Oregon Decriminalized All Drugs To Stop Overdoses. Will It Work?

In 1973, Oregon became the first state to decriminalize marijuana use, setting in motion a movement that has unraveled much of the disastrous U.S. drug war—with far-reaching consequences.

Today, Oregon is once again at the vanguard of reform: In February, it enacted Measure 110, a law ending prison and jail sentences for all types of drug use and possession, whether it be cocaine, meth, heroin, or psychedelics.

In 2019, before this new law was passed in a statewide referendum, more than 4,000 people were convicted of drug possession in Oregon, and many more cut deals with prosecutors, allowing them to avoid a conviction in exchange for supervised probation and some rehab.

With the new law, not only does possession bring nothing more than a $100 ticket, defendants can get the fine dismissed if they place just one phone call to a drug abuse assessment hotline. So far, only 29 people ticketed for possession have placed that call, according to the nonprofit that runs the hotline.

"That's the downside, the lack of accountability built into the measure," says Mike Marshall, executive director of Oregon Recovers, which lobbies for more funding for addiction treatment and opposed Measure 110.

Marshall has a personal history with alcoholism and meth use and worries that the lack of drug treatment capacity in Oregon, which has the third-largest addiction problem in the nation but ranks 47th in addiction treatment access, will lead to more overdoses and deaths post-decriminalization.

"I'm worried about the person living on the street, in the tent, right outside this window who's smoking meth all day long," says Marshall. "We need to have a system of care to take care of them."

Marshall believes Oregon should've more closely followed the example of Portugal—the first country to decriminalize personal possession of all drugs. It spent two years building a more robust treatment system before decriminalization went into effect. Portugal also required those caught with drugs to appear before a special committee of doctors and addiction specialists.

Oregon's new law does require the state to allocate at least $57 million in its first year to establish a comprehensive substance abuse treatment system that offers immediate rehab. The state legislature awarded $20 million in grants to treatment providers in June and approved spending $302 million over the next two years on substance abuse treatment.

But the introduction of the synthetic opioid fentanyl into the black market has made street drug use deadlier than ever, with an estimated 36,000 nationwide deaths involving the drug in 2019 and increasing by as much as 38 percent with the onset of the pandemic, according to the Centers for Disease Control and Prevention (CDC).

Marshall says Oregon should have bolstered its treatment infrastructure before moving forward with decriminalization.

"The notion of criminalizing someone's addiction is terrible, particularly when we know that communities of color are disproportionately arrested for drugs and disproportionately impacted by the criminal justice system," says Marshall. "But how you do decriminalization is equally important. And that was the concern about [Measure 110]." 

But Haven Wheelock, who runs a needle exchange in Portland called Outside In, says delaying decriminalization would have been morally unacceptable.

"Anything we do is better than doing nothing, and we know the harms of criminalization are harming people on the regular," says Wheelock. "We know that these interactions between law enforcement and people who are using drugs can be deadly. And so for me, decriminalizing drugs is a priority in and of itself. Those harms are real. Those harms are happening today."

Monta Knudson, executive director of Bridges to Change, which helps drug offenders who've recently been released from jail or prison transition into housing and reintegrate into society, says that the new law will greatly expand treatment access. Bridges to Change is one of several nonprofits that will receive additional money through Measure 110, financed by cannabis taxes, to provide services to drug users before they enter the criminal justice system.

"We want to interrupt that prison [and] jail cycle and offer services instead," says Knudson.

As a former drug user, however, Knudson did find treatment through the criminal justice system. He struggled for years with a meth addiction and was arrested dozens of times. After a two-year prison stint for crimes related to his drug problem, he was released to a rehab program that provided the help he needed.

"Every time I was released from prison or jail, I always wanted to do the next right thing. I just didn't know how to do it," says Knudson.

But at that point, Knudson had spent a total of 10 years behind bars. He sees the criminal justice system as an overly blunt tool for getting drug addicts help and thinks Measure 110 will make it easier for others to avoid wasting so much of their lives behind bars by providing immediate access to treatment as opposed to going on a waitlist, which often happened before.

"The deeper my addiction grew, in those windows of time where I wanted and needed help, help wasn't to be found in a way that was accessible to me," says Janie Gullickson, executive director of a peer support group called the Mental Health & Addiction Association of Oregon. "[Treatment] finally was accessible in prison, which is backwards in my mind."

Gullickson overcame a meth addiction that began at age 15 and continued until she ended up in prison at age 36. As a chief petitioner for Measure 110, she agrees that there are better ways to get drug addicts treatment than through the criminal justice system.

