In November 2020, facing a record-breaking overdose crisis, voters in Oregon decided to take a chance on a novel approach to drug use in this country. That fall, voters overwhelmingly approved a measure to decriminalize possessing small amounts of some controlled substances, including heroin, cocaine, and methamphetamine. This ballot initiative, known as “Measure 110,” went into effect in early 2021. It reclassified personal drug possession from a misdemeanor to a lower-level violation and set up a “Drug Treatment and Recovery Services Fund” to create new addiction recovery centers. By replacing low-level drug arrests with more humane and health-oriented approaches, such as citations and referrals to services, Oregonians began to undo the harms caused by over 50 years of a failed War on Drugs.
As the first state in the nation to decriminalize so-called “hard drugs,” Oregon’s new policy takes a historic step toward treating drug use as a health issue rather than a criminal issue. The passage of Measure 110 was the culmination of years of efforts to show Oregonians and people across the country that the harms of incarceration can compound on, exacerbate, and—in some cases—exceed the harms caused by drug use itself. In recent years, progressives and conservatives alike began to embrace this perspective. For instance, President Trump’s First Step Act took some steps to reduce harsh drug-related penalties at the federal level. At the time, Senator Ted Cruz said that “mandatory minimums for nonviolent drug offenders produce injustices,” and the bill was supported by 38 attorneys general. This followed similar steps that states were taking—South Carolina adjusted its penalties for low-level drug offenses in 2010, and Louisiana took a similar step in 2018. That same year, Pennsylvania passed a bipartisan bill to wipe low-level offenses from people’s criminal records.
Yet if you recently took a look at the pages of The New York Times or The Atlantic, it would be easy to conclude that Oregon’s experiment with decriminalization has failed. These narratives blame decriminalization for accelerating the overdose crisis and normalizing public drug use—leading to more deaths and more public disorder. After less than three years, incarceration is once again being proposed by elected officials as a solution to deal with drug use.
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The reality is far more complex, of course. Decriminalization is an evidence-based policy that is being implemented at time when the United States is facing multiple complex social and economic challenges. The implementation of Oregon’s decriminalization measure coincided with both the emergence of fentanyl in local drug supplies and the height of the Covid-19 pandemic—a combination that has led to over 100,000 deaths annually nationwide. With such a challenging backdrop, the appearance of failure provides a convenient narrative for those who wish to return to the status quo. But the data tells a different story.
Let’s start with overdose deaths. It is true that overdose rates have increased significantly in Oregon in recent years. From March 2022 to March 2023 (the most recently available CDC data), Oregon saw an estimated 20 percent increase in overdose deaths based on CDC predictions. This is a sizable increase, and detractors have been quick to attribute this rise in deaths to Measure 110. But that’s a flawed conclusion. Oregon’s increase in overdose deaths is comparable to that of neighboring states without decriminalization measures; in the same time period, estimated overdose rates increased by 19 percent in Nevada and by a staggering 28 percent in Washington State. The data show us that overdose rates are currently surging in the West and that this surge is not specific to Oregon alone or associated with the implementation of its decriminalization measure.
While overdoses may not have declined with decriminalization, incarceration rates have dropped from pre-pandemic highs, and we know that incarceration and overdose deaths are closely linked. Extensive previous research has shown that release from incarceration is a major risk factor for overdose death. A recent study found that among those recently released from prison, overdose risk is nearly 10 times higher than among the general population. Past studies, like one that looked at people incarcerated in North Carolina, have found the risk to be as high as 40 times greater than in the general population. By diverting people who use drugs from prisons and jails, Oregon has greatly reduced the risk of overdose among those who are most vulnerable. For this reason, overdose deaths may have climbed even higher without decriminalization.
Critics may contend that the failures of this policy go beyond overdose death rates—that decriminalization is to blame for increased crime and disorder. In his column for The New York Times, Brett Stephens quotes a businesswoman who says she’s seen oral sex being performed in public and a police officer who says that he has seen people shooting up drugs on playgrounds. Indeed, police officers have made multiple statements over the past year decrying decriminalization and claiming that it contributes to crime. Sgt. Matt Ferguson, a leader of the Special Investigations Unit of the Multnomah County Sheriff’s Office, told KGW8 that drug dealing, specifically of fentanyl, is up and that Measure 110 “has everything to do with it.” A Portland State University study found that police officers across the state think that the measure has been a failure.
But statistics tell another story. One study led by researchers at RTI International looked at 911 calls in Portland after decriminalization and found that there was no increase in crime, and a recent analysis using FBI data found that, from 2021 to 2022, violent crime and property crime both declined in Oregon. These statistics paint a picture of steady, unchanged crime rates in Portland following decriminalization and a downward trend in crime rates statewide.
