The limitations of decriminalization at overdose events and lessons from an evaluation in British Columbia, Canada

Background: Drug prohibition has been associated with poor health and social outcomes for people who use drugs (PWUD), including an increased risk of overdose. However, drug prohibition remains the dominant drug policy in many parts of the world, including Canada. In 2017, the federal government of Canada enacted the Good Samaritan Drug Overdose Act (GSDOA), to encourage people to contact emergency medical services in the event of an overdose by decriminalizing simple possession and conditions related to simple possession at the scene of an overdose.

Methods: We conducted an evaluation of the GSDOA in British Columbia (BC), Canada that included one-on-one interviews with people with lived and living experience of substance use (PWLLE), to determine peoples’ experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews.

Results: We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWLLE to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUDs with intersecting marginalized identities.

Conclusion: Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve as to guide jurisdictions implementing or amending dejure decriminalization policies.