"I did want treatment. And I had been in [prison] for a year before I was accepted into the [prison drug treatment program]," says Gullickson. "And, God, I wish this program would have been accessible to me before I wasn't able to raise my five kids."

When Portugal decriminalized drugs in 2001, the country saw treatment rates increase by 32 percent within the first eight years of enacting the policy.

Portugal's experience also belies the claim of drug warriors that decriminalization leads to more consumption.

In Portugal, drug use rates stayed about the same, and HIV rates decreased significantly since unsafe needle sharing is a source of spread.

But Marshall says he expects Oregon's results to be worse.

"If somebody down on the street on January 30 was using [illegal drugs], a cop saw them and so busted them for having drugs out in the open," says Marshall. "They ended up in jail. They then went to the court. So there was a week's period of time where their drug use was interrupted versus the cop now just walking right by or giving them a ticket and walking on by, and they continue to use drugs…the net effect of [the new law] is that [substance abusers] are using drugs more often in an unsafe environment. And so the overdose rates could go up."

In Portugal, overdose rates fell after decriminalization, before trending back up a few years later. But in Oregon, needle exchange providers are hopeful that the passage of the new law will allow them to experiment with new initiatives to drive down overdose rates significantly.

Clean needle exchanges like Wheelock's program reduce disease transmission. They also prevent fatal overdoses because they distribute naloxone, an opioid-overdose antidote. Further, several studies have shown that needle exchanges help connect drug users with substance abuse treatment programs.

"We regularly have clients come in and be like, 'Haven, I hate using drugs,'" says Wheelock. "And then the next question is, 'Okay, what's next? Like, what are we going to do?'…And just having that nonjudgemental, open, curious community of people ready to answer questions and be really honest and transparent really helps build trust, build therapeutic relationships, build hope for people who are using drugs."

Wheelock also hopes the new law will allow her to expand beyond needle exchanges and into safe consumption spaces, where users can go to have their drugs checked for adulterants like fentanyl and be around workers who can help prevent overdoses.

Vancouver has such a site, and there's also one operating in the United States that doesn't have government approval. A five-year study of that facility published in The New England Journal of Medicine found that with more than 10,000 injections, there were 33 overdoses, none of them fatal or requiring hospitalization.

Safe consumption sites may also help to bring the outdoor drug use and many of the associated problems rampant on the streets and sidewalks of Portland under a roof, says Wheelock.

"No one wants to see someone using [drugs] on their front porch or in the doorway, and those people that are using there also don't want to be seen," says Wheelock. "If they had a place where they could do that in a safer manner, people would."

While Oregon is the first state in the nation to decriminalize all drugs, following Portugal's example as first in the world, neither go so far as to legalize drug sales, leaving a black market and the crime, violence, and danger associated with it fully intact.

Vancouver began trying to mitigate this problem in 2020 by allowing some of its safe consumption sites to dispense clean opioids to drug users so that they no longer have to risk overdosing on street drugs.

There are also recreational drug users who don't have a substance abuse problem. A 2018 meta-analysis of three major national drug use surveys found that 74 percent of those who've used heroin at least once don't ever become dependent, yet under Oregon's system, they can be issued a fine and be compelled to be evaluated for a substance abuse problem.

"There [will] always be folks that are entering the addiction system that might not need treatment and might not want treatment," says Knudson. "And to be honest, if they're not causing community harm, then why should they?…I do think those people are few and far between, and that having a system that provides treatment services is the best way to go because those folks will have access to the care."

And while Oregon's 1973 marijuana decriminalization was decades ahead of its time, proponents believe that if the state succeeds now, the wave of complete drug decriminalization will spread across the entire country much sooner.

"Nothing launches perfectly," says Gullickson. "So what are the lessons other states can learn in five years? I would hope maybe our neighbors…Washington, Colorado…are able to follow suit and do what's right for their communities in their states."

Wheelock says that even if Oregon's decriminalization gets off to a bumpy start, in no small part because the pandemic has exacerbated substance abuse problems nationwide, that Oregon voters have made the right choice.

"I think we're going to see systems improve. I think we're going to see people have access to care that they currently don't have access to. I think we're going to see less people getting saddled with convictions that harm them for the rest of their lives. And to me, all of that is a win," says Wheelock.

Produced by Zach Weissmueller; camera by John Osterhoudt; additional b-roll by Mark McDaniel and Jim Epstein

Photos: David Tesinsky/ZUMA Press/Newscom; Luis Nunes/Sipa USA/Newscom; Tommaso Salvia/Newscom;  Governor Tom Wolf Flickr; Teun Voeten/Sipa USA/Newscom