Navigating the nexus between British Columbia’s public consumption and decriminalization policies of illegal drugs

Abstract

In January 2023, the province of British Columbia (BC) decriminalized the possession of certain illegal drugs for personal use. The province’s primary intent was to reduce the stigma associated with drug use, as well as barriers for people who use drugs (PWUD) to access treatment and supports. However, less than ten months into the decriminalization policy, due to growing concerns about public safety voiced by municipal governments and communities, the provincial government made amendments to the policy to ban the public consumption of illicit drugs in additional locations, and subsequently introduced additional legislation, Bill 34 , aimed at regulating public consumption of drugs in public spaces. Some communities have also implemented local bylaws similarly regulating public drug use. Bill 34 and local bylaws may serve as tools to promote community health and safety and minimize direct and indirect harms associated with public drug use. However, such legislation may re-criminalize PWUD and reinforce negative perceptions surrounding drug use, especially if these policies are not paired with strategies to expand the availability and accessibility of critical harm reduction and housing services. Without ample access to these services, limitations on public drug use can potentially displace individuals to areas where they are more likely to use alone, further exposing them to substance use-related harms, and undermining the goals of decriminalization. The potential effects of these restrictions may also disproportionately impact marginalized populations. As of April 2024, Bill 34 remains on hold. Moving forward, it will be important to monitor this bill, as well as other public consumption bylaws and legislation, and their impact on BC’s overall decriminalization initiative. Decision-makers are urged to increase engagement with PWUD and relevant stakeholders in the design and implementation of policies pertaining to public consumption to ensure that they effectively address the evolving needs and realities of PWUD, and align with decriminalization goals.

Full text

Alietal. Health Research Policy and Systems (2024) 22:60
https://doi.org/10.1186/s12961-024-01150-6
COMMENTARY
Navigating thenexus betweenBritish
Columbia’s public consumption
anddecriminalization policies ofillegal drugs
Farihah Ali1,2,3* , Justine Law1,2, Cayley Russell1,2, Jean‑Francois Crépault3,4, João Castel‑Branco Goulão5,
Kurt Lock6 and Jürgen Rehm1,2,7,8,9,10
Abstract
In January 2023, the province of British Columbia (BC) decriminalized the possession of certain illegal drugs for per‑
sonal use. The province’s primary intent was to reduce the stigma associated with drug use, as well as barriers
for people who use drugs (PWUD) to access treatment and supports. However, less than ten months into the decrimi‑
nalization policy, due to growing concerns about public safety voiced by municipal governments and communities,
the provincial government made amendments to the policy to ban the public consumption of illicit drugs in addi‑
tional locations, and subsequently introduced additional legislation, Bill 34, aimed at regulating public consumption
of drugs in public spaces. Some communities have also implemented local bylaws similarly regulating public drug
use. Bill 34 and local bylaws may serve as tools to promote community health and safety and minimize direct and indi‑
rect harms associated with public drug use. However, such legislation may re‑criminalize PWUD and reinforce nega‑
tive perceptions surrounding drug use, especially if these policies are not paired with strategies to expand the avail‑
ability and accessibility of critical harm reduction and housing services. Without ample access to these services,
limitations on public drug use can potentially displace individuals to areas where they are more likely to use alone,
further exposing them to substance use‑related harms, and undermining the goals of decriminalization. The poten‑
tial effects of these restrictions may also disproportionately impact marginalized populations. As of April 2024, Bill 34
remains on hold. Moving forward, it will be important to monitor this bill, as well as other public consumption bylaws
and legislation, and their impact on BC’s overall decriminalization initiative. Decision‑makers are urged to increase
engagement with PWUD and relevant stakeholders in the design and implementation of policies pertaining to public
consumption to ensure that they effectively address the evolving needs and realities of PWUD, and align with decrim‑
inalization goals.
Keywords Decriminalization, Canada, British Columbia, Substance use, Stigma, Public drug consumption, Bylaws
Open Access
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Health Research Policy
and Systems
*Correspondence:
Farihah Ali
farihah.ontcrism@gmail.com
Full list of author information is available at the end of the article

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Introduction
On January 31, 2023, a 3-year provincial drug decrimi-
nalization policy was piloted in British Columbia (BC) as
an exemption granted by Health Canada under section56
of the Controlled Drugs and Substances Act (CDSA) [1].
is policy aims to eliminate criminal penalties for pos-
session of up to a cumulative 2.5g of select illegal drugs
for personal use by adults (aged 18+), including cocaine/
crack-cocaine, methamphetamine, ecstasy, and opioids
such as heroin, morphine, and fentanyl [1]. e primary
goal of the decriminalization policy, as stated by the BC
government, is to reduce public stigma and reframe the
discourse surrounding drug use as a public health issue
rather than a criminal justice issue [2]. is policy aims
to limit police interactions with people who use drugs
(PWUD) and redirect them away from the criminal jus-
tice system by encouraging and supporting access to
health and social services. Although criminal penalties
for possession under this 2.5 g threshold are removed,
possession of drugs in amounts over the threshold is still
illegal. In addition, there are several stipulations under
the policy in which possession of illegal drugs (of any
amount) remains a criminal offense, and for which peo-
ple are still subject to arrests and confiscation of their
drugs. ese include possession for purposes other than
personal use (e.g., trafficking, production, importation/
exportation), among individuals under the age of 18,
as well as consumption on the premises of schools and
child-care facilities, airports, and on Canadian Coast
Guard vessels and helicopters. e use of illegal drugs
also remains prohibited on private property, including
shopping malls, bars, and cafes [1].
