Background Decriminalization of personal possession of illegal drugs was implemented in British Columbia, Canada on January 31, 2023. We examined the short-term impacts of decriminalization on drug possession criminal incidents and criminal cases in British Columbia. Methods We sourced population-based monthly counts of drug possession incidents, persons charged by police in drug possession incidents, and drug possession cases in British Columbia and other provinces in Canada (2013-2023). Crude and age-standardized rates per 100,000 population were calculated and differenced to generate single time series for the outcomes. Controlled interrupted time series analyses were conducted using generalized additive models that tested immediate effects and trend changes in the outcomes. Results Decriminalization resulted in an immediate downshift (β [95% CI]: 0.46 [0.04, 0.88]) in the difference of the crude rates of drug possession incidents between British Columbia and other provinces in Canada. Similar significant effects were not observed in regards to the trend change. These changes corresponded to an overall average reduction of 5.5 (95% CI: 1.1, 11.9) drug possession incidents per 100,000 population per month in British Columbia compared to other provinces in Canada. Decriminalization was not associated with changes in persons charged by police in drug possession incidents or drug possession cases in British Columbia compared to other provinces in Canada. Conclusions Decriminalization was associated with reductions in drug possession incidents, but it was not associated with changes in persons charged by police in drug possession incidents or drug possession cases.

INTRODUCTION:British Columbia, Canada, implemented a 3-year pilot that decriminalized the personal possession of select illegal drugs beginning January 31, 2023. The policy was amended to prohibit drug possession in all public spaces starting May 7, 2024. The impacts of decriminalization and the subsequent decriminalization amendment on police-reported drug possession seizures were examined; these seizures were identified on the basis of incidents in which drug possession offences were recorded as the most serious offence. METHODS:Monthly, population-based crude rates of police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams were analyzed using an interrupted time series design with generalized additive models (January 2019-July 2025; data were collected and analyzed in 2026). The models tested level changes in the outcomes associated with the initial decriminalization policy and the subsequent decriminalization policy amendment relative to the predecriminalization. RESULTS:Decriminalization relative to predecriminalization was associated with a 68% decrease in police-reported drug possession seizures of any quantity (β= -1.1, 95% CI= -1.4, -0.9). However, police-reported drug possession seizures of any quantity increased after the decriminalization amendment, such that they were statistically indistinguishable from predecriminalization levels (β= -0.2, 95% CI= -0.6, 0.1). A similar pattern of findings was observed for police-reported drug possession seizures involving up to 2.5 grams: decriminalization relative to predecriminalization was associated with an 87% decrease (β= -2.0, 95% CI= -2.5, -1.6), whereas the decriminalization amendment relative to predecriminalization status was not associated with significant changes (β=0.4, 95% CI= -0.2, 1.0). CONCLUSIONS:Decriminalization was associated with decreases in police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams. The subsequent decriminalization amendment reversed this trend because both types of police-reported drug possession seizures returned to levels comparable to those observed before decriminalization.

BACKGROUND:Research suggests that adolescents belonging to equity-deserving populations often experience pronounced health consequences due to barriers they face at the intersection of their social identities. Our study examined how current cannabis use varies among ethno-racial groups by gender identities. METHODS:Cross-sectional data from 68,533 adolescents in the 2022/2023 COMPASS survey were analyzed. Logistic regression analysis using generalized estimating equations (GEEs) was conducted to determine the likelihood of current cannabis use among diverse ethno-racial groups stratified by gender identities. All models accounted for clustering by province, and were adjusted for age, perceived relative affluence, current binge drinking, and current e-cigarette use. RESULTS:Among cisgender girls, the highest risk group for current cannabis use were Multiethnic (aOR: 1.26, 95% CI: 1.18-1.35), Black/African and Caribbean (aOR: 1.05, 95% CI: 1.04-1.07), and "other ethno-racial group" (aOR: 1.55, 95% CI: 1.43-1.67) youth relative to White/European cisgender girls; the lowest risk group included East Asian, South Asian, Southeast Asian youth. Cisgender boys displayed similar risk profiles to cisgender girls. However, current cannabis use was significantly more likely among all racialized transgender and gender-diverse youth, except for Southwest Asian and North African, and Southeast Asian youth, relative to their White/European counterparts. CONCLUSIONS:Current cannabis use risk profiles varied by ethno-racial and gender identities. The findings suggest that culturally tailored education and prevention approaches incorporating an intersectional lens are warranted to address cannabis use among adolescents at risk.

