Decriminalizing drugs in Oregon and Washington isn't associated with overdose increases, study finds

In 2020, Oregon voters passed Measure 110, a law decriminalizing the possession of small amounts of controlled substances like cocaine, heroin and methamphetamine. The measure, which passed with 58 percent of the vote, was praised as a "historic, paradigm-shifting win" that could serve as a model for the rest of the country, but it wasn't long before the decriminalization was blamed for a rise in overdose deaths. The legislation has been called a "disaster" and a "botched" job with a "troubled start."

"To judge by the catastrophe unfolding in Oregon, I'd think twice before replicating this reckless experiment elsewhere," wrote New York Times opinion writer Bret Stephens.

Meanwhile, Oregon's northern neighbor Washington overturned a court case in 2021 that also significantly reduced the criminalization of drug possession. The state's Supreme Court, ruling on the so-called "Blake decision," declared Washington's main drug possession statute unconstitutional and "void."

Between 2020 and 2021, overdose deaths did increase in Oregon and Washington with some apparent missteps in the rollout of decriminalization programs: An audit of Oregon's program released in January 2023 found the legislation was vague in dictating how it would actually connect people using drugs to recovery and struggled to get grants secured for harm reduction efforts. By April 2023, more than 60% of Oregonians blamed Measure 110 for increasing homelessness and drug use. 

Still, the audit said it was "too early to tell" the full extent of the initiative's impacts, and a new study published today paints a different picture of how the overdose crisis in these states has played out in recent years. Writing in JAMA Psychiatry, researchers compared the rate of fatal overdoses in both states to a comparison group of matched states with similar characteristics and found no significant difference in the rate of overdoses between the two groups after decriminalization policies took effect.

"What we found is that both in Oregon and in Washington, if you're looking at overall trends, there seems to be an increase in overdose death rates," said study author Spruha Joshi, Ph.D., a social epidemiologist studying the overdose crisis at the University of Michigan. "But this increase in death rates is not due to the policy changes."

Furthermore, these increases were minor to begin with, described as "not statistically significant" in the study. In nearby states that didn't enact decriminalization policies, overdose deaths were comparable. While overdose deaths spiked 66% in Washington between 2019 and 2021, for example, overdose deaths rose 55% in Nevada between 2019 and 2020.

Measure 110, officially known as the Drug Addiction Treatment and Recovery Act, was modeled in some ways after Portugal's decriminalization policy, enacted in 2001. People found to be in the possession of drugs are charged a $100 fine, which can be avoided if they agree to call a treatment referral hotline. In Washington, drugs were recriminalized in later legislation, though the new law reclassified most drug possession crimes from felonies to misdemeanors.

In Oregon, it was estimated that Measure 110 could prevent thousands of people from being charged with felonies, reduce racial disparities in arrests and decrease drug overdose deaths by treating substance use as a public health problem rather than something to be handled by the police. Similarly, the legislation that somewhat decriminalized drug possession in Washington was enacted to redirect people using drugs to treatment facilities rather than prisons.

In one qualitative study published in 2022, researchers interviewed Oregon residents who used drugs and many reported not calling the police when a friend overdosed because they were afraid of getting arrested. Being arrested for drug crimes has been shown to increase the risk of death by an overdose, with that risk increasing with each arrest.

"I don't say [overdose]," one study participant said about calling emergency services. "I'm saying, 'Someone's having a hard time breathing. Someone's having complications.' Because if you say 'overdose,' then they have to notify the police because the police are there to 'protect' the fire department/EMTs."

The criminalization of drug use disproportionately impacts Black, brown and Indigenous communities who are already overpoliced, said Fernando Peña, the Operation Director at the Northwest Instituto Latino De Addicciones in Oregon.

"Black and brown communities are underserved," Peña told Salon in a phone interview. "They are overcharged when they are being arrested and arraigned. They get more charges and they get less frequent referrals to diversion or mandated treatment services."

In Oregon, Measure 110 uses cannabis tax revenue to fund harm reduction programs, while Washington's new legislation requires police officers to refer people using drugs to recovery at least twice before they are arrested. In a recent study, some 650,000 Oregonians were found to be untreated for substance use disorder in 2020.

Peña said Measure 110 is expanding access to recovery services for thousands of people, and especially historically underserved communities. It has taken decades of neglect and mismanagement to get to this point in the opioid overdose crisis, and it's unrealistic to assume that will be fixed in such a short time period, he said.

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"We can just keep making it better," Peña said. "That takes time, strategic planning, leadership and investment. Measure 110 began a process that can hopefully go on to make generational systemic change." 

However, some have been critical of the program, which has struggled to get off the ground. The majority of the $287 million dedicated to harm reduction programs in Oregon was delayed and not distributed until 2022, according to the JAMA Psychiatry study. In the first 15 months after the hotline intended to redirect people toward recovery services began, it received 119 calls that cost the state $7,000 each. Ultimately, the program's manager resigned due to a lack of support.

Many critics and supporters of Measure 110 alike both thought the legislation would impact overdose deaths one way or the other, said study author Haven Wheelock, who is also Outside In's drug users health services program supervisor. The lack of an association found in this study could be explained by the fact that the study took place before much of the funding for harm reduction programs had been dispersed, the authors noted. It also took place during the COVID-19 pandemic, which was associated with increased rates of substance use across the country.

At the same time, the West Coast is also experiencing unprecedented amounts of fentanyl in the drug supply, with overdoses from synthetic drugs like fentanyl increasing 84% between 2020 and 2021. Synthetic fentanyl, which is 50 times more potent than heroin, was responsible for two-thirds of overdose deaths nationwide in 2022. Meanwhile, stimulants are playing a greater role in overdose deaths, with some describing these shifts as a "fourth wave" of the crisis. Some blame the U.S. War on Drugs, which increased the criminalization of drug use, for these changes in the drug supply in the first place. 

"It's really easy to want to blame something new and novel for an issue, but we are seeing these [overdoses] increase everywhere," Wheelock told Salon in a phone interview. "People want an easy why. With all things related to poverty, all things related to addiction, it is a much more complicated issue than any one given policy or intervention."

Overdose deaths aren't the only data point that can be monitored to track the effects of decriminalization, Joshi said. One study showed decriminalization has reduced drug-related arrests in Oregon, especially among people of color. Data from the Oregon Health Authority shows marked increases in people seeking treatment, housing services and employment. The Centers for Disease Control and Prevention (CDC) reported a significant decrease in non-fatal overdoses between 2021 and 2022 in Oregon.

Still, earlier this month, voters submitted a ballot measure to the Secretary of State's office that could recriminalize drug possession if it is accepted. 

"I feel like it is shortsighted, that going back to the status quo, which wasn't working, which isn't working in cities similar to Portland across the country, and is not going to get us to the solutions," Wheelock said. "We really need to switch our thinking from a punitive approach to a healthcare-based approach."