In response to decriminalization, citing concerns
around public safety, many BC communities imple-
mented or expressed the intention to implement their
own public consumption bylaws, further limiting where
PWUD can use drugs in the community. Public con-
sumption bylaws are a means by which communities can
tailor regulations to their specific needs and values, and
can be used to prohibit certain activities within a munici-
pality with the aim of protecting public safety and con-
trolling public behavior [3]. Acknowledging increasing
concerns related to public consumption, Health Canada
made additional amendments to the decriminalization
policy on September 18th 2023. is update prohibited
the possession of illegal drugs within 15m of parks, spray
or wading pools, or skate parks, province-wide [1]. Fur-
ther, on November 9th, 2023, the provincial government
of BC tabled additional legislation, Bill 34, ‘Restricting
Public Consumption of Illegal Substances Act’, which
outlines additional rules regarding drug use in public
spaces across the province [4]. However, the implemen-
tation of Bill 34 was placed on hold by the BC Supreme
Court due to a constitutional challenge, citing concerns
about its potential to cause harm to PWUD once in effect
[5]. Most recently, on April 26, 2024, following an unsuc-
cessful attempt to appeal the court’s pause on Bill 34, the
BC government announced that they are in the process
of requesting an additional amendment to the decrimi-
nalization policy by Health Canada to exclude consump-
tion of drugs in all public places, thereby expanding the
existing list of banned public spaces [6]. eir action plan
includes new measures to provide police with more tools
to address extraordinary circumstances where public
safety is compromised, while simultaneously investing an
additional $25 million to expand the provision of treat-
ment and supports [6].
Considering that decriminalization seeks to allevi-
ate the legal impacts associated with the policing of
substance use, legislation and bylaws related to public
consumption have the potential to result in unintended
consequences for PWUD. is commentary will describe
BC’s decriminalization policy, public consumption legis-
lation, community bylaws, and reflect on the interplay of
these policies. e commentary will discuss the poten-
tial effects of bylaws and public consumption legislation
on communities, and its impact on the health and safety
of PWUD, substance use, access to services, and efforts
to reduce stigma, including its effects on marginalized
populations. It will underscore the importance of com-
prehensively examining such legislation to understand
its impact on decriminalization goals and marginalized
populations.
The context ofdecriminalization inBC
Historically, the legal framework for drug control and
enforcement in Canada has been premised on prohibi-
tion, which forbids the possession, distribution, and pro-
duction of any illegal substances without authorization
[7]. Understanding the historical and colonial implica-
tions of prohibition is crucial for comprehending con-
temporary substance use policies, especially regarding
public consumption bylaws.
e enactment of the prohibition of substances in Can-
ada in the early 1900s, notably targeting substances like
tobacco and alcohol, has had effects on societal attitudes
and legal frameworks surrounding substance use [7, 8].
is prohibitionist framework has disproportionately
impacted marginalized populations, leading to differen-
tial treatment in terms of enforcement and criminaliza-
tion among these populations [7, 8]. Over time, Canadian
drug policies have evolved to move away from prohibi-
tionist approaches towards policies that recognize drug
use as a public health issue rather than solely a criminal
justice concern [9]. As such, decriminalization offers an
opportunity to continue to push a public health-centred

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Alietal. Health Research Policy and Systems (2024) 22:60
approach which can mitigate the harms associated with
drug use.
Despite policy evolution, criminal drug laws continue
to disproportionately impact marginalized populations
and reinforce oppressive colonial power structures and
systemic racism. For instance, drug law enforcement has
led to mass incarceration, particularly among Black and
Indigenous Peoples, who face higher rates of prosecution
and incarceration for drug offenses compared to other
communities [10]. When examining drug policy reforms
in Canada, it is therefore essential to consider these his-
torical and ongoing disparities.
Further, to understand how drug policies and related
legislation are enacted in Canada, it is essential to under-
stand the distinct roles of Canada’s various government
levels. In Canada, there are three levels of government:
federal, provincial, and municipal, each with its own dis-
tinct set of legislative powers. e federal government
holds authority over matters of national concern, includ-
ing the regulation of controlled substances through legis-
lation like the CDSA, which generally prohibits activities
involving controlled substances unless permitted by reg-
ulations or exemptions [9, 11]. However, provinces have
the autonomy to enact additional laws and regulations,
such as provincial bills aimed at preventing public con-
sumption of substances [11]. Moreover, municipali-
ties possess the authority to establish local-level bylaws
that further regulate activities within their bounda-
ries, including restrictions on public consumption of
substances (e.g., tobacco, alcohol, as well as the drugs
included under the CDSA exemption) [3]. is decentral-
ized system allows for a layered approach to lawmaking,
where municipalities can enact bylaws that complement,
contradict, or extend provincial laws while adhering to
the framework established by federal legislation [9, 11].
