Drug decriminalization in BC reduced police encounters for drug possession, with no changes in drug-related deaths
Canadian Medical Association Journal
British Columbia’s drug decriminalization policy was associated with a substantial decrease in police encounters for drug possession, while neither decriminalization nor the subsequent partial recriminalization was associated with detectable changes in deaths due to drug toxicity or drug-related hospitalizations, found new research in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.260038.
In January 2023, the Government of British Columbia introduced a time-limited initiative that decriminalized possession of up to 2.5 grams of opioids, cocaine, methamphetamine, and methylenedioxymethamphetamine (MDMA or ecstasy). The aim was to reduce overdose deaths and increase treatment engagement by reducing fear and stigma that lead to hiding substance use or using drugs alone and avoiding treatment and support. In May 2024, following concerns about drug use in public and public safety, the government partially recriminalized possession in most public spaces, while it remained decriminalized in designated spaces. In January 2026, the government of BC opted not to renew the decriminalization initiative.
“These regulatory shifts — the initial decriminalization and subsequent partial recriminalization — allow for the evaluation of changes in drug-related health and drug crime outcomes over time,” writes Dr. Daniel Myran, Gordon F. Cheesbrough Research Chair at North York General Hospital, and a scientist with the University of Toronto’s Department of Family Medicine, ICES, and the Bruyère Health Research Institute, with coauthors.
Over the 5-year study period from August 2020 to March 2025, the authors compared changes in police encounters for drug possession and trafficking and opioid- and stimulant-related hospitalizations and deaths from drug toxicity in BC to other parts of Canada before and after decriminalization and partial recriminalization. In total, 97 630 instances of police encounters for drug possession, 75 485 for drug trafficking, 161 278 opioid-related hospitalizations, 113 747 stimulant-related hospitalizations in Canada, and 29 730 drug toxicity deaths occurred in BC, Ontario and Alberta.
Decriminalization in BC was associated with a 39% decrease in police encounters for drug possession, which returned to pre-decriminalization levels after partial recriminalization. Decriminalization in BC was not associated with changes in drug-related hospitalizations or overdose deaths. The partial recriminalization period aligned with declines in both drug-related hospitalizations and overdose deaths in BC; however, similar declines occurred in the rest of Canada, suggesting that broader national trends likely accounted for these changes.
“The findings of this study reinforce that BC’s temporary decriminalization achieved the intended effect of reduced criminalization of drug possession among people who use drugs. The absence of changes in overdose outcomes highlights that there are no simple solutions to the overdose crisis in Canada and that other factors and interventions are urgently needed to improve key health outcomes related to drug use,” said Dr. Myran.
Although decriminalization was not associated with changes in hospitalizations or deaths from drug toxicity, the authors suggest it may have had positive benefit for people who use drugs.
“Decriminalization was intended to reduce the harms associated with criminalizing people who use drugs, and our findings suggest that it meaningfully reduced police-reported possession incidents,” said study coauthor Adrienne Gaudreault, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia. “At the same time, changing possession laws alone cannot make an unpredictable and highly toxic drug supply safer. Decriminalization should be understood as a component of a comprehensive public health response that must also address the toxicity of the drug supply.”
In a related commentary https://www.cmaj.ca/lookup/doi/10.1503/cmaj.261198, Dr. Alexis Crabtree, British Columbia Centre for Disease Control and the School of Population and Public Health, University of British Columbia, Vancouver, BC, with coauthor writes, “decriminalization may be best understood as a complex systems intervention, with myriad effects — and possible unintended consequences — emerging from interactions across institutions and sectors. The lesson from BC is not that decriminalization is irrelevant, but that such policies must be supported within prepared, trusted, and adequately resourced systems.”
Journal
Canadian Medical Association Journal
Method of Research
Observational study
Subject of Research
People
Article Title
Impact of drug decriminalization and recriminalization on drug-related crime and health outcomes in British Columbia: a population level time-series analysis
Article Publication Date
14-Sep-2026
FAU study pinpoints non-fatal overdose hotspots in Palm Beach County
image:
FAU Schmidt College of Medicine researchers found that nearly half of mapped non-fatal overdose hotspots in Palm Beach County significantly overlapped with gas stations, while others followed major transportation corridors.
view moreCredit: Alex Dolce, Florida Atlantic University
Fatal drug overdoses have long been the focus of the nation’s overdose crisis, but non-fatal overdoses occur far more frequently. These events often bring people to emergency departments, creating opportunities to connect them with lifesaving treatment and prevention services.
Yet many patients do not receive follow-up care. At the same time, overdose patterns are becoming increasingly complex, driven by illicit fentanyl, stimulants, alcohol and polysubstance use. Florida reported more than 31,000 suspected overdose-related emergency department visits in 2024, including more than 5,000 in Palm Beach County.
New research from Florida Atlantic University’s Charles E. Schmidt College of Medicine is revealing important geographic patterns in non-fatal overdoses, offering new insight into where non-fatal overdoses are concentrated and where prevention efforts could potentially have the greatest impact. The findings also point to environmental and social factors that may influence where overdoses occur.