BACKGROUND:Despite the gradual shift in public policy and perception toward cannabis use, there is limited evidence on the co-use of cannabis and antidepressants, and comparative use of these substances across the 3 distinct phases of cannabis legalization. We examined the use of cannabis and/or antidepressant patterns over time, and explored potential sex differences over legalization phases. METHODS:Data were utilized from the 2013 to 2023 Centre for Addiction and Mental Health (CAMH) Monitor study, a repeated cross-sectional survey of adults 18 years of age and older (n = 20 498; 52% female). The surveys employed a regionally stratified sampling design using computer-assisted telephone interviews and web surveys. Multinomial logistic regression modeling was performed to analyze the data. RESULTS:The exclusive use of cannabis increased from 7.2% to 14.9%, and use of both cannabis and antidepressant increased from 1.3% to 5.5% between pre-and post-legalization of cannabis periods, respectively (P < .001). There was a significant interaction between legalization periods and sex on the use of cannabis and/or antidepressant (P < .001), suggesting that the relative risk ratio (RRR) of using cannabis rather than antidepressant was higher among females during the post-legalization period, compared to the pre-legalization period (RRR = 2.27, 95% confidence interval: 1.76-2.93). In both sexes, the relative risk of using both substances was significantly higher during the post-legalization period. CONCLUSIONS:As cannabis becomes legal and commercialized, the likelihood of using it over antidepressants seems to increase, especially among females. The growing trend of using both substances could have significant public health and clinical implications due to the potential for harmful drug interactions.

Background In January 2023, British Columbia (BC) became the first Canadian province to implement a legally sanctioned drug decriminalization policy, removing criminal penalties for adults possessing 2.5 g or less of opioids, cocaine, methamphetamine, and MDMA. Introduced as a three-year pilot, it aimed to reframe substance use as a public health issue, reduce stigma, and improve health and social service engagement. Criminal penalties were reintroduced for drug possession in most public spaces in May 2024, and the pilot ended in January 2026. Its termination has been interpreted as policy failure; this review aimed to examine how the pilot was implemented in practice and to identify factors that shaped its operationalization and early implementation-relevant outcomes. Methods We conducted a systematic review with narrative synthesis of peer-reviewed literature examining implementation-relevant aspects of BC’s decriminalization pilot. Six databases were searched (January–February 2026) for studies published May 31, 2022–February 1, 2026. The protocol was registered in PROSPERO (CRD420251271694). Results Twenty-seven studies were included. Four cross-cutting implementation barriers were identified: pilot design features, public and cross-sector communication gaps, limited frontline training, and insufficient funding and infrastructure. Design features included the 2.5 g possession threshold, misalignment with real-world drug use patterns; the three-year timeframe, which constrained system-level effects; and the May 2024 amendment, which introduced additional instability. The pilot was implemented without commensurate investment in harm reduction, treatment, or housing infrastructure, within already constrained systems. Conclusion BC’s decriminalization pilot suggests the effects of legal reform are shaped by implementation context. Early outcomes may reflect design features, institutional readiness, and system capacity rather than legal change alone; longer-term impacts remain uncertain. Future reforms should align legal change with coordinated implementation, operational guidance, public communication, and adequate service infrastructure.

Background: Heavy episodic drinking (HED) poses significant risks during adolescence. Despite declining prevalence over years, it remains unclear whether these trends are influenced by historical changes or are independent of age and birth cohort effects.Objectives: To investigate the age-period-cohort (APC) effects on HED among adolescents in Ontario, Canada.Methods: Data drawn from the Ontario Student Drug Use and Health Survey (OSDUHS) from 1999 to 2023. OSDUHS is a repeated cross-sectional survey of students in grades 7 through 12 attending publicly funded schools in Ontario, Canada. The survey used a stratified two-stage cluster sampling method, including 103,977 adolescents (50.9% females) aged 12-18 years.Results: The observed prevalence of HED in the past 30 days declined from 27% in 1999 to 9.6% in 2023. In the pooled sample, HED increased from 2.2% at age 12-41.6% at age 18, with a notable divergence in HED rates between males and females at ages 17 and 18. APC analysis revealed that adolescents born in the early 1990s (cohort effect) were nearly twice as likely to engage in HED as those born in 2000 (RR = 1.78, 95%CI: 1.63-1.95). The strongest period effect was evident in 2000, with odds of HED higher than 2015 (RR = 1.55, 95%CI: 1.39-1.72), followed by a peak in 2018 and a decline in recent periods.Conclusions: Teen binge drinking has declined over time, with newer generations drinking less. These shifts may reflect changing social norms and lifestyle preferences. Identifying the most affected age and cohort groups can guide targeted prevention.

