Policing and access to harm reduction services among young people who use drugs and young Indigenous people who use drugs before and after the pilot implementation of decriminalization of personal possession

Abstract

Background: On January 31, 2023, the province of British Columbia, Canada, implemented a pilot decriminalization of personal possession of certain drugs. This study investigated temporal trends in policing-related barriers to accessing harm reduction services among young people who use drugs (PWUD) in Vancouver before and after decriminalization.

Methods: Data from 2021-2024 were collected from an open prospective cohort of street-involved young PWUD. Logistic regression with generalized estimating equations (GEE) assessed trends in self-reported policing-related barriers to harm reduction services before and after decriminalization, with calendar time and decriminalization (plus their interaction) as primary explanatory variables. A sub-analysis was conducted among participants who identified as being of Indigenous ancestry.

Results: Among 319 participants, the median baseline age was 28.0 years, and 83 (26 %) reported policing-related barriers to harm reduction services at some point during the study period. In multivariable GEE analysis, an increasing trend in reporting police barriers was observed before decriminalization (adjusted per-year odds ratio [AOR]=2.41; 95 % confidence interval [CI]: 1.29-4.51). At the implementation of decriminalization, a significant level drop of 65 % was observed (AOR=0.35; 95 % CI: 0.15-0.82), with no trend observed post-decriminalization (AOR=1.12; 95 % CI: 0.48-2.58 per year). In sub-analysis among Indigenous participants, a significant decreasing trend of 72 % per year in reported policing-related barriers was observed in the post-decriminalization period (AOR = 0.28; 95 % CI: 0.08-0.97).

Implications: Among young PWUD, we observed relative reductions in experiencing policing-related barriers to harm reduction services after the pilot implementation of decriminalization, and this benefit extended to young Indigenous PWUD.

Keywords: Criminalization; Decriminalization; Harm reduction; Policing; Substance use; Young people who use drugs.