Using the Florida Department of Health’s overdose surveillance data, researchers mapped non-fatal overdoses across Palm Beach County and compared indoor and outdoor events by demographic and social characteristics. They also examined associations between overdose locations and built-environment features, including gas stations and major transportation corridors.
The results of the study, published in the journal Drug and Alcohol Dependence, show that non-fatal overdoses were not randomly distributed across Palm Beach County, but instead clustered in specific geographic areas, particularly near major transportation corridors and gas stations. Of the 1,661 non-fatal overdose events analyzed, 39.6% occurred outdoors, and these events were more frequently located near gas stations and major transportation corridors than indoor overdoses.
Outdoor overdoses also differed significantly from indoor events in the substances involved and the demographic and social characteristics of those affected. They were more likely to involve stimulants and alcohol and were more common among men, younger adults, people experiencing housing instability and people without health insurance.
Housing instability emerged as the strongest factor associated with outdoor overdose. The relationship was particularly pronounced near gas stations: among people experiencing non-fatal overdose, those identified as unstably housed had more than five times the odds of the overdose occurring within a quarter mile of a gas station compared with those in stable housing. Transitional housing and lack of health insurance also were associated with greater odds of an overdose occurring near a gas station.
Spatial analyses found that nearly half of outdoor overdoses occurred within a quarter mile of a gas station, compared with 23.5% of indoor overdoses. Outdoor overdoses were also more likely to occur near major highways or interstates (33.6% vs. 21.2%) and in non-residential areas (68.2% vs. 32.8%). These patterns were particularly evident in eastern Palm Beach County, where overdose hotspots frequently followed major transportation corridors.
Overall, 91% of mapped areas showed alignment between overdose and gas station distributions, with 45.5% showing statistically significant hotspot overlap. Gas stations may be relevant because they are highly accessible, often open for extended hours and commonly located along major transportation corridors. While the findings do not suggest that gas stations themselves cause overdoses, these locations may help identify areas where targeted prevention, naloxone access and outreach could reach people at increased risk.
“These findings show us that understanding overdose risk requires us to look beyond the individual and consider the places where people live, travel and spend time,” said Maria C. Mejia, M.D., senior author and professor of population health, Schmidt College of Medicine. “If we know where non-fatal overdoses are clustering and which populations are most affected, we can be more strategic about where prevention and intervention resources are placed. That could mean expanding naloxone access, deploying outreach teams or connecting people to treatment and other services in the places where they are most likely to be encountered.”
The strong relationship between housing instability and outdoor overdose also underscores the importance of integrating health, housing and social services into overdose prevention strategies. Spatial surveillance could help public health officials identify priority locations and better understand the populations most in need of targeted support.
The study’s first author is Whitney Van Arsdale of the Florida Department of Health in Palm Beach County. Co-authors are Lea Sacca, Ph.D., assistant professor of population health, Schmidt College of Medicine; Stephanie Barajas, Florida Department of Health in Palm Beach County; Nathan Flothe, FAU medical student; and Lewis S. Nelson, M.D., dean and chief of health affairs, Schmidt College of Medicine.
Mejia and Sacca were supported by the Substance Abuse and Mental Health Services Administration through the Strategic Prevention Framework Partnerships program.
- FAU -
About Florida Atlantic University:
Florida Atlantic University is one of the nation’s fastest-rising public research universities, serving more than 32,000 students in South Florida. Ranked among the Top 100 Public Universities by U.S. News & World Report, recognized as a Top 25 Best-In-Class College, and cited by Washington Monthly as one of the nation’s most effective engines of upward mobility, Florida Atlantic is also one of only 13 institutions nationwide to hold Carnegie Foundation designations for R1 research, opportunity and community engagement. Guided by its strategic plan, “2031FAU: Where Tomorrow Begins,” the university is focused on delivering career-ready education and experiential learning, driving scholarly inquiry that creates healthier, safer and more prosperous communities, strengthening institutional excellence, and elevating its impact across South Florida and beyond. Florida Atlantic continues to advance its position as Florida’s first quantum university, integrating research, education and industry partnerships around next-generation computing technologies. Through other signature strengths in neuroscience and healthy aging, environmental, ocean and coastal innovation, and national defense and autonomous systems, Florida Atlantic expands knowledge, fuels economic opportunity and fulfills its mission as South Florida’s hometown university.
Journal
Drug and Alcohol Dependence
Method of Research
Meta-analysis
Subject of Research
People
Article Title
Spatial patterns of non-fatal overdose in relation to the built environment in Palm Beach County, Florid
Teen cannabis surveys may be missing rise in diagnosed disorder, study of 637,000 adolescents finds
Cannabis use disorder diagnoses rose among California teens after legalization, erasing a prior three-year decline
Public Health Institute
Oakland, CA—New diagnoses of cannabis use disorder (CUD) among adolescents in Northern California began climbing after recreational cannabis was legalized in California in 2016, reversing a steady decline in the three years prior, according to a new study published in the journal Addiction. The researchers say their findings call for disorder-level outcomes to be tracked alongside standard measures of use prevalence and frequency when evaluating the public health effects of cannabis legalization.