Background: In January 2023, British Columbia (BC) implemented a three-year pilot decriminalizing possession of up to 2.5 grams of certain illegal drugs, including opioids, cocaine, methamphetamine, and MDMA, the first policy of its kind in Canada. This initiative has faced scrutiny, culminating in a May 2024 amendment banning possession and use in public spaces.Objectives: To examine public opinion on BC's decriminalization policy by assessing perceptions of the 2024 policy amendment, potential changes in support between 2024 and 2025, and demographic factors associated with support for repealing the policy.Methods: We analyzed two waves of online, non-probability surveys of BC adults (male 48%, non-male 52%): Wave 1 (March 26-April 1, 2024; N = 1,202) and Wave 2 (February 12-18, 2025; N = 1,200). Changes in values between both waves were tested with Rao-Scott chi-square analyses, and demographic predictors of support for the policy's repeal were assessed using multinomial logistic regression.Results: Support for decriminalization weakened between 2024 and 2025, as opposition rose from 41% to 47% (p = .0427). Fewer respondents believed decriminalization reduced criminalization (50% vs. 39%; p < .0001), reduced policing costs (37% vs. 25%; p < .0001), or improved treatment access (34% vs. 27%; p = .0229). Disagreement that decriminalization reduced stigma increased from 45% to 55% (p < .0001), while perceptions of community safety declined from 28% vs. 22% (p = .0019). Overall, 61% supported the amendment, and 46% supported repeal, with support varying by age, gender, region, education, and household composition.Conclusion: Public opinion in BC reflects growing skepticism toward decriminalization, strong support for public use restrictions, and significant backing for the policy's repeal. Without visible improvements in overdose prevention, service access, and public communication, the policy's long-term viability remains uncertain. Sustained investments in harm reduction and strategic public messaging are essential.

Ontario, Canada, legalized cannabis for recreational use in October 2018. Taxation consists of a federal base taxation, and provincial additional duties and adjustments. Different tax methods are used for different cannabis products: specific (only) taxation (SO) for processed products (e.g., vapes and edibles), and ad valorem with specific floor taxation (ASF) for unprocessed products (e.g., dried flower and pre-rolls). This study aimed to simulate and compare the impact of the cannabis excise tax methods currently used in Ontario with alternative tax methods to determine which method would be most effective in reducing consumption of high-tetrahydrocannabinol (THC) products. Using data on 2,568 units of cannabis products sold legally in Ontario in March 2022, we explored the structure of taxes and prices per mg of THC of these products under the current cannabis excise tax methods: Compare ASF and SO taxationto alternative simulated tax methods, bases, and rates. Our study found four key insights. (1) The currently used ASF taxation, based on flower weight, created a lower tax per mg of THC for high THC products. (2) THC-based SO taxation created a greater percentage of excise tax on high THC products. (3) Compared to other tax methods, SO taxation produced the greatest average excise tax per mg of THC for all THC-concentration products and higher tax rates per mg of THC for high-THC products, and reduced the tax and price gaps between the lowest and the highest THC-concentration categories. (4) SO taxation, however, produces much lower tax per mg of THC for the lowest THC products, such as youth-friendly edible cannabis products. The Ontario government could consider changing from applying the complex cannabis excise tax system to a single excise tax method to all types of cannabis products, either utilizing the SO taxation based on total THC content to reduce the consumption of the high THC-concentration products, or the mixed ad valorem and specific taxation based on total THC content, with a high proportion of the specific tax, to reduce consumption of youth-friendly edible-type cannabis products in addition to reducing consumption of high THC products in general.

