A qualitative study of the impacts of a government crackdown against revenue sharing between pharmacies and patients in Vancouver, Canada.

Background: The city of Vancouver, Canada has been under a public health emergency driven by the unregulated toxic drug supply since April 2016. Interventions implemented during the crisis have often been driven by electoral interests, and in turn, temporary in nature. Sunsetting of these pilot interventions has the potential to cause acute instability in people's lives. We examine an abrupt government crackdown on revenue sharing between pharmacies and their patients in early 2024. Methods: Our qualitative semi-structured interviews ( Results: Our findings indicate that participants felt an overall loss of trust in the healthcare system, and faced potential exposure to violence, including due to increased engagement with the unregulated drug market after a substantial loss of income. Participants pointed to drug user-led groups and relationships with their pharmacists as stabilizing forces in their lives during this time period. Conclusion: This study explores the perspectives of people impacted by one unilateral policy shift, and traces some public health cautions that should be considered during time-limited or sudden changes to public health interventions and policies, particularly health-related programming amid a toxic drug supply emergency. Findings also point to possible protective factors, such as scaling up peer-to-peer groups, during periods when interventions come to an abrupt end.