"Most surveys of adolescent cannabis use tell us how many teens have tried cannabis, but don’t tell us how many are developing a disorder that brings them into clinical care," said Alisa Padon, Ph.D., the lead author on the study and research director at Getting it Right from the Start, a project of the Public Health Institute. “The public health goal is to reduce the harms caused by cannabis use and we cannot reduce what we do not measure.”
National surveys have shown that overall rates of teen cannabis use have stayed relatively flat for two decades. Those figures are often cited as evidence that legalization has not affected young people. However, research shows that the risk of developing CUD, a complex condition that involves a problematic pattern of cannabis use, rises sharply with more frequent use and with earlier age of first use. By tracking diagnoses over time rather than at a single point, the study makes visible a shift toward frequent and problematic use that national survey figures of cannabis use alone do not reveal.
Researchers analyzed six years of electronic health record data from 637,000 adolescents receiving care at Kaiser Permanente Northern California. The periods studied were before the 2016 ballot measure passed, between passage and implementation, and after recreational retail sales began, through early 2020. Using an interrupted time series design, they tested whether trends in new CUD diagnoses shifted across those policy periods. The cohort had a mean age of 14.1 years at baseline and was 50.9% male, 33.6% non-Hispanic White, 29.6% Hispanic, 17.1% non-Hispanic Asian, 8.0% non-Hispanic Black and 11.5% multiple, other, or unknown race and ethnicity. Average enrollment lasted 27.4 months, and the demographic makeup of the cohort was similar across time periods.
Key findings:
- CUD diagnoses fell about 6% a year before the 2016 vote and rose about 8% a year after, a reversal of the prior trend.
- The upward trend continued after recreational retail sales began.
- By early 2020, more than three years after passage, diagnoses were back to their 2014 level.
- Among the 637,461 adolescents studied, 8,804 were newly diagnosed with CUD over the six years.
The shift in CUD diagnosis began at passage of legalization rather than at the opening of retail stores, which the authors say may reflect changes in the broader legal and social environment around the vote. Passage reduced criminal penalties for cannabis offenses for juveniles, potentially altering how teens weighed the consequences of use. It may also have acted as a normative signal that cannabis is socially acceptable or low-risk, a message amplified by cannabis-related promotion around the 2016 ballot campaign. In addition, as the retail market matured, youth-appealing advertising, product variety and higher-potency THC products expanded, factors that can increase the likelihood of progression to frequent use.
“The new study shows that cannabis laws are tied to changes in young people's rates of cannabis use disorder,” said senior author Kelly Young-Wolff, PhD, MPH, a research scientist at the Kaiser Permanente Division of Research. “As potency has risen, it's more important than ever that families understand this is a product that can be addictive and, for some kids, requires real medical care.”
The pattern of CUD diagnosis the research team found echoes a companion study on adolescent self-reported cannabis use they published earlier this year in JAMA Network Open. The study found use was falling before California’s legalization, began climbing after the law passed but before retail stores opened and continued rising to a high of 9.5% in early 2020, when the COVID-19 pandemic began. In 2024 adolescent use was at 6.5%—near where it stood just before legalization.
The new study has several limitations. The study population were adolescents insured through and seeking care at Kaiser Permanente Northern California, so results may not apply to teens in Southern California, other states or those who are uninsured. Because Proposition 64 took effect statewide, there was no comparison group of unexposed adolescents, and the single-group design cannot rule out unmeasured trends over the same years, including broader shifts in adolescent mental health, screening practices or health care use. The analysis was not preregistered, and the study period ended before the COVID-19 pandemic, limiting conclusions about longer-term trends.
Study:
Padon, AA, Cortez, CA, Alexeeff, SE, Slama, NE, Liccardo Pacula, R, Silver, LD, Sterling SA, Campbell CI, Satre DD, Does MB, Young-Wolff KC. Adolescent Cannabis Use Disorder Following Recreational Cannabis Legalization in California, USA: A Population-Based Interrupted Time Series Study. Addiction. 2026. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.70597
The Public Health Institute is a national independent nonprofit that advances the health and wellbeing of all people and communities, particularly those facing the greatest barriers. Rooted in 60 years of public health experience, PHI moves ideas into action through practice, policy, research and community engagement, while serving as the operational backbone for more than 40 programs delivering evidence-based solutions to complex health challenges. For more information, visit www.phi.org.
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Journal
Addiction
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Adolescent cannabis use disorder following recreational cannabis legalization in California, USA: A population-based interrupted time series study
Article Publication Date
11-Sep-2026
COI Statement
MB Does and CI Campbell have received support managed through their institution from the Industry PMR Consortium, a consortium of companies working together to conduct post-marketing studies required by the Food and Drug Administration that assess risks related to opioid analgesic use. All remaining authors declare no financial competing interests.