As a result, BC’s drug policy landscape is intricate.
Illegal drugs are decriminalized provincially under the
federal CDSA exemption. e BC provincial govern-
ment oversees policies governing public consumption of
these drugs (through Bill 34, for example). However, local
municipalities retain the authority to enact their own
bylaws, which can add further restrictions or regulations
on drug use [11].
ese historical and legal contexts set the backdrop for
the current drug policy situation in BC, the implications
of which are further described below.
Provincial legislation restricting public
consumption ofillegal substances act
Bill 34 proposes the prohibition of any public consump-
tion of drugs within a 6-m radius from additional pub-
lic spaces not initially included in the decriminalization
policy amendment, including building entrances and
public transit stops, and within 15m of parks, beaches,
and sports fields in all communities within BC [4]. e
bill aims to allow police officers to direct anyone caught
consuming an illegal drug in these specified areas to leave
the area, and they will have the authority to arrest indi-
viduals for non-compliance and/or seize and destroy any
illegal substances they may be using or carrying, even if
under the 2.5g threshold [4].
e Bill also provides municipalities with guidance on
requirements for implementing bylaws in their respec-
tive communities, should they wish to impose any further
public consumption-related bylaws [4]. e Bill states
that municipalities wishing to do so will need to consult
with the regional health board and the medical health
officer responsible for public health measures within the
area before considering a proposed bylaw [4].
As Bill 34 currently faces an injunction, the govern-
ment has indicated its intent to amend the decriminaliza-
tion policy to re-criminalize drug use in all public spaces.
Both of these initiatives, if passed, will effectively ban the
public use of drugs province-wide.
BC municipal bylaw legislation
Historically, BC municipalities have implemented vari-
ous bylaws prohibiting the use of substances such as
alcohol and smoking/vaping on public property, in public
indoor areas, in public parks, some municipal properties,
and on school grounds. After the federal legalization of
non-medical cannabis in Canada in 2018, many of these
municipal bylaws were updated to extend place-based
restrictions to include the use of cannabis [12]. In the
months prior to the tabling of Bill 34, a number of BC
municipalities moved to adopt or amend existing local
bylaws in order to regulate the use of illegal substances
in public spaces such as municipal parks and facilities,
streets, malls, or cafes, citing concerns over the safety
risk to their communities. For instance, in January of
2023, several days before the decriminalization policy
officially took effect, the City of Campbell River imple-
mented a new bylaw prohibiting the open consumption
of drugs on city property, including those listed under
the decriminalization exemption [13]. is included a
fine of up to $200 for violating the bylaw. is move was
quickly appealed by a legal advocacy group, Pivot Legal
Society, who launched a court challenge against the city
on the grounds that it was outside of their jurisdiction
to pass public health measures without consulting any
public health officials [14]. In April 2023, the city made
a second attempt to pass the bylaw, limiting its scope
by outlining specific city-owned areas where the bylaw
would apply, such as in specific municipal public spaces
where children and families carry out leisure activities,
and it was officially adopted on July 20, 2023 [13]. Instead

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Alietal. Health Research Policy and Systems (2024) 22:60
of issuing a fine, the city will manage enforcement of the
bylaw through education and redirection approaches for
a trial period of 6 months, in which individuals will be
connected to Campbell River’s only Overdose Prevention
Site (OPS) [15].
Several municipalities followed suit. Between July and
September 2023, the cities of Port Coquitlam, Pitt Mead-
ows, Kamloops, Sicamous, and Nelson adopted amend-
ments to their existing public consumption bylaws for
alcohol and smoking to include substances listed under
the decriminalization exemption [16–20]. Within the
same time period, other municipalities, including Fort
St. John, Maple Ridge, and Penticton, made attempts to
propose similar bylaws, banning the use or display of ille-
gal drugs or drug paraphernalia in their parks and public
spaces [21].
Potential implications ofpublic consumption
andbylaw legislation
Public consumption legislation carries the potential to
bring about both benefits and costs for the community
and PWUD. For instance, these laws carry the potential
to promote community health and minimize the direct
and indirect harms associated with public substance use,
including neighbourhood disturbances, drug-related
crime, violence associated with unregulated use, and
stigma against PWUD [22]. However, they also hold the
potential to undermine the decriminalization policy by
re-entangling PWUD within the criminal justice system,
reinforcing stigmatizing attitudes, and exposing them to
substance use-related risks. is could potentially hin-
der decriminalization’s progress and lead to unintended
consequences.
