Health experts say Oregon should stay the course on decriminalization, drug treatment programs
A core tenet of Measure 110 — the ballot measure Oregon voters passed decriminalizing possession of small amounts of drugs — is using cannabis tax dollars for long-term investments in drug treatment programs.
Just one year after the first round of funding ended, the state's approach to addiction hangs in the balance.
As opponents embark on a mission to tweak the law and, in some cases, recriminalize drug possession, advocates say reverting to drug war policies of the past will cause harm to marginalized communities while simultaneously failing to address the state's part in the national drug addiction epidemic.
Since passing with 58% of the vote statewide in 2020, Measure 110 has waned in popularity, though it has shown progress in addressing some of the issues that made it popular, including narrowing the gap on racial disparities in drug possession arrests. The disproportionately high rate of Black Oregonians arrested for drug possession decreased by 77% since the law took effect in 2021, though some racial disparities in enforcement remain.
Regardless, a spring survey conducted by DHM Research found 63% of Oregonians support bringing back criminal penalties for drug possession while continuing to use cannabis taxes to fund drug treatment programs.
Lost in the political fray is the reality of a 15-month lag between decriminalization and funding for treatment infrastructure, despite the lack of such infrastructure being a core critique for opponents. While possession of small amounts of drugs was decriminalized Feb. 1, 2021, the state didn’t begin dispersing funds for treatment until May 2022.
Max Williams, Coalition to Fix and Improve Measure 110 founder, points to an as-yet inadequate number of treatment centers as a need for altering Measure 110. The group started working together over the summer, Williams said.
“The people who pushed Measure 110 forward decided that the first thing we should do is decriminalize before any of that potential infrastructure might be built,” Williams, who officially founded the group in September, said.
Advocates, for their part, don't totally disagree with Williams’ characterization of the problem. However, just a year removed from the end of the first round of Measure 110 treatment funding, they argue early successes are evidence the fledgling system is already making a difference, and the public should give it room to grow rather than uproot it in its infancy.
Shannon Jones, Oregon Change Clinic co-founder and CEO, opened the clinic February 2021 as a Monday through Friday, closed-on-holidays outpatient treatment facility working with veterans and people of color. The clinic is an example of what advocates say is evidence Measure 110, now codified as Oregon Senate Bill 755, is beginning to make positive differences in Oregon’s addiction treatment infrastructure.
Through her work, Jones quickly pinpointed a significant barrier to success: people in the program experienced inconsistency with treatment largely because they first needed housing to help them succeed. Often, people slept in an adjoining parking lot, waiting for the clinic to open and hoping for a meal.
"The treatment outcomes were really low," Jones said. "People needed a place to live."
The clinic started housing people in four different motels around town to address the issue. New challenges arose as people in treatment found themselves living in rent-by-the-hour motels, commonly seeing drug deals and drug use.
"It was difficult for people in treatment," Jones said.
Oregon Change Clinic started leasing the Sixth Avenue Motel to provide housing for patients, but the motel was run down and needed an upgrade. By September 2022, the clinic received Measure 110 funding to take over the motel and pay for necessary renovations. Oregon Change Clinic now provides intensive outpatient treatment with housing for people participating in its six-month program.
“There’s trust that’s looking to be built moment by moment by moment. That’s how people can begin some of the healing process. So, you’re trying to get into a trusting space.”
— Shannon Jones, Oregon Change Clinic co-founder and CEO
The clinic fits neatly within lawmakers’ vision when the Oregon Senate codified Senate Bill 755, creating Behavioral Health Resource Networks, or BHRNs, supporting people with substance use disorders. The bill requires all treatment centers be evidence-informed, trauma-informed, patient-centered, nonjudgmental and centered on harm reduction principles.
The Oregon Change Clinic is a culturally specific service provider. Across a diverse range of people in counties across the state, the Oregon addiction and recovery bill explicitly requires service centers to be culturally responsive and prioritizes community-based nonprofits within each service area.
"There's something about being in a space where you believe people get you, right?" Jones said.
Whether a space for women, people of a particular age group or LGBTQIA+ people, for example, Jones said when people are in a space where they feel like others understand them, they feel a sense of safety.
"There's trust that's looking to be built moment by moment by moment," Jones said. "That's how people can begin some of the healing process. So, you're trying to get into a trusting space."
With its goal of removing barriers to success and bolstering substance use treatment, Measure 110 prioritizes grants for community-based service programs within each service area, according to language in the bill. Culturally responsive treatment also fits within the criteria of evidence-based treatment, as marginalized groups are typically overrepresented in overdose rates.
The most recent National Center for Health Statistics report on overdose death rates, 2019–2020, shows Black Americans experienced the most significant percentage increase in overdoses in the United States that year, from 24.8% to 35.8%.
Impact
Nationally, people of all racial demographics use drugs at roughly the same rate, aside from Asian Americans, who use drugs substantially less than any other racial demographic, according to CDC data from 2002–2019. However, the impacts of enforcement are not equal across racial demographics.