Adolescent substance use is common, though heterogeneous with respect to the substances used. School-based studies have used latent class analysis (LCA) to delineate patterns of adolescent substance use, though rarely in settings where non-medical cannabis is legal and using multilevel analytic frameworks to account for clustering of students within schools. This study used multilevel LCA to identify subgroups of high school students based on substance use patterns and correlates of subgroup membership in Ontario, Canada, where cannabis use is legal for adults ages 19 years and older. Data were from a representative sample of N = 7189 grades 9–12 students. Multilevel LCA with past-year use of alcohol, cannabis, nicotine, illegal drugs, and prescription drugs as latent class indicators identified no/low use (68.99

This study estimates the prevalence of co-use of alcohol and cannabis, assesses the sociodemographic risk factors of co-use, and examines the associations between mental health and heavy episodic drinking (HED) and alcohol–cannabis co-use in Canada during the early years of the COVID-19 pandemic. Nine successive cross-sectional surveys, held from May 2020 to January 2022, of adults (aged ≥18 years) living in Canada were pooled for 9011 participants. The prevalence of co-use was calculated across sociodemographic groups. Logistic regressions were used to assess associations. Alcohol–cannabis co-use was associated with a greater likelihood of engaging in HED and experiencing symptoms of anxiety, depression, and loneliness. The prevalence of co-use of alcohol was different across sociodemographic groups. The highest prevalence was among TGD people (35.5%), followed by individuals aged 18–39 years (14.5%). Additionally, being TGD (aOR = 3.61, 95% CI 2.09–6.25), separated/divorced/widowed (aOR = 1.60, 95% CI 1.23–2.07), living in an urban area (aOR = 1.26, 95% CI 1.07–1.56), and having a high household income (aOR = 1.41, 95% CI 1.09–1.82) increased the likelihood of reporting alcohol–cannabis co-use. These findings underscore the fact that developing public health and clinical interventions for preventing and treating excessive alcohol or cannabis use must consider both alcohol and cannabis use patterns and should be tailored to the highest-risk TGD and young adults.

INTRODUCTION:Although cannabis use has been historically higher in men than women, some research suggests a narrowing of the sex/gender gap in recent decades. We characterised trends in cannabis use patterns by sex/gender and examined trends in the sex/gender ratios of cannabis use patterns in Ontario, Canada. METHODS:Data were drawn from the Centre for Addiction and Mental Health Monitor Survey, a repeated, population-based, cross-sectional telephone survey of adults in Ontario, Canada (2001-2019). Participants provided self-reports of cannabis use during lifetime and cannabis use during the past 12 months. Male-to-female ratios of both outcomes in each year were calculated. Trends in these outcomes were analysed using join point regression. RESULTS:All outcomes increased among males and females between 2001 and 2019: cannabis use in lifetime (average annual percentage change [AAPC; 95% confidence interval]: 2.0 [0.6-3.3] and 2.9 [1.8-4.0], respectively) and cannabis use during past 12 months (3.5 [2.2-4.9] and 4.7 [2.8-6.6], respectively). The male-to-female ratio of cannabis use during lifetime decreased between 2001 and 2019 (AAPC [95% confidence interval]: -0.7, [-1.0 to -0.4]), unlike cannabis use during past 12 months (-0.5 [-1.8-0.7]). DISCUSSION AND CONCLUSIONS:Our findings suggest a narrowing of the sex/gender gap in cannabis use. Continued monitoring of the sex/gender gap is important to inform health promotion efforts and guide cannabis policy.

OBJECTIVES:In January of 2023, the provincial government of British Columbia, Canada, received federal approval to decriminalize the personal possession of certain illegal drugs. The policy had multiple aims, including a long-term goal of reducing drug-related overdoses by decreasing stigma associated with drug use and promoting health service and treatment engagement. In May of 2024, the policy was amended to recriminalize drug possession in public spaces. We evaluated the association between the implementation of British Columbia's drug decriminalization policy, including both the initial enactment and the May 2024 amendment, and opioid-related poisoning hospitalizations. STUDY DESIGN:We conducted interrupted time series analyses using quarterly data on opioid-related poisonings leading to hospitalization. METHODS:The study period spanned from the first quarter of 2016 to the third quarter of 2024, inclusively. Data were sourced from British Columbia and other Canadian provinces without decriminalization (excluding Quebec, Newfoundland and Labrador, and Prince Edward Island). Two intervention time points were assessed: January 31, 2023, marking the implementation of the initial decriminalization exemption, and May 7, 2024, when a substantial amendment to the exemption was enacted. Data were analyzed using generalized additive models. RESULTS:We found no association between the slope of opioid-related poisoning hospitalization rates associated with the original enactment of the decriminalization legislation, and also no associations with this indicator after the May 7th amendment either in level or slope. CONCLUSIONS:Our findings indicate that decriminalization was not associated with increases in opioid-related poisoning hospitalizations.

