In March 2024, Oregon lawmakers voted to recriminalize the simple possession of small amounts of opioids, heroin, fentanyl and other drugs, reversing Measure 110, the landmark 2020 voter initiative that had decriminalized personal possession in favor of a health-centered response. The reversal was sold as a necessary correction. Politicians, police unions and prohibitionists’ voices pointed to the rise in overdose deaths after Feb. 21, the date the law took effect, as proof that removing criminal penalties had unleashed disorder.
That story was powerful. It was also incomplete.
Oregon did experience visible public drug use, homelessness, open-air markets and heartbreaking overdose deaths. Communities had legitimate reasons to feel unsafe and abandoned. But the central question is not whether Oregon had a crisis. It did. The question is whether Measure 110 caused the overdose surge that followed. The best available evidence suggests it did not.
A 2023 JAMA Psychiatry study using synthetic control methods and National Vital Statistics System data found no evidence that Measure 110 in Oregon and a parallel policy change in Washington state increased fatal overdose rates during the first year after implementation. Overdose deaths were already rising before the law took effect, largely in line with regional fentanyl trends. Yet the political and media narrative hardened: decriminalization had failed, and recriminalization was the remedy.
A newer study published in Academia Global and Public Health in April 2026 reinforces that conclusion. Using CDC WONDER monthly mortality data from 2015 through 2023, the authors compared Oregon with neighboring California, Washington, Nevada and Idaho. Their changepoint analysis identified the most probable moment when overdose trends shifted. For Oregon, that moment was December 2019 — 14 months before Measure 110 was implemented. At that point, deaths increased sharply and shifted from a flat pattern to a steep monthly rise.
Neighboring states saw nearly identical breaks. Washington and California shifted in March 2020, Nevada in April 2020 and Idaho later in April 2021. No state showed a meaningful change in death rate at or after the February 2021 implementation date. A statistical analysis found that the post-2021 increase was regional, not uniquely Oregonian. Oregon was not spared from the fentanyl crisis, but the evidence does not show that decriminalization added measurable overdose harm.
This matters because public policy often turns on the simplest available story. Measure 110 was easy to blame because the timing appeared persuasive: decriminalization happened, then overdose deaths rose. But sequence is not causation. When the rise began before the law and unfolded similarly across neighboring states, the “failed experiment” narrative becomes harder to sustain.
None of this means Measure 110 was well-implemented. Oregon failed to build treatment access, methadone capacity, housing supports, crisis response and harm-reduction infrastructure quickly enough to match the scale of need. Decriminalization without a functioning care system leaves people visible but not necessarily helped. That is a serious failure of implementation. It is not the same as proving that criminal penalties would have saved lives.
The danger now is that recriminalization may satisfy a public demand for visible action while doing little to reduce overdose deaths.
The danger now is that recriminalization may satisfy a public demand for visible action while doing little to reduce overdose deaths. Returning vulnerable people to the justice system can bring its own harms: incarceration, lost employment, family separation, stigma and reduced access to care. If the underlying crisis is driven by untreated addiction, poverty, isolation, unstable housing and an illicit fentanyl supply of unprecedented lethality, then criminal penalties are unlikely to address its causes.
Oregon’s experience should not be used as a slogan for either side of the drug-policy debate. Public disorder is real. Community distress is real. Overdose deaths are real. But so is the need for understanding the cause of overdoses before reversing major health policy.
Measure 110 may have been flawed, underfunded and politically vulnerable. But the claim that it caused Oregon’s overdose surge is not supported by the strongest evidence available. The more honest conclusion is harder: Oregon faced a regional fentanyl crisis with inadequate treatment and public health infrastructure. Recriminalization may change the optics. It is far less clear that it will save lives.
Lynn R. Webster M.D. is an addiction medicine specialist and senior fellow at Center for U.S. Policy. He is co-author of “Deconstructing Toxic Narratives: Data, Disparities, and a New Path Forward in the Opioid Crisis.”
This article appears in July 15, 2026.