Oregon law enforcement arrests or cites Black Oregonians for drug possession at nearly twice the rate corresponding with their population share. Black Oregonians face 4.2% of all Class-E violations — the new misdemeanor classification for drug offenses created by Measure 110 — despite making up just 2.3% of the population, according to Oregon Judicial Department statistics.
That disparity exists beyond Oregon. Nationally, Black Americans make up 26% of all drug-related arrests despite being 13% of the population, according to the Health Justice Recovery Alliance.
Statistically and anecdotally, Measure 110 has made headway in addressing the issues that prompted its passage, but by the time the state’s Measure 110 Oversight and Accountability Council, or OAC, started dispersing funding to service providers in May 2022, the train to repeal or significantly alter the law had left the station.
During the 15-month gap between decriminalization and the state dispersing the first funds to BHRNs, public criticism mounted, calling to recriminalize possession and replace voluntary addiction treatment with required treatment. The Coalition to Fix and Improve Measure 110 announced it filed paperwork in September 2023 for a ballot initiative to appear on the November 2024 ballot to achieve its goals, devising a narrative in which Measure 110 is the cause of an increase in overdoses since its passage.
"Since then, addiction and overdoses skyrocketed, open-air drug use is out of control, and drug-related crimes are rising," the initiative said. "It's clear Measure 110 is not working as promised."
Drug overdoses have risen consistently over the past decade in Oregon and in the United States. However, there’s currently no evidence linking Measure 110’s implementation to increases in addiction or overdoses in Oregon, as the rates climbed during the COVID-19 pandemic. Oregon’s overdose rate climbed from 18.7 per 100,000 people in 2020 to 26.8 in 2021 — a stark increase, yet slower than national trends. To the contrary, a recent study published by researchers at Grossman School of Medicine at New York University shows decriminalization did not contribute to increased overdose deaths in Oregon and Washington in the first year after implementation.
"This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates," the study concluded.
The study noted people who use drugs are often more reluctant to call for help in the event of an overdose due to fear of legal ramifications, which may effectively increase the number of fatal overdoses.
"Additional research could examine potential other outcomes as well as longer-term associations with fatal drug overdose overall and across racial and ethnic groups," the study said.
Measure 110 critics also say repealing or altering the law is in the interest of public safety, citing it as a driving factor in a supposed rise in crimes other than possession or sales. However, violent crime arrests actually decreased slightly after the implementation of Measure 110 — from 50.6 to 40.8 average monthly arrests per 100,000 people.
"These results suggest that shifting from an approach that prioritizes arresting individuals for possession of small amounts of drugs to one that replaces criminal arrests with non-criminal citations (Oregon) or requires prioritization of health-focused responses (Washington) significantly reduced drug possession arrests and did not increase arrests for crime overall or for violent crimes," an International Journal for Drug Policy report concluded.
In the 25 months prior to the implementation of Measure 110, an average of 23.5 per 100,000 people were arrested for drug possession in Oregon. In the 11 months that followed, that number dropped to 7.6 per 100,000 people — a 68% decrease, according to research published in the International Journal for Drug Policy. For Black Oregonians, decriminalization reduced possession arrests by 77%, while white and Native American Oregonians saw a 50% decrease.
Oregon law enforcement still arrests Black Oregonians at a much higher rate than the average despite the decrease — 236.3 per 100,000 before implementation and 207.1 per 100,000 people after.
Impatience v. patients
Max Williams was a former attorney with Miller Nash law firm, a former Republican state legislator who served on the judiciary committee, CEO of the Oregon Community Foundation and director of the Oregon Department of Corrections from 2004 until 2011 before founding the Coalition to Fix and Improve Measure 110 in 2023.
"Oregon as a state didn't wage a war on drugs," Williams said. "When I spent my eight years running the (Oregon) Department of Corrections, there was nobody in the Department of Corrections custody that was in custody as a result of the possession of drugs."
Williams said Oregon never adopted mandatory sentencing for drug users or drug possession and has not incarcerated people for drug possession since the 1970s. While Williams is correct Oregon never adopted mandatory minimum sentences for drug use or possession, an OHA report on drug decriminalization in Oregon said enforcement of drug laws disproportionately impacted people of color, noting law enforcement’s use of asset forfeiture as a way to target people of color.
“While these laws were originally intended to target large trafficking organizations, in practice, most cases involving property seizure have targeted low-level offenders in economically depressed neighborhoods,” the report found.
Williams spoke carefully about the long-term impact a felony conviction can have on an individual. He insisted the coalition is simply working to recriminalize drug possession as a misdemeanor, not a felony. The misdemeanor, he said, would be automatically expunged following the completion of parole or probation sentences.
"The idea here is to put some consequence and reward back into the system that will take people who will otherwise not be motivated to find access to treatment and recovery, and to reinstitute some of those motivations that pre-existed, but with better off ramps to diversion," Williams said.
