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The impact of drug decriminalization policy on mental health- and substance-related service utilization among people who use drugs with prior care in British Columbia.

Erin Kwak·Mana Mohebbian·Heather Palis·Joseph H Puyat
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Abstract

BACKGROUND: In 2023, British Columbia implemented a pilot illicit drug decriminalization policy aimed at addressing the high burden of illicit drug toxicity deaths, creating a need to examine its health system impacts. Although research on decriminalization has largely focused only on substance-related outcomes, broader mental health service utilization, including substance-related mental health care, among people who use drugs remains an insufficiently studied domain that this study seeks to address. METHODS: In this single interrupted time series analysis of prevalent people who use drugs with prior care (PWUD-PC) in BC, we examined the proportion of people who accessed mental health and substance-related (MH-SR) services and their average monthly MH-SR visits one year before and after the decriminalization policy, stratified by physician visits, emergency department visits, and hospitalizations. RESULTS: The population prevalence of PWUD-PC remained stable at 1.8% before and after decriminalization, and no statistically significant changes were observed in the proportion of PWUD-PC accessing MH-SR physician services and hospitalizations. The early period following decriminalization did not produce large shifts in overall MH-SR service use among PWUD-PC. Some movements in trends were seen in emergency department use, while several other outcomes, particularly in hospitalizations and physician visits, continued pre-existing trends. CONCLUSION: Overall, we found stable patterns of MH-SR service engagement across the intervention period and small shifts in the post-intervention trends of average MH-SR service visits. These findings suggest that the early period following decriminalization did not lead to abrupt or large shifts in MH-SR service use among PWUD-PC.

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HumansBritish ColumbiaMental Health ServicesSubstance-Related DisordersIllicit DrugsInterrupted Time Series AnalysisMaleFemaleAdultHospitalizationEmergency Room VisitsPatient Acceptance of Health CareEmergency Service, HospitalDrug decriminalizationHealth service utilizationMental health outcomesPolicy analysisTime series analysisJournal Article

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Erin Kwak, Mana Mohebbian, Heather Palis, Joseph H Puyat. 2026-06-30. The impact of drug decriminalization policy on mental health- and substance-related service utilization among people who use drugs with prior care in British Columbia.. https://doi.org/10.1016/j.drugpo.2026.105422

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Journal Article resourceAdult subjectFemale subjectHospitalization subjectHumans subjectJournal Article subjectMale subjectPatient Acceptance of Health Care subject

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