INTRODUCTION:Canada is in the midst of a crisis featuring drug poisonings. Decriminalisation of personal possession of select illegal drugs was implemented in British Columbia, Canada on 31 January 2023 as one element of a public health response to reduce drug-related harms. We evaluated the short-term impacts of decriminalisation on paramedic responses to opioid poisonings and drug poisoning deaths to detect if there were early signals of change. METHODS:We sourced population-based monthly counts of drug poisonings from the provincial emergency services provider and coroners service to compute total and sex-specific age-standardised rates per 100,000 (January 2015-December 2023 [97 months pre-decriminalisation and 11 months post-decriminalisation]). Generalised additive models in an interrupted time series design were used to evaluate the short-term impacts of decriminalisation on rates of paramedic responses to opioid poisonings and drug poisoning deaths. RESULTS:Decriminalisation was not associated with an immediate effect (β [95% confidence interval; CI] -0.078 [-0.318, 0.163]) or trend change (β [95% CI] -0.022 [-0.082, 0.037]) in the total rate of paramedic responses to opioid poisonings, nor was it associated with an immediate effect (β [95% CI] -0.165 [-0.477, 0.147]) or trend change (β [95% CI] -0.010 [-0.082, 0.062]) in the total rate of drug poisoning deaths. These findings were consistent after stratification by sex. DISCUSSION AND CONCLUSIONS:Decriminalisation of select illegal drugs was not associated with significant changes in drug poisonings in the first 11 months of its implementation. However, the direction of effects was encouraging from a public health standpoint.

OBJECTIVE:The opioid crisis remains an important public health concern, with nonmedical use of prescription opioids (NMUPO) playing a significant role. However, limited evidence exists on how adults engaging in NMUPO for subjective effects differ from those who use them for other nonmedical reasons. This study aims to identify and examine factors associated with engagement in NMUPO for subjective effects. METHOD:Data were from the 2020 to 2024 CAMH Monitor study, a repeated cross-sectional survey of adults age 18 and older (N = 7,655). The surveys used a Qualtrics-based web survey to assess NMUPO, sociodemographic factors, substance use, and mental health. Data were analyzed using multivariate multinomial logistic regression. RESULTS:About 3% of adults engaged in NMUPO for subjective effects/to get high, and 15% of participants engaged in NMUPO for other nonmedical purposes during 2020 and 2024. These percentages remained stable over the years. The risk of NMUPO for subjective effects, compared with NMUPO for other purposes, was significantly higher among Asian people compared with their White counterparts (relative risk ratio [RRR] = 1.80, 95% CI [1.08, 3.01]) and among those with children (RRR = 2.53, 95% CI [1.64, 3.92]). Similarly, individuals with low household income, current other substance use, and psychological distress exhibited a higher risk of NMUPO, after adjusting for covariates. CONCLUSIONS:Individuals who use prescription opioids nonmedically for subjective effects or other reasons differ by race/ethnicity, parental status, income, substance use, and level of psychological distress. These findings suggest the need for targeted prevention and intervention strategies to address the unique needs and behaviors of different user groups.