Jones said in the interest of public safety, society may ultimately need to create a different space that is neither jail nor treatment for people who want to continue using drugs.
“Now, what do we do when someone says, ‘Well, I want to still get high?’” Jones said. “At some point, we will possibly be addressing the people who don't fit in this space and may not fit in that space. So, there's this other space that needs attention.”
A September report from the Oregon Department of Justice showed police issued 6,177 Class-E citations since Feb. 1, 2021. Of the 4,566 convictions, just 50 people completed a treatment evaluation, allowing them to avoid the ticket. Williams said that statistic shows Measure 110 is not working to motivate people to seek treatment and recovery, and further consequences are necessary to compel people into treatment. However, the statistic only references data from within the court system. BHRNs provided substance use treatment to more than 7,000 people, and saw 47,000 encounters with people seeking treatment in the first quarter of 2023, according to an OHA report.
While Williams’ proposal to leverage harsher legal penalties to compel people into treatment is a core idea among Measure 110 critics, service providers say it’s not a winning strategy.
The impact of forcing a person into treatment is different than when someone says they are ready to make a life change on their own, according to Jones. People may enter into treatment to avoid consequences, but it will not typically have as lasting an impact as it does for those who enter treatment voluntarily. In fact, a person compelled into treatment can be disruptive to a group of people who have chosen treatment and are working to avoid using drugs.
"The mixed group of people will be something that we would really need to look into how we work with that," Jones said. "I think that's one of the ways it could impact us here."
Jones believes solutions are found by focusing on new ideas.
“We go backwards when we are not helping to fund new ideas and honor some of the culture of, you know, culturally specific spaces,” Jones said.
Williams said in a perfect world, there would be other ways to impose consequences and opportunities for people that wouldn't require any involvement with law enforcement.
"Despite the protestations that, you know, we were going to be the second Portugal — we don't have the same tools, we don't have the same systems," he said. "We're Oregon. We're not Portugal."
For example, he said Oregon doesn't have the same housing opportunities, socialized insurance systems, or the ability to deny people access to federal benefits. Portugal decriminalized drugs in 2001, and advocates view it as a model for success in addressing drug addiction through a public health lens.
Williams said the people who pushed Measure 110 forward prioritized decriminalization before building the infrastructure. Despite Oregon having socialized insurance via the Oregon Health Plan, which provides health insurance to nearly 1.5 million Oregonians, according to the most recent data from OHA, the Measure 110 treatment system is still in its early stages.
OAC approved funding for 233 organizations across the state to form 42 BHRNs since May 2022, and applications for OHA grants investing in treatment centers through 2025 are ongoing.
What does treatment look like?
When someone calls Oregon Change Clinic, one of the first questions the clinic asks is whether or not they need housing. The clinic provides exclusively sober housing, and staff helps determine if a person needs to first go to a detox facility like Cedar Hills Hospital or Central City Concern before they return to continue the program.
The clinic works through an assessment to help determine any immediate safety concerns, quickly connects them with housing if needed, and helps put together a treatment plan, which brings them into a community of people facing similar challenges for 16-18 hours a week.
The staff leads regular meditation, yoga, and acupuncture sessions just a block from the main clinic. It has a private room for Transcranial Magnetic Stimulation, an FDA-approved treatment for chronic major depressive disorder.
A former Marine, Jones said Oregon Change Clinic is a highly structured and supportive place. The clinic can provide a HOP card so people can take public transit from supportive housing to the clinic in Northeast Portland.
For some, being on public transportation can be a barrier to success. Measure 110 helped remove that barrier by funding a fifteen-passenger vehicle to transport people to the clinic, Jones said.
Jones said the state’s investment in addiction treatment has started to succeed in part by providing funding to smaller and culturally specific organizations that have historically been underfunded, like community recovery center The Miracles Club and post-prison support nonprofits Going Home and Fresh Out.
Despite making up 21.3% of the population in Multnomah County, Black, Native American and Hispanic people make up 39.2% of the jail population, according to the September Multnomah County monthly jail report. Prior jail reports show similar statistics.
In September, one year after OHA distributed the final first-round funding of addiction treatment programs, Gov. Tina Kotek announced Oregon State Police began strategic enforcement and disruption of fentanyl sales in Portland. In a press conference following the second of three Central City Task Force meetings, Kotek said public drug use is a public health and safety issue and announced she was reallocating Oregon State Police officers to work on enforcement teams in Portland to make it uncomfortable for dealers distributing fentanyl, meth and other drugs.
Asked how the previous war on drugs policies influenced her approach to the current drug crisis, particularly concerning racial disparities in enforcement, Kotek highlighted the need to address addiction as a public health issue.
"What I think we've learned on the war on drugs is it is a public health issue," Kotek said. "There has to be treatment."
Editor's note: A paragraph referencing OHA statistics on BHRN usage was added after publication to clarify statements regarding the prevalence of Measure 110-funded treatment.
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