More than two-thirds of Vancouver residents recently voted in favor of two plebiscite questions to crack down on public drug use and call on the province of British Columbia to convert an existing medical center into a treatment facility. These votes sent a clear message about the general public’s desire for the city to take a new direction in addressing the drug crisis.

The first question asked, “Are you in favour of the City of Vancouver strengthening its laws to forbid open-air hard drug (Heroin, Meth, Fentanyl, and Crack) use in public spaces?” It passed with 68.6% (137,178 of 200,058) of the vote.

The second question asked, “Should the City of Vancouver formally ask the Province of BC to convert portions of the old St. Paul’s Hospital, or another similar site, into a secure medical facility that provides acute voluntary and 100-plus involuntary care beds for individuals posing a serious risk to themselves or others due to severe substance use and mental health disorders?” It passed with 68.0% (135,509 of 199,231) of the vote.

Unlike many ballot measures in the United States, the two votes in Vancouver are non-binding, instead serving as an official measure of public opinion. The two measures were championed by Mayor Ken Sim, who lost re-election.

The results are striking, given Vancouver’s history with progressive drug policy reform. The province of British Columbia implemented a three-year pilot program to decriminalize the possession of all drugs in 2023, which was not renewed in 2026. Kevin Sabet, the head of the Foundation for Drug Policy Solutions, said, “Vancouver has had enough,” calling the city in British Columbia “ground zero for drug decriminalization.”

A report released prior to the vote by the Policy Roundtable On Substance Prevention, Education, and Recovery (PROSPER) summarized a range of drug-related outcomes in Vancouver, helping to explain why more than two-thirds of voters supported both questions. Key findings from the report include:

• The 2024 Harm Reduction Client Survey, conducted at harm reduction sites by the British Columbia Centre for Disease Control, found that 85.7% of respondents said that they used substances in public places (e.g., parks and sidewalks) at least once in the past 30 days.
• In 2025, 21% of the overdose deaths in British Columbia occurred outside, up from 19% in 2024 and 19% in 2023.
• Between the first half of 2025 and the first half of 2026, the number of violent crimes in Vancouver increased 6.0% from 2,616 to 2,774.
• In response to questions about the province’s existing Red Fish Healing Centre, Josie Osborne, who is British Columbia’s Minister of Health, said, “The program, it’s fair to say, consistently receives more referrals than it can admit annually, and it’s consistently full.”
• Osborne also stated that 95 clients were on the 105-bed facility’s wait list as of December 31, 2025. The average wait time to admission for clients admitted in 2025 was 97.9 days, an increase from 70 days during the 2023–2024 fiscal year.

PROSPER concluded, “if the City and Province can work together, both questions have the potential to improve public service capacity, which would contribute to a virtuous loop that would serve to improve public health and public safety.”

Although it remains to be seen whether the two questions will translate into substantive policy reforms, they illustrate how the residents of Vancouver no longer support permissive drug policies and are demanding change.