Don't Blame Decriminalization for Oregon Drug Deaths

Oregon lawmakers recently voted to recriminalize drugs after voters approved landmark reforms in 2020.

In March, Oregon legislators overwhelmingly approved recriminalization of low-level drug possession, reversing a landmark reform that voters endorsed in 2020. Although critics of that ballot initiative, Measure 110, cited escalating drug-related deaths as a reason to reinstate criminal penalties, there is little evidence that decriminalization contributed to that problem.

Deaths involving opioids have been rising nationwide for more than two decades. That trend was accelerated by the emergence of illicit fentanyl as a heroin booster and substitute, a development that hit Western states after it was apparent in other parts of the country.

"Overdose mortality rates started climbing in [the] Northeast, South, and Midwest in 2014 as the percent of deaths related to fentanyl increased," RTI International epidemiologist Alex Kral noted at a January conference in Salem, Oregon. "Overdose mortality rates in Western states did not start rising until 2020, during COVID and a year after the introduction of fentanyl."

That lag explains why Oregon saw a sharper rise in opioid-related deaths than most of the country after 2019. But so did California, Nevada, and Washington, neighboring states where drug possession remained a crime.

"After adjusting for the rapid escalation of fentanyl," Brown University public health researcher Brandon del Pozo reported at the Salem conference, "analysis found no association between [Measure 110] and fatal drug overdose rates." Kral concurred, saying "there is no evidence that increases in overdose mortality in Oregon are due to" decriminalization. That conclusion is consistent with the results of a 2023 JAMA Psychiatry study, which found "no evidence" that Measure 110 was "associated with changes in fatal drug overdose rates" during the year after decriminalization took effect in February 2021.

The expectation that decriminalization would boost overdose deaths hinges on the assumption that it encourages drug use. Yet an RTI International study of 468 drug users in eight Oregon counties found that just 1.5 percent of them had begun using drugs since Measure 110 took effect. And contrary to the claim that decriminalization attracted hordes of drug users to the state, the subjects' median length of residence in Oregon was 24 years.

Because Measure 110 did not address the iffy quality and unpredictable potency of illegal drugs, it is not surprising that overdoses continued to rise. Those problems are created by drug prohibition and exacerbated by efforts to enforce it.

The government's crackdown on pain pills pushed nonmedical users toward more dangerous substitutes, replacing legally produced, reliably dosed pharmaceuticals with products of uncertain provenance and composition. Worse, the crackdown coincided with the rise of illicit fentanyl, which is much more potent than heroin and therefore made safe dosing even trickier.

That phenomenon also was driven by prohibition, which favors highly potent drugs that are easier to conceal and smuggle. Treating drug users as criminals compounds the harm caused by prohibition while ignoring the perverse impact of existing policies.