"It's going to get pretty tippy": Stakeholder perspectives on the (dys)function of a four pillars drug strategy.

A 'drug strategy' is a policy document that structures the priorities and directions for interventions for drug related issues within a particular jurisdiction and/or context. A 'pillars' drug strategy concentrates efforts through clustering separated columns of activity, such as law enforcement, harm reduction, treatment, and prevention. In this study, we examined drug policy stakeholders' perspectives on the structure, function, and fit of a four pillar drug strategy framework in Vancouver, Canada. Utilizing qualitative interview data from fifteen drug policy stakeholders, we examine perspectives on Vancouver's four pillar drug strategy that was implemented over 20 years ago. Our findings are organized under three main themes: (1) the notion of 'balance' of efforts, resources, and attention across the pillars; (2) how the pillars function as a cohesive whole; (3) whether the pillars' architecture is still fit-for-purpose. The architecture of four discrete pillars did not enable a sense of cohesion and collaboration of efforts, and instead elicited a sense of competition, conflict, fragmentation, simplicity, and rigidity of the strategy as a whole. These findings suggest that, in practice, a four pillars framework may be structurally dysfunctional in working towards a common goal. Our study questions the effectiveness of a commonly used 'pillars' framework and whether it needs to be reenvisaged.

People who use drugs' prioritization of regulation amid decriminalization reforms in British Columbia, Canada: A qualitative study.

BACKGROUND: North America and the province of British Columbia (BC), Canada, is experiencing an unprecedented number of overdose deaths. In BC, overdose has become the leading cause of death for people between the ages of 10-59 years old. In January 2023, BC decriminalized personal possession of a number of illegal substances with one aim being to address overdose deaths through stigma reduction and promoting access to substance use services. METHODS: We conducted a qualitative study to understand people who use drugs' (PWUD) perceptions of the new decriminalization policy, immediately prior to its' implementation (October-December 2022). To contextualize decriminalization within broader drug policy, we also asked PWUD what they perceived as the priority issues drug policy ought to address and the necessary solutions. Our final sample included 38 participants who used illegal drugs in the past month. RESULTS: We identified four themes: 1) The illicit drug supply as the main driver of drug toxicity deaths 2) Concerns about the impact of decriminalization on drug toxicity deaths 3) Views towards decriminalization as a policy response in the context of the drug toxicity crisis 4) Regulation as a symbol of hope for reducing drug toxicity deaths. CONCLUSION: From our data it became clear that many anticipated that decriminalization would have minimal or no impact on the overdose crisis. Regulation was perceived as the necessary policy approach for effectively and candidly addressing the drivers of the ongoing overdose crisis. These findings are important as jurisdictions consider different approaches to moving away from prohibition-based drug policy.

Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study.

BACKGROUND: In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction. METHODS: The current multi-method study examines people who use drugs' awareness and knowledge of British Columbia's decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September-November 2022, immediately prior to the implementation of decriminalization. RESULTS: Quantitative findings show that two-thirds (63%) of people who use drugs were aware of the policy, but substantial knowledge gaps existed about the legal protections afforded (threshold amount, substances included, drug trafficking, confiscation). The qualitative findings suggest that people who use drugs misunderstood the details of the provincial decriminalization model and often conflated it with regulation. Results suggest that information sharing about decriminalization were minimal pre-implementation, highlighting areas for knowledge dissemination about people who use drugs' rights under this policy. CONCLUSIONS: Given that decriminalization in British Columbia is a new and landmark reform, and that the success of decriminalization and its benefits may be undermined by poor awareness and knowledge of it, efforts to share information, increase understanding, and empower the community, may be required to promote its implementation and benefits for the community.