Potential implications ofpublic consumption andbylaw
legislation forcommunity health, public safety andstigma
e public consumption of psychoactive substances—
legal or illegal—can pose risks to public health and
community safety, while also reinforcing stigmatizing
attitudes against drug use and PWUD. For instance, the
disposal of drug-related paraphernalia and litter in public
spaces may be associated with public consumption, pos-
ing risks of accidental injury and disease transmission to
community members [22]. It can also lead to unsafe con-
sumption or injection practices, endangering PWUD and
increasing the risk of transmitting blood-borne viruses
such as HIV and Hepatitis C [23, 24]. Furthermore,
public drug use is often associated with drug-related
crimes, as individuals seeking drugs may engage in sur-
vival crimes to support their use, such as theft, robbery,
property crimes, and assaults [22]. erefore, legislation
regulating public consumption can help reduce unsafe
use practices and improve public safety. Legislation
governing substance use can also reduce exposure to sec-
ond-hand smoke, protecting non-users from the harmful
effects of passive inhalation. Drawing from global expe-
riences with tobacco control policies, measures such as
creating smoke-free public spaces have been highly effec-
tive in improving cardiovascular and respiratory health
outcomes related to second-hand smoke exposure [24].
As such, policies regulating public consumption can
mitigate the risk of second-hand harms from others’ drug
use, and can contribute to increased feelings of safety and
public amenity among community members [22].
Additionally, public consumption regulations may also
significantly benefit individuals who may feel discom-
fort or face triggers in environments where they may be
exposed to drug use, including those in recovery from
drug use and individuals who have experienced harm or
trauma associated with other’s substance use [25]. Lim-
iting exposure to drug consumption in common pub-
lic spaces has the potential to promote a safer and more
inclusive environment for these individuals, which is cru-
cial to their ongoing recovery and well-being [25].
However, touting public consumption legislation as
a policy aimed at community safety may inadvertently
reinforce the notion that legislation is necessary to safe-
guard communities from PWUD and to prevent public
drug use. is narrative can have significant impacts on
the overarching goal of decriminalization, which is to
reduce the stigma associated with drug use. Laws clamp-
ing down on public drug consumption can potentially
send a message to the public about the social acceptabil-
ity of using drugs. Associating public drug consumption
with inherent danger or risk to the public can stigmatize
PWUD, reinforce negative stereotypes, and push them
further into the margins of society. is may contradict
the broader intent of decriminalization by reinforcing
prohibitionist drug policies that emphasize the percep-
tion of drug use as a criminal rather than a public health
issue.
Moreover, the specific stipulations of Bill 34, particu-
larly its restrictions on illegal drug use within 15 m of
parks, sports fields, playgrounds, and beaches, broad-
ens the scope of areas where the consumption of illegal
drugs is prohibited. is expansion is in contrast to the
current provincial regulations for other regulated sub-
stances such as alcohol, tobacco, and cannabis, which
only prohibit their use directly within these spaces, not
in the surrounding vicinity [12]. Further, it contradicts
recent amendments made to alcohol bylaws in some BC
communities such as Vancouver, which permit drinking
in a growing number of public areas, including parks and
beaches, in addition to regulated areas such as bars and
restaurants, underscoring the disparate policy approach
that has been taken in regards to these regulated

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Alietal. Health Research Policy and Systems (2024) 22:60
substances [26]. ese differences have the potential to
further stigmatize drug users, suggesting that there is no
place for their consumption within and around such pub-
lic places. ese contrasting approaches highlight dispar-
ities in the social acceptance of different types of drugs,
disproportionately stigmatizing the users of some drugs
over others.
is stigma can have damaging effects, leading to social
isolation, alienation, increased risk of using alone, and the
creation of an uncomfortable and hostile environment
that discourages PWUD from accessing critical support
services, such as housing, employment, harm reduction,
treatment, and social services [27–29]. When individuals
are deterred from accessing critical supports due to stig-
matization, their ability to engage with life-saving pro-
grams and services diminishes. Furthermore, experiences
with internalized stigma have been extensively docu-
mented as barriers to help-seeking among PWUD [27,
29]. Taken together, these stigmatizing perceptions have
the ability to significantly impact the decision-making of
PWUD as to whether they seek service support.
Potential implications ofpublic consumption andbylaw
legislation forrisks related todrug use initiation andharms
Public consumption legislation aimed at discouraging
drug use in specific public areas may have broader impli-
cations beyond public and community safety, including in
relation to drug use initiation and drug use-related harm.
Regulations that discourage drug use in certain pub-
lic areas may hold the potential to reduce the likelihood
of substance use initiation within communities. For
instance, existing evidence suggests that public policies
regulating tobacco consumption play a significant role in
deterring young individuals from starting to use tobacco
and in facilitating smoking cessation among both adults
and adolescents [23, 24]. e same may be true about
alcohol [30]. is is because such policies can reduce the
visibility of and exposure to substance use, subsequently
de-normalizing and diminishing the social acceptability
of substance use among individuals, particularly youth
[23].
However, while recognizing the potential to discourage
substance use initiation, public consumption bylaws may
lead to riskier drug use practices. Such legislation can
displace individuals to spaces where they are more likely
to use drugs alone or in secluded areas, which can lead
to increased health risks, such as unsafe drug use prac-
tices or overdoses [27]. In these hidden settings, there is
often no one present to provide immediate assistance or
administer life-saving naloxone in case of an overdose.
