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Peer-reviewedCC BY-NC-NDBMC public health

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

  • Farihah Ali1,2,3,4,5
  • Jordan Mende-Gibson6,7
  • Cayley Russell6,7
  • Geoff Bardwell8
  • Juls Budau9
  • Andrew Ivsins10,11
  • Sanjana Mitra12
  • Jürgen Rehm6,7,13,14,15,16,17,18
18 affiliations
  1. 1Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada. [email protected].
  2. 2Ontario Node, Canadian Research Initiative in Substance Matters (CRISM), 250 College Street, Toronto, ON, M5T 1R8, Canada. [email protected].
  3. 3Division of Social Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada. [email protected].
  4. 4Faculty of Applied Health and Community Studies, School of Applied Health, Clinical Research, Sheridan College, 7899 McLaughlin Rd, Brampton, ON, L6Y 0P8, Canada. [email protected].
  5. 5Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada. [email protected].
  6. 6Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada.
  7. 7Ontario Node, Canadian Research Initiative in Substance Matters (CRISM), 250 College Street, Toronto, ON, M5T 1R8, Canada.
  8. 8School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
  9. 9School of Population and Public Health, University of British Columbia, East Mall, Vancouver, BC, 2206, V6T 1Z3, Canada.
  10. 10British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
  11. 11Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
  12. 12Centre on Drug Policy Evaluation, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1TB, Canada.
  13. 13Division of Social Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.
  14. 14Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada.
  15. 15Institute of Medical Science, University of Toronto, 2374, 1 King's College Circle, Toronto, Ontario, M5S 1A8., Canada.
  16. 16Department 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.
  17. 17Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, Hamburg, 20246, Germany.
  18. 18Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario, M5T 3M6, Canada.
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{ali2026symbolic,
  title = {{The symbolic power of decriminalization and recriminalization in shaping stigma toward people who use drugs in British Columbia.}},
  author = {Farihah Ali and Jordan Mende-Gibson and Cayley Russell and Geoff Bardwell and Juls Budau and Andrew Ivsins and Sanjana Mitra and Jürgen Rehm},
  journal = {BMC public health},
  year = {2026},
  month = aug,
  doi = {10.1186/s12889-026-28913-w},
  url = {https://europepmc.org/article/MED/42968044},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - The symbolic power of decriminalization and recriminalization in shaping stigma toward people who use drugs in British Columbia.
AU  - Farihah Ali
AU  - Jordan Mende-Gibson
AU  - Cayley Russell
AU  - Geoff Bardwell
AU  - Juls Budau
AU  - Andrew Ivsins
AU  - Sanjana Mitra
AU  - Jürgen Rehm
PY  - 2026
DA  - 2026/08/05
JO  - BMC public health
DO  - 10.1186/s12889-026-28913-w
UR  - https://europepmc.org/article/MED/42968044
AB  - 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.
SN  - 1471-2458
ER  -