretation of the benefits of decriminalization,” Meldon Kahan, MD, medical director of META:PHI (Mentoring Education and Clinical Tools for Addiction: Partners and Health Integration), a program supported by the Ontario government to promote education and training in addiction, told Medscape News Canada.

“There was a drop in arrest rates, which they view as a positive thing, less stigma, and so on, but the fact is that if you make drug possession legal, then people will be out there using and selling. It will actually make it easier for drug dealers to buy and sell and use drugs, thus exposing more people to the drugs. That’s the downside of decriminalization,” Kahan said.

Additional measures could reduce exposure to toxic drugs and improve health outcomes, he said. “There is strong evidence that opioid agonist treatment (OAT) reduces overdose mortality, even in people who continue to use fentanyl. But in Ontario, the number of people who are on OAT is far below the number of people who have an opioid use disorder. In fact, the number of people on OAT has actually declined in the past several years, despite a marked increase in overdose deaths.”

Kahan proposed making OAT more widely available. “OAT should be available in emergency departments, hospitals, primary care, prisons, and shelters. Also treatment protocols need to be adapted to fentanyl, which is so powerful that treatments like methadone and buprenorphine are ineffective. So improve protocols and improve access by making it part of the general healthcare system.”

Access to housing is also important, he noted. “Housing is critical, but housing should be integrated with access to OAT, as well as primary care, wound care, harm reduction measures, and mental health care, because so many of the people who are using are quite sick, psychiatrically and physically. We need to have an all-out major infusion of resources and services to address this.”

The study was funded by North York General Hospital and the Bruyére Health Research Institute. Myran and Kahan reported having no relevant financial relationships.