Emergency response times may be delayed, heightening
the chances of a fatal overdose [27]. e data on unregu-
lated drug deaths from the BC Coroners Service revealed
that in 2023, 80% of these tragic fatalities occurred
indoors, 48% of which occurred in private residences,
and another 32% in various other residential environ-
ments, such as supportive housing, shelters, hotels, and
single room occupancies, as well as in businesses and
public buildings [31]. ese data underscore a press-
ing need to create environments where PWUD feel safe
accessing harm reduction services, rather than resort-
ing to using drugs in private spaces, especially in light of
public consumption restrictions.
Public consumption legislation may further encourage
expedited drug use behaviors by making PWUD feel that
they need to use their drugs as quickly and discreetly as
possible when using in public to avoid criminalization,
placing them at even greater risk [32]. Hasty drug use in
an effort to avert criminalization or the public’s gaze can
lead to practices such as rushed injections or improper
hygiene procedures, which can also increase the risk of
developing abscesses. In these circumstances, PWUD
may overlook proper sterilization of consumption and
injection equipment, and can result in environmental
hazards, such as discarded needles and paraphernalia,
endangering the broader community [32]. Additionally,
under Bill 34, punitive policing practices such as drug
seizures may be enforced in public spaces, which could
lead to increased interactions with the unregulated drug
market among PWUD [33]. PWUD who face the risk of
seizures of their substances may be forced to seek alter-
native and perhaps unfamiliar sources to replace what
has been confiscated, which has the potential to increase
the risk of fatal or non-fatal overdose from a potentially
contaminated drug supply [33]. erefore while public
consumption bylaws and legislation may reduce the like-
lihood of drug initiation, they may also result in the unin-
tended consequences of increasing risk for drug-related
harms.
Potential implications ofpublic consumption andbylaw
legislation foraccessing housing andharm reduction
services
Under bans on the public consumption of drugs, PWUD
will increasingly have to rely on access to indoor spaces
such as private homes or harm reduction services such
as supervised consumption services (SCS) and overdose
prevention services (OPS) to consume their drugs. SCS
and OPS offer safe and controlled spaces for drug con-
sumption under the supervision of professionals and
peers trained in overdose prevention, and provide harm
reduction supplies, medical assistance in case of over-
doses, and other key services such as drug checking, safer
supply programs, and referrals to other services [34–36].
However, there is a paucity of both housing and SCS/
OPS available in communities throughout the province,

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Alietal. Health Research Policy and Systems (2024) 22:60
which makes it difficult for PWUD to find safe and acces-
sible spaces to consume drugs [37]. erefore, it is crucial
that public consumption regulations are accompanied
by enhanced access to housing and SCS/OPS services to
ensures that PWUD have access to safe and supportive
environments to consume their drugs.
e ongoing housing crisis in BC highlights significant
challenges in addressing the social and structural factors
that contribute to drug use. A lack of access to secure
housing is compounded by housing unaffordability and a
limited availability of low-barrier housing programs and
supports in the province that do not require PWUD to
be abstinent as a precondition for eligibility [38]. With-
out stable housing, individuals may face increased expo-
sure to drug use in unsafe environments, an elevated risk
of overdose due to using alone or in secluded areas, and
risks related to being subject to re-criminalization [38].
Addressing housing insecurity is therefore crucial in
mitigating the adverse consequences of drug use and pro-
moting the health and well-being of PWUD [39–41].
In addition to a lack of housing, there is also a lack of
harm reduction services in BC, with only 44 OPS and 4
federally-sanctioned SCS currently in operation [37].
is limited number underscores significant gaps in the
ability of PWUD to access these essential services, result-
ing in the potential for re-criminalization when using
outdoors. Increasing the number of and access to SCS
and OPS would not only address concerns surrounding
public consumption but could also help mitigate issues
related to the disposal of drug-related paraphernalia in
public areas and other public nuisance concerns. It could
also contribute to reducing the incidence and presence of
drug-related crimes [40, 41].
Additional community bylaws and zoning restrictions
exist within many municipalities, further exacerbat-
ing challenges with SCS and OPS service implementa-
tion. For instance, some regulations restrict land use and
development within a given area, whereas others restrict
smoking and vaping indoors and within specified dis-
tances of outdoor spaces such as parks, playgrounds, and
entryways [42]. ese bylaws may present specific chal-
lenges, including an inability for SCS/OPS to offer inha-
lation services for PWUD [42]. Smoking is currently the
most common form of illegal drug consumption in the
province, and has increased from 29% to 56% between
2016 and 2021, while injection has declined from 39% to
20% within the same time period [31]. However, despite
the preference for inhalation as a mode of consumption
for many PWUD, as of September 2023, only 42% (or 20
of the 48 sites across the province) offer a safe place for
people to smoke [37]. e inability of SCS and OPS to
offer inhalation services may undermine the decriminali-
zation policy, which aims to reduce barriers to life-saving
services and supports to prevent health harms [2]. Invest-
ments in expanding housing and harm reduction services
for PWUD and providing safe spaces for drug use away
from the public can combat ‘Not In My Backyard’ men-
talities (NIMBYism), in which people resist initiatives
like SCS or OPS in their local communities [43]. Increas-
ing access to these services for PWUD can reduce com-
munity stigma around drug use and ultimately mitigate
NIMBY attitudes that often hinder the implementation
of and support for harm reduction services [34]. When
communities see drug use as a health issue and observe
the benefits of harm reduction services, such as fewer
overdose deaths and less public drug use, they may
become more accepting of these services, potentially
combatting stigma [34].