Opioid-related harms and deaths remain a persistent public health crisis across Ontario, Canada, with non-urban regions facing a disproportionate burden. However, discussions of opioid-related harms across Ontario’s geographic regions have provided an oversimplified assessment, contrasting rural and urban regions which mask the unique challenges and true disparities faced by sparsely populated communities, which are commonly located in the Northern regions. Our study aims to provide a more in depth understanding of the opioid crisis in Ontario across different geographic classifications in accordance to population size, such as rural, urban, and sparsely populated regions, presenting data in both absolute numbers and crude rates with contextual grounding of regional characteristics. A number of different opioid-related indicators such as hospitalizations, overdose rates, opioid service provision and harm reduction supply distribution were analyzed across all 34 of Ontario’s public health units (PHUs) to understand the differences in these indicators based on region across the province. The findings can inform the development of targeted interventions and improve service accessibility for those most affected by the overdose crisis in Ontario. Publicly-available secondary data for each PHU was collected from several provincial and national data sources and analyzed between November 2024 and January 2025. Annual data from 2022 to 2023 on opioid-related harms, opioid agonist treatment (OAT) prescribers and engagement, and the distribution of harm reduction supplies, as well as annual data from 2024 on opioid-inclusive service provision, were collected. Using Statistics Canada’s 2023 Health Region Peer Group Classification, the PHUS were grouped into four geographic classifications: sparsely populated, rural, urban/rural mix, and urban. Crude average rates were calculated for all indicators. Statistical analysis was performed to assess significance of indicators between regions. Sparsely populated PHUs were primarily located in Northern Ontario, while rural, urban/rural mix, and urban PHUs were mainly concentrated in Southern Ontario. Urban PHUs have the highest number and lowest rate of opioid-related harms (e.g. 947 opioid-related deaths, representing a rate of 12.5 per 100,000 population), while sparsely populated PHUs reflect the opposite trend (e.g. 158 opioid-related deaths, representing a rate of 44.2 per 100,000 population). A similar pattern emerges for harm reduction services and naloxone distribution. The number of treatment services is highest in rural PHUs (n = 237) and lowest in sparsely populated PHUs (n = 83), despite having the highest rate. OAT prescribers, OAT engagement, and needle distribution follow a similar trend. Statistical significance was found between geographic regions for most indicators, except opioid-inclusive support services, harm reduction services, and naloxone distribution. Sparsely populated and rural PHUs experience the highest burden of opioid-related harms, coupled with limitations in service accessibility, demonstrating a clear need for additional harm reduction services. Decision-makers may be misled into underestimating the crisis in non-urban areas as a result of oversimplified reporting, resulting in inadequate support for these regions. Addressing these disparities is key to reducing opioid-related mortality and ensuring equitable access to life-saving services across Ontario.

In January 2023, British Columbia (BC), Canada, piloted a three-year decriminalization policy to address the escalating overdose crisis. The policy seeks to reduce stigma and the fear of criminal prosecution, and foster a safer and more supportive environment, encouraging greater utilization of treatment and harm reduction (HR) services among people who use drugs. There are limited data on the operational characteristics of HR sites in BC, which are essential for monitoring how decriminalization may influence service operations and utilization. This study aimed to characterize HR site operations in BC and assess any operational changes following decriminalization. A cross-sectional, online self-report survey was distributed to HR sites across BC between March and April 2024. The survey was completed by a site representative, and survey questions focused on client demographics and drug use patterns, service uptake and capacity, resource and staffing demands, police activity near sites, and the availability of HR services. Changes pre-and post-decriminalization were analyzed descriptively to identify trends. A total of 33 HR sites completed the survey. Almost a third (30%) of sites reported an increase in client's post-decriminalization, and 18% indicated plans to expand or modify services to meet the increasing demand. However, challenges related to staffing and resources were highlighted, with 45% of sites reporting increased staffing demands post-decriminalization, and 33% noting changes to resource needs, most of which increased. Five sites reported an increase in annual operating budgets. Nearly half (43%) of sites that experienced police activity around their site reported increased police activity post-decriminalization. Moreover, approximately one-fifth (21%) of sites received formal decriminalization training. HR sites have experienced an increase in client engagement post-decriminalization, reporting challenges related to site capacity and funding, and emphasizing the need for additional investments to support and expand HR services. Consideration should be given to needs-based planning and providing decriminalization training to HR staff. Moreover, steps are necessary to address the continued police presence near sites, which may hinder service uptake and perpetuate stigma. Addressing these gaps is critical for improving health system engagement for people who use drugs and achieving the goals of decriminalization.

Aims To examine the price and tax structures of cannabis products sold in Ontario to inform the government on how to improve the policy on the cannabis tax base from a public health standpoint. Design Economic evaluations to assess price and tax structures of various cannabis products Setting Ontario Participants Data of cannabis products sold in Ontario regarding the Ontario Cannabis Store (OCS)’s buy and sell prices and product characteristics, including the product’s type, quantity per package, and quantity of THC and CBD. The OCS provided data on 2,601 units of cannabis products in March 2022. Measures Measures examined include the harmonized sales tax, the seller’s markup, the producer’s price, the flat-rate tax, ad valorem tax, effective excise tax, provincial adjustment tax, and excise tax per mg THC. The percentage of each tax compared to the retail price is also calculated. Findings A flat-rate tax of $1 per gm of 10% THC flower produces a tax of $0.01 per mg THC. Taxing cannabis products based on gm of dried flower results in high-THC products being taxed at a lower rate. Evidence showed that product categories with types and potencies that had lower taxes rates per mg THC imposed upon them had more product varieties. Conclusions The Ontario government should consider changing the tax base from the current one based on gm of flower to one based on mg of THC. Moreover, indexing the flat-rate tax to inflation is important to prevent the tax’s flat rate from becoming lower over time.

