{ "abstract": "Background\n\nIn 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\n\nWe 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\n\nParticipants 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\n\nBC'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.", "abstract_shown": true, "affiliations": [ "Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada. farihah.ontcrism@gmail.com.", "Ontario Node, Canadian Research Initiative in Substance Matters (CRISM), 250 College Street, Toronto, ON, M5T 1R8, Canada. farihah.ontcrism@gmail.com.", "Division of Social Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada. farihah.ontcrism@gmail.com.", "Faculty of Applied Health and Community Studies, School of Applied Health, Clinical Research, Sheridan College, 7899 McLaughlin Rd, Brampton, ON, L6Y 0P8, Canada. farihah.ontcrism@gmail.com.", "Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada. farihah.ontcrism@gmail.com.", "Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada.", "Ontario Node, Canadian Research Initiative in Substance Matters (CRISM), 250 College Street, Toronto, ON, M5T 1R8, Canada.", "School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.", "School of Population and Public Health, University of British Columbia, East Mall, Vancouver, BC, 2206, V6T 1Z3, Canada.", "British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.", "Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.", "Centre on Drug Policy Evaluation, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1TB, Canada.", "Division of Social Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.", "Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada.", "Institute of Medical Science, University of Toronto, 2374, 1 King's College Circle, Toronto, Ontario, M5S 1A8., Canada.", "Department of Psychiatry Dalla Lana School of Public Health & Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.", "Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, Hamburg, 20246, Germany.", "Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario, M5T 3M6, Canada." ], "article_type": "research article", "arxiv": null, "author_total": 8, "authors": [ { "affs": [ 0, 1, 2, 3, 4 ], "name": "Farihah Ali" }, { "affs": [ 5, 6 ], "name": "Jordan Mende-Gibson" }, { "affs": [ 5, 6 ], "name": "Cayley Russell" }, { "affs": [ 7 ], "name": "Geoff Bardwell" }, { "affs": [ 8 ], "name": "Juls Budau" }, { "affs": [ 9, 10 ], "name": "Andrew Ivsins" }, { "affs": [ 11 ], "name": "Sanjana Mitra" }, { "affs": [ 5, 6, 12, 13, 14, 15, 16, 17 ], "name": "Jürgen Rehm" } ], "bibtex": "https://research.draconitic.com/paper/b33v8vg6d0yyn.bib", "cited_by": 0, "doi": "10.1186/s12889-026-28913-w", "fulltext_url": "https://europepmc.org/articles/PMC13725961", "id": "b33v8vg6d0yyn", "issns": [ "1471-2458" ], "landing_url": "https://europepmc.org/article/MED/42968044", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research" ], [ "openalex", "2713|HIV, Drug Use, Sexual Risk" ] ], "openalex": "W7172495503", "pdf_url": "https://europepmc.org/articles/PMC13725961?pdf=render", "pmcid": "PMC13725961", "pmid": "42968044", "published": "2026-08-05", "publisher": "BMC", "ris": "https://research.draconitic.com/paper/b33v8vg6d0yyn.ris", "sources": [ { "first_seen": "2026-11-03T15:20:54Z", "native_id": "MED:42968044", "source": "europepmc", "url": "https://europepmc.org/article/MED/42968044" }, { "first_seen": "2026-11-05T12:22:23Z", "native_id": "PMC13725961", "source": "pmc", "url": "https://doi.org/10.1186/s12889-026-28913-w" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|HIV, Drug Use, Sexual Risk", "subfield": "epidemiology-public-health" } ], "title": "The symbolic power of decriminalization and recriminalization in shaping stigma toward people who use drugs in British Columbia.", "title_text": "The symbolic power of decriminalization and recriminalization in shaping stigma toward people who use drugs in British Columbia.", "type": "peer-reviewed", "updated_at": "2026-11-06T12:22:01Z", "url": "https://research.draconitic.com/paper/b33v8vg6d0yyn", "venue": "BMC public health", "versions": [] }