Potential implications ofpublic consumption andbylaw
legislation forvulnerable populations
It is crucial to recognize that restrictions on public drug
consumption may have particularly consequential impli-
cations on vulnerable populations, including individuals
experiencing homelessness, who often lack alternatives
and may be forced to use drugs in public settings. His-
torically, marginalized and racialized populations, who
experience higher rates of visible poverty and housing
precariousness, are much more likely to be criminal-
ized for the consumption of drugs in public spaces [44].
ese populations have been largely excluded from the
development of population-level drug use policies such
as public consumption regulations, and are more at risk
of experiencing the harms and implications associated
with the application of these laws [44, 45]. For instance,
as briefly described above, the City of Vancouver passed
a recent bylaw in 2023 that allows public drinking in sev-
eral city parks, however, parks located near and within
Vancouver’s Downtown Eastside, a neighbourhood with
high incidences of drug use overdoses, criminalization,
and poverty, and home to 31% of the city’s Indigenous
population, have been largely excluded from the program
[45, 46]. As such, residents in this vulnerable neighbour-
hood continue to be targeted by over-policing and the
inequitable application of these bylaws.
Additionally, recent data reveals a striking 32% increase
in homelessness in Vancouver in 2023 compared to 2020,
with 71% of those individuals reporting addiction [47].
People experiencing homelessness face a multitude of
challenges, especially amid the housing crisis, with lim-
ited shelters and housing services. Without access to
designated drug-use spaces they face heightened vulner-
ability to harassment, including from law enforcement,
and risk drug confiscation due to having to carry their
entire supply [32, 41]. is exacerbates housing inse-
curity, potentially perpetuating cycles of poverty and

Page 7 of 11
Alietal. Health Research Policy and Systems (2024) 22:60
substance use. As a key example, in Prince George, the
controversial Safe Streets bylaw enacted in August 2021
imposes fines ranging from $100–$50 000, imprison-
ment, and other penalties for activities like open drug
use and panhandling [48]. Results from a preliminary
analysis conducted by the British Columbia Assembly
of First Nations in 2022 found that 40% of respondents
felt less safe, and 62% found it harder to consume drugs
safely due to bylaw officers confiscating harm reduction
supplies [48]. e punitive nature of the bylaw, combined
with inadequate public education, increased inequities
among PWUD and homeless populations, and strained
city resources has increased petty survival crimes and
contradicts public safety goals [48].
Public consumption legislation represents strategies
for drug control that perpetuate the historical colonial
nature of prohibitionist frameworks. is approach con-
tradicts the goals of decriminalization, which seeks to
dismantle such frameworks and promote public health
initiatives. Depending on their design and implementa-
tion, these policies can perpetuate inequalities among
oppressed and marginalized groups [10, 49]. e current
design of public consumption laws, does not effectively
address the root causes and social determinants of drug
use and public consumption. Consequently, they may
lead to increased police interventions and PWUD inter-
actions with the criminal justice system, as well as more
arrests of marginalized individuals for public consump-
tion offenses [10, 49].
Support andopposition ofpublic consumption
legislation andbylaws
In line with the potential benefits and costs of public
consumption legislation described above, several organi-
zations have taken various positions either in support
or opposition to these bylaws. For instance, public con-
sumption legislation has garnered political and commu-
nity support due to its role in upholding public order and
safety. Some political leaders have highlighted the law’s
perceived potential to enhance community well-being,
while others have suggested that the legislation equips
law enforcement with vital tools for fostering public
safety, all while emphasizing a non-criminal approach to
guiding drug users toward care pathways [50].
However, several organizations (e.g., the Harm Reduc-
tion Nurses Association Vancouver Area Network of
Drug Users, Canadian Mental Health Association BC
Division, BC Association of Social Workers, the BC
Green Party, and Union of British Columbia Indian
Chiefs) have publicly opposed the implementation of
Bill 34, expressing concerns about its potential impact
on the health, safety, and fundamental rights of PWUD
[51–57]. In particular, arguments have emphasized the
specific implications of the bill on unhoused individuals,
calling for strategies to address issues surrounding the
lack of affordable housing and other supports [53–55].
Collectively, these organizations maintain that there is a
lack of evidence demonstrating any association between
increased public drug use and decriminalization, and
argue that the bill and community bylaws re-criminal-
ize drug using communities which may drive drug use
underground, increasing risks and fatalities, undermining
the objectives of decriminalization [51–57].