INTRODUCTION:British Columbia's (BC) three-year drug decriminalization policy-introduced in January 2023 and amended just over a year later in 2024-had multiple goals, including reducing drug use stigma, shifting perceptions of drug use from a criminal to a health issue, and improving health outcomes for people who use drugs. As part of the policy, the BC government was required to implement public education tools to raise awareness and build understanding of the policy. However, little is known about the scope or impact of these public education efforts or how the information environment shaped public perceptions and attitudes toward the policy. To address these gaps, this study examines: 1) how BC's decriminalization policy was communicated and represented across government and media sources, and 2) how exposure to these information sources influenced public support and perceptions of safety. METHODS:This mixed-methods study analyzed 98 government resources, 301 media articles, and a cross-sectional public opinion survey of 1200 BC residents. Content analyses of government resources and media articles examined government resource and media source intent, misinformation, misleading narratives, and perspectives, while the public opinion survey assessed information exposure, policy support, and perceived safety. RESULTS:Approximately one-quarter of all sources were government resources, and among those with publication dates, only 13 % were released prior to the policy's implementation and 9 % contained misinformation, representing a missed opportunity for expectation-setting and public education. In contrast, 34 % of media articles contained misinformation, commonly misrepresenting the policy's intent and linking decriminalization to increased crime, disorder, and public drug use. Survey findings showed no significant associations between specific information sources and outright opposition. However, respondents exposed to multiple information sources were significantly less likely to report a neutral stance compared to support (OR [95 % CI]: 0.31 [0.15-0.65]). Those accessing official/academic sources or multiple sources were also less likely to feel less safe (OR [95 % CI]: 0.22 [0.07-0.71] and 0.43 [0.24-0.78]). CONCLUSION:These findings highlight critical gaps in government communication and the dominance of misrepresentative media framing in shaping public attitudes. Effective drug policy requires not only legislative change but also proactive, coordinated, and sustained public education strategies to counter misinformation, reduce stigma, and build lasting support.

On January 31, 2023, Health Canada granted British Columbia (BC) a three-year (2023–2026) exemption under the Controlled Drugs and Substances Act (CDSA), decriminalizing the personal possession of up to 2.5 g of certain unregulated drugs among adults (18+) without arrest, seizure of drugs, or criminal penalty. A key objective was to increase awareness, engagement, and retention in harm reduction (HR) and opioid agonist treatment (OAT) services by reducing stigma and enhancing service access. In May 2024, however, the policy was amended to re-criminalize drug use and possession in public spaces. This study examines how decriminalization and its subsequent amendment affected HR and OAT service operations from the perspective of service providers across BC. Between October 23rd, 2024 and January 29th, 2025, 18 semi-structured virtual key informant interviews were conducted with HR and OAT service providers across BC. The interviews examined participants’ experiences with decriminalization and its amendment, and how these policy changes impacted service operations and delivery. Thematic analysis was used to identify patterns across interview data. Key informants reported few operational changes following decriminalization, with no major adjustments to service delivery. Despite expectations of increased client engagement, sites received no additional funding and faced ongoing staffing and resource shortages. Informants emphasized that systemic issues—such as the toxic drug supply and rising homelessness—had a greater impact on service use than the policy itself. A lack of clear communication and site-specific training resulted in uncertainty and confusion, further limiting frontline staff’s ability to respond effectively to policy changes. Key informants perceived that decriminalization did not lead to immediate changes in HR and OAT site operations. Longstanding systemic barriers continued to limit service capacity and policy impact. Providers highlighted the need for sustained investment in housing, staffing, and supervised spaces to support meaningful engagement and reduce stigma. Addressing these foundational issues was seen as essential for realizing the policy’s intended public health objectives.