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Background <p>In January 2023, British Columbia (BC) implemented a three-year decriminalization pilot to reduce harms of drug criminalization and address stigma toward people who use drugs. In May 2024, the policy was amended to “recriminalize” drug possession, a reform that excluded most public spaces from the decriminalization pilot. While stigma reduction was a central goal of the reform, little is known about how these policy shifts have shaped perceptions of stigma among people who use drugs.</p> Methods <p>We conducted qualitative interviews with 75 people who use drugs after the introduction of the recriminalization amendment. Participants were recruited across urban and rural communities in BC to explore how decriminalization and the subsequent recriminalization amendment influenced perceptions of public, structural, and self-stigma. Transcripts were thematically analyzed with attention to both overarching and nuanced themes.</p> Results <p>Participants consistently emphasized that stigma remained pervasive throughout both policy phases. Most reported stigma as unchanged or worsening, describing persistent judgment from the public, discriminatory treatment from healthcare providers and law enforcement, and entrenched internalized shame. Rural participants highlighted amplified stigma due to small-town dynamics and limited anonymity. Drivers of stigma included policy backlash, misinformation, sensationalized media coverage, and gaps in education. Although a minority perceived modest reductions in experiences of stigma during decriminalization, these gains were fragile. The policy amendment was described as a powerful symbolic reversal that not only erased tentative progress but also legitimized hostility, reinforced stereotypes, and increased shame around drug use, which placed participants at risk of overdose through solitary drug use.</p> Conclusions <p>BC’s decriminalization pilot did little to dismantle entrenched stigma, and its amendment exacerbated harms by symbolically and materially reinforcing negative perceptions of people who use drugs. These findings highlight the limits of short-term, politically fragile reforms. Stigma reduction requires long-term, multi-level strategies, including public education, healthcare provider training, and embedding lived experience, implemented alongside decriminalization to achieve meaningful change.</p>

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The symbolic power of decriminalization and recriminalization in shaping stigma toward people who use drugs in British Columbia

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月5日

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  • Farihah Ali,
  • Jordan Mende-Gibson,
  • Cayley Russell,
  • Geoff Bardwell,
  • Juls Budau,
  • Andrew Ivsins,
  • Sanjana Mitra,
  • Jürgen Rehm

摘要

Background

In January 2023, British Columbia (BC) implemented a three-year decriminalization pilot to reduce harms of drug criminalization and address stigma toward people who use drugs. In May 2024, the policy was amended to “recriminalize” drug possession, a reform that excluded most public spaces from the decriminalization pilot. While stigma reduction was a central goal of the reform, little is known about how these policy shifts have shaped perceptions of stigma among people who use drugs.

Methods

We conducted qualitative interviews with 75 people who use drugs after the introduction of the recriminalization amendment. Participants were recruited across urban and rural communities in BC to explore how decriminalization and the subsequent recriminalization amendment influenced perceptions of public, structural, and self-stigma. Transcripts were thematically analyzed with attention to both overarching and nuanced themes.

Results

Participants consistently emphasized that stigma remained pervasive throughout both policy phases. Most reported stigma as unchanged or worsening, describing persistent judgment from the public, discriminatory treatment from healthcare providers and law enforcement, and entrenched internalized shame. Rural participants highlighted amplified stigma due to small-town dynamics and limited anonymity. Drivers of stigma included policy backlash, misinformation, sensationalized media coverage, and gaps in education. Although a minority perceived modest reductions in experiences of stigma during decriminalization, these gains were fragile. The policy amendment was described as a powerful symbolic reversal that not only erased tentative progress but also legitimized hostility, reinforced stereotypes, and increased shame around drug use, which placed participants at risk of overdose through solitary drug use.

Conclusions

BC’s decriminalization pilot did little to dismantle entrenched stigma, and its amendment exacerbated harms by symbolically and materially reinforcing negative perceptions of people who use drugs. These findings highlight the limits of short-term, politically fragile reforms. Stigma reduction requires long-term, multi-level strategies, including public education, healthcare provider training, and embedding lived experience, implemented alongside decriminalization to achieve meaningful change.