Recommendations fornextsteps
Engage multidisciplinary stakeholders includingPWUD
indecision‑making
Going forward, in order to fully achieve the goals of the
decriminalization policy, the province should consider
the potential impacts of public consumption legislation,
such as Bill 34 and community bylaws. e design and
implementation of policies that directly impact PWUD
necessitate the active engagement of those directly
affected. However, a significant issue that has emerged
in the discussions surrounding public consumption leg-
islation is the perceived exclusion of organizations and
advocacy groups representing PWUD [52]. ese voices,
which are essential in shaping policies that directly
impact PWUD, appear to have been marginalized in the
decision-making process. As described above, advocacy
groups and representatives for PWUD and other mar-
ginalized communities have publicly opposed such leg-
islation, urging for a more comprehensive, non-punitive
approach to address the underlying challenges driv-
ing drug use and public safety concerns in BC [51–57].
Involving PWUD and other historically marginalized or
racialized communities, advocacy groups, and frontline
workers can ensure that policies do not perpetuate harm-
ful inequities caused by previous prohibitionist drug
strategies, are rooted in real-world experiences, and are
responsive to evolving needs and concerns [58].
e legislation’s potential implementation must be
thoughtfully approached to ensure it aligns with the
principles and objectives of the decriminalization policy,
and appropriately considers the unique realities and per-
spectives of everyone they aim to benefit [58]. Other-
wise, it runs the risk of further contributing to existing
inequities.
Expand harm reduction andhousing services
It is crucial to address its underlying structural factors
related to homelessness, vulnerability, and the lack of
safe spaces for PWUD. Focusing on these systemic chal-
lenges first and developing viable solutions should be a
priority over enacting public consumption legislation. By
ensuring that individuals have access to stable housing,

Page 8 of 11
Alietal. Health Research Policy and Systems (2024) 22:60
comprehensive support services, and harm reduction
resources, a foundation can be created upon which pub-
lic consumption legislation can be considered. Intro-
ducing such legislation without concurrently addressing
these systemic issues may not only be ineffective but is
also unjust to PWUD as it fails to provide them with
appropriate alternatives and support systems.
Expanding housing and social supports, along with
enhancing accessibility to essential harm reduction ser-
vices such as OPS and SCS, is urgently needed. Research
has consistently indicated that improving access to pri-
vate indoor spaces, such as low-threshold supportive
housing and consumption sites, can reduce public dis-
order and drug-related litter, decrease interactions with
law enforcement, and minimize the potential harms
from open drug scenes for both the public and PWUD
[40, 41]. Moreover, the integration of harm reduction and
substance use treatment services within housing-first
models, which prioritize permanent, low-barrier hous-
ing without prerequisites for abstinence or treatment has
been associated with improvements in health and social
well-being outcomes, such as employment and higher
retention in care [59–61].
To expand harm reduction services effectively, estab-
lishing supervised inhalation sites is crucial. Since inha-
lation is a preferred consumption method for many
PWUD, especially with the potential of public consump-
tion laws in place, these sites are vital. Currently there
are no indoor stand-alone supervised inhalation sites in
the province. Instead, most operate via temporary setups
like covered outdoor tents, garages, and trailers, as per-
manent SCS and OPS locations often lack the space and
ventilation infrastructure to be able to provide inhalation
services [62].
Adding to the complexity of the issue, some municipal
representatives have cited perceived limitations in their
authority to open up such services, frequently pointing
to provincial regulations that prohibit indoor smoking,
as well as other economic and occupational health and
safety concerns [62]. ese regulatory challenges align
with smoking and zoning bylaws that similarly restrict
indoor smoking and the use of land for OPS purposes,
creating a web of interconnected issues and contributing
to the confusion surrounding the implementation of vital
harm reduction services. However, temporary measures
can be adopted to address this issue whilst promoting
broader acceptance of permanent solutions amidst the
evolving discourse on drug use under decriminalization.
For instance, the introduction of mobile SCS in several
BC cities offers a feasible interim solution that may be
more readily accepted by the public [34]. Furthermore,
applying for municipal council resolutions to temporar-
ily lift indoor smoking bans at SCS/OPS for a trial period
can be explored [63]. is approach allows for monitored
indoor inhalation, while assessing its effectiveness in
practice.
e investment in social and harm reduction services
to provide spaces for PWUD to access and help address
the systemic issues they face requires financial commit-
ment. Recently, the BC government has substantially
focused on expanding treatment and recovery services,
with $586 million (59%) of the $1 billion allocated for
mental health and addictions support in the 2023 pro-
vincial budget going towards increasing treatment and
recovery beds for PWUD [64]. ese investments are
welcome, and should be accompanied by investments
in other pillars of the overdose crisis response, includ-
ing poverty reduction and the expansion of evidence-
based harm reduction services. Harm reduction and
housing-first strategies are suggested to be cost-effective
approaches for healthcare systems to help prevent and
reduce the harms associated with drug use, especially
when combined with evidenced-based treatments [39,
65–67].
By pairing public consumption restrictions with invest-
ments in secure housing and other indoor consumption
spaces like OPS and SCS, communities can aim to strike
a balance between what they deem as public safety con-
cerns and the welfare of PWUD.