That’s not to say Oregon isn’t facing real problems or frustrations. A recent poll conducted by the Portland-based firm DHM research shows that a significant amount of Oregonians polled think that crime, addiction, and homelessness have worsened because of Measure 110. One reason people may feel that crime and disorder are rising is the increased visibility of public drug use, due to homelessness. As others have pointed out, the state’s ongoing housing crisis forces drug use out into the open, effectively relocating a problem that was previously behind closed doors, in the privacy of homes, to the streets and other public settings. Indeed, Oregon has seen a massive increase in its unhoused population, which has risen 63 percent over the last six years. More than 18,000 people are currently unhoused, but there are only around 5,200 shelter beds in the state. A national model known as Housing First may effectively reduce public drug use. Once again, Oregon does not face unique challenges; nationally, the rates of chronic homelessness are rising, and officials in Washington State have cited increases in public drug use.
There are also real barriers to treatment in Oregon. One study from 2020 conducted by the federal government found that Oregon had the highest rates of methamphetamine and prescription opioid use but ranked last in the country in having accessible treatment. Measure 110 has taken steps to address this problem, approving more than $300 million in funding to harm reduction, treatment, and supportive housing programs, among other services. But the state of Oregon estimates that through September 2022, well over a year after Measure 110 was implemented, there were high rates of unmet treatment need and significant statewide gaps in available treatment and harm reduction services.
While news articles are filled with anecdotes from police about people who are offered resources and refuse to make use of them, the data has shown an increase in uptake of treatment services. Oregon’s Health Authority has reported a 44 percent increase in people seeking treatment and a 115 percent increase in people being screened within a span of a few months in 2022. This is in addition to a 144 percent increase in people receiving housing services and a 190 percent increase in people receiving supportive employment services.
It is also important to note that the issue of drug treatment cannot be divorced from broader issues with the health care system at large. Oregon still has a lack of treatment beds available at inpatient facilities and though there is disagreement about whether the language about services’ needing to be “low barrier” in Measure 110 restricts money to treatment providers—and widespread agreement that more money is needed. As O’Nesha Cochran, a chair for the Measure 110 Oversight & Accountability Council, told KGW8, inpatient facilities require a substantial amount of start-up costs, and existing grants are not sufficient to completely fund new inpatient centers. “When people think of $300 million they say, ‘Well [that’s] a lot of money.’ But not when you’re splitting it with the entire state of Oregon,” she told KGW8.
Measure 110 provides grants to organizations (including those that provide inpatient treatment) but it cannot fund services that are already billable to insurance. Cochran notes that these aren’t necessarily designed to address the full budgetary needs of these organizations, including unexpected costs. And as Morgan Godvin, another member of the accountability council adds, harm reduction and peer outreach organizations are still underfunded and are not able to bill insurance or Medicaid for these services.
Portugal is often referenced as a model for decriminalization, and indeed, for years prior to and after decriminalizing drugs, the country focused on increasing its capacity for treatment services. Since decriminalization was implemented, drug use and overdoses have remained below the EU average in Portugal. Still, the United States faces a variety of challenges—some different and more severe than what Portugal faces—that make a comparison between the two difficult. For instance, fentanyl is not prevalent in Europe’s drug supply at the moment. Given the existing challenges that Oregon faces, from its growing population of people who are unhoused to its increasingly potent drug supply, the steps Oregon has taken under Measure 110 are laudable—but of course, more needs to be done by all levels of government. This interim funding will not fill the gaps caused by societal failures overnight.
Of course, the rollout of Measure 110 could have been handled better. There were delays in funding being allocated and dispersed; most recently, the manager of the Measure 110 program resigned citing a lack of institutional support from the Oregon Health Authority for the program. In a scathing letter, Angela Carter alleged that the OHA leadership “made a concerted effort to undermine the program in any way it can.”
But the debate happening nationally about Measure 110 is not about the program’s implementation or management. At the heart of this debate is whether drug use should be considered a crime. That is, whether someone using drugs in public constitutes such a violation to the peace that they must be incarcerated or forced to stop through other coercive means. Critics of decriminalization assume that those who use drugs have no desire to stop using and that the only effective way to cease drug use is through the threat of prison. But more than 50 years of punitive drug policy have failed to stop drug use and overdoses (if anything, overdose deaths have only increased over the past two decades) and has subjected people to further harm in the form of psychological trauma, lost employment and housing and voting rights, feeding a cycle that damages communities and sends people back into prison—primarily, people of color. This debate, it seems, is not about the best approach to keep people alive, but rather how to maintain systems that perpetuate structural racism, systemic forms of oppression, and remove people who use drugs from the public eye.
We can’t talk about the War on Drugs without talking about its disproportionate impact on communities of color, and Oregon is no exception. A report released by the state in 2016 found significant racial disparities in drug conviction rates—with African Americans having double the rate of convictions for possession of methamphetamine, heroin, and cocaine statewide. In order to pursue racial justice, decriminalization is a necessary step, and already, Measure 110 has had a demonstrable impact in reducing drug-related arrests.
Faced with a crisis and inadequate solutions, the people of Oregon decided to conduct a bold experiment, while many other states remain committed to a failed and cyclic strategy of incarceration. Oregon is not alone; many states are dealing with similar problems—it is just that Oregonians refused to perpetuate further harm under the guise of tackling them. Federal and state partners should be coming together to support, enhance, and strengthen decriminalization, not just in Oregon but across the country.
The War on Drugs has been lost, but the path to repair has just begun. Let’s not sabotage progress by indicting decriminalization for the failures of the drug war.
