Police drug seizures without arrest before and during a decriminalization pilot in Vancouver, Canada: a longitudinal analysis

On 31 January 2023, the province of British Columbia (BC), Canada implemented a three-year “Decriminalization Pilot” in response to a toxic drug supply public health emergency, which removed criminal sanctions for the personal possession of some drugs below a cumulative total of 2.5 g. We sought to measure frequency of police drug seizures without arrest before and during the Decriminalization Pilot, and to determine potential relationships between police drug seizures and nonfatal overdose in the urban setting of Vancouver, BC. We drew from a prospective cohort study and employed multivariable generalized estimating equations models. We used data collected between March 2022 and February 2024 among a prospective cohort of people who use drugs. Among study participants ( n = 490), the quarterly prevalence of police-enforced drug seizures without arrest in the past month ranged from 0.8% to 2.1% before the Decriminalization Pilot, and from 1.1% to 4.1% during the Pilot. In multivariable analyses, police drug seizures without arrest significantly trended upward during the Decriminalization Pilot (adjusted odds ratio [AOR] = 1.66, 95% confidence interval [CI]: 1.01, 2.73). Further, police drug seizures without arrest were associated with increased odds of experiencing a nonfatal overdose (AOR = 3.21; 95% CI: 1.79, 5.75). We observed an upward trend in police drug seizures without arrest during the Decriminalization Pilot. Additionally, we observed a significant association between police drug seizures without arrest and increased odds of experiencing an overdose. Our study adds to the evidence needed to inform decriminalization policies in Canada and elsewhere.