Conduct thorough evaluations
e importance of conducting ongoing comprehensive
evaluations to assess the impacts of public legislation
and bylaws on PWUD and the decriminalization policy
cannot be overstated, as it holds significant implications
in several critical areas. Firstly, it is essential to gauge
whether these policies reduce or, conversely, increase
stigmatization against PWUD. e shift towards decrim-
inalization is grounded in recognizing drug use as a pub-
lic health issue rather than a criminal one. erefore, if
the evaluation reveals an increase in stigmatization, it
signals a misalignment between the policy’s intentions
and its real-world consequences. However, if the evalu-
ation reveals a decrease in stigmatization, it may suggest
that the policies are effectively changing public percep-
tions and attitudes toward PWUD.
Secondly, assessing whether these policies result in an
increase in risky drug use practices is critical. Decrimi-
nalization aims to reduce the harm associated with drug
use. However, if the evaluation shows an uptick in dan-
gerous drug consumption patterns, it may indicate a
need for enhanced harm reduction measures and ser-
vices. is information will be vital to refine policies and
ensure they effectively protect the health and well-being
of PWUD.

Page 9 of 11
Alietal. Health Research Policy and Systems (2024) 22:60
Additionally, evaluating the legislation’s impact on the
utilization of harm reduction services, is of paramount
importance. An increase in the availability and use of
these services could signal the legislation’s effectiveness
in providing safe spaces for PWUD to consume drugs.
However, if the services remain unchanged in terms of
increasing capacity and accessibility, which can be cou-
pled with lack of increase in utilization and access, it can
signify the need for additional supports. is aspect of
evaluation is especially crucial for people experiencing
homelessness, as it directly affects their access to vital
harm reduction resources and services.
e implementation of public consumption legislation
within a short timeframe after the decriminalization pol-
icy raises concerns about the sequence of policy actions
and their overall effectiveness. Although it is unclear
what will influence decision-making with regards to the
currently proposed public consumption legislation, it is
also important to note that the potential of introducing
this legislation in such close proximity to the implemen-
tation of the decriminalization policy can pose challenges
in appropriately assessing and evaluating its impact. A
critical aspect of a comprehensive evaluation is the need
for sufficient time to gather meaningful data and analyze
trends while minimizing confounding factors. With the
rapid introduction of public consumption legislation,
there may not be adequate temporal distance to discern
the nuanced effects of the decriminalization policy.
Overall, conducting a thorough evaluation is crucial
to safeguarding the integrity of public consumption leg-
islation and bylaws as it relates to decriminalization. It
enables policymakers to make data-driven decisions that
align with the core principles of harm reduction and pub-
lic health and consistently reflect on-the-ground reali-
ties, ensuring that PWUD receive the support and dignity
they deserve.
Conclusion
e relationship between the decriminalization of ille-
gal drugs in BC and policies related to the consumption
of illegal drugs in public is complex, and many ques-
tions remain to be answered, including how the poten-
tial implementation of the tabled public consumption
legislation will impact the decriminalization initiative.
Banning public consumption may hold some benefits.
However, it also has the potential to undermine the pol-
icy, reinforce inequities and harms associated with drug
prohibition and the criminal justice system, and entrench
stigma regarding drug use, pushing PWUD to engage
in risky behaviours, increasing risks for harms such as
infections and overdoses, and creating barriers for engag-
ing with health and treatment services. Going forward,
it will be important to conduct further consultations
with PWUD and advocacy groups and monitor and
evaluate the potential effects of public consumption
and bylaw legislation, to ensure that these do not negate
the spirit of decriminalization and result in unintended
consequences.
Abbreviations
BC British Columbia
CDSA Controlled Drugs and Substances Act
NIMBY Not In My Backyard
OPS Overdose Prevention Site(s)
PWUD People who use drugs
SCS Supervised consumption service(s)
Acknowledgements
Not applicable.
Author contributions
All authors read and approved the final manuscript. FA developed the concept
for the Commentary. FA, JL, CR, and JFC procured and interpreted related data,
and contributed to the writing, reviewing, and editing. JG and KL contributed
to the reviewing, and editing. JR oversaw all aspects of the commentary
including reviewing and editing.
Funding
The authors would like to acknowledge funding from the Canadian Institutes
of Health Research (CIHR) Institute of Neurosciences, Mental Health and
Addiction (grant # EVD‑184698). The funding source had no role in the design
of this study, not its execution, analyses, interpretation of data or publication.
Availability of data and materials
Not applicable.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare they have no competing interests.
Author details
1 Institute for Mental Health Policy Research (IMHPR), Centre for Addiction
and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON M5S 2S1,
Canada. 2 Ontario CRISM Node Team (OCRINT ), Canadian Research Initiative
in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH),
Toronto, Canada. 3 Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada. 4 Communications and Partnerships, CAMH, Toronto, Canada.
5 The Intervention Service for Addictive Behaviors and Addictions (SICAD),
Lisbon, Portugal. 6 BC Centre for Disease Control, Vancouver, BC, Canada.
7 Department of Psychiatry, University of Toronto, Toronto, Canada. 8 PAHO/
WHO Collaborating Centre, CAMH, Toronto, Canada. 9 WHO European Region
Collaborating Centre at Public Health Institute of Catalonia, Barcelona, Spain.
10 Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS),
Universitätsklinikum Hamburg‑Eppendorf, Hamburg, Germany.
Received: 8 January 2024 Accepted: 12 May 2024
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