Oregon just decriminalized small amounts of all drugs. Now what?

On Feb. 1, a big experiment began in Oregon: The state decriminalized small amounts of all drugs, including heroin, cocaine and methamphetamine. In the November election, voters passed ballot Measure 110 by a 16-point margin.

Now, if you’re caught with one or two grams of what some refer to as “hard drugs,” you won’t be charged. Instead, you’ll either pay a maximum $100 fine, or complete a health assessment within 45 days at an addiction recovery center. This new system for services will be funded through the state’s marijuana tax.

But the measure is still controversial, and members of Oregon’s addiction and recovery community are split on if it’s a good idea. So how did we get here?

How did this pass in Oregon?

Oregon has a long history of progressive health-related measures, said reporter Tatiana Parafiniuk-Talesnick. She reports on things like COVID-19, poverty and Measure 110 for the Register-Guard newspaper in Eugene.

“There’s just a strong legacy of counter-culture culture here,” she said. “I think most people familiar with some of the bigger cities here know that.”

Oregon became the first state to decriminalize marijuana use in 1973. Eugene, the third-largest city in the state, deploys health care workers, not police, when someone is having a mental health crisis. And Oregon was the first state to enact a Death with Dignity Act in 1997, which allows terminally ill people to end their lives on their terms, using lethal medications.

Measure 110 was spearheaded by the Drug Policy Alliance, a New York-based organization focused on reducing criminalization associated with drug use across the country. Kassandra Frederique, executive director of the DPA, said the organization has worked in Oregon for more than two decades.

“We have worked with folks on medical marijuana, on adult use, and we’ve supported folks on the ground there for a very long time,” she said. “And Oregon also has urban centers and rural centers and super rural centers, so there’s a lot of diversity.”

This means how well decriminalization works in Oregon could reflect how well it works across the country, too.

From criminal justice to health care

In Oregon, as in the rest of the country, there’s racial disparity in who gets written up for drug possession. Before Measure 110, if you were Black or Native in Oregon, you were a lot more likely to get in trouble for possession of a controlled substance. However, Oregon had already reduced the possession of small amounts of drugs from a felony to a misdemeanor, so not a lot of people were spending time in jail just for possession.

Andy Seaman, an assistant professor of medicine at Oregon Health & Science University and health care for the homeless clinician at Central City Concern in Portland, said successful care for people with addiction is all about transparency and empathy.

“I will not judge you for your substance use,” he said. “Addiction can be a relapsing and remitting disease. It’s OK if you use again, please just come back.”

Seaman used to be a doctor in the Multnomah County Jail in Portland. He said he often saw a cycle with patients who had to go cold turkey in jail: They go through withdrawal in an unfamiliar environment, they’re traumatized, and when they’re released, they seek out drugs to self-medicate. Overdose risk for opioid users is 129 times higher in the first two weeks of someone being released from jail.

“Certainly, there are scenarios where people have gone to jail, and that was a wake up call,” Seaman said. “A lot of people in Oregon recovery are those people. But these are the people who survived.”

Is Oregon ready?

Measure 110 requires the establishment of a statewide network of addiction recovery centers. The problem is these centers haven’t been established yet, and they don’t legally have to be until October. Temporarily, there’s a phone line where people can call to do their assessment on the phone. If you don’t want to do that, you pay a fine.

Those who work in addiction recovery services in Oregon are split: There are people who are really excited about Measure 110, and those who are wary.

Mike Marshall was one of the loudest voices against Measure 110. He is executive director of Oregon Recovers, an organization that serves and advocates for people in recovery for addiction. He’s in recovery himself, for alcohol and crystal meth.

Marshall supports decriminalization, but he said Oregon’s recovery services system is fractured and incomplete. People often have to wait several weeks for a treatment bed, and many service centers are outside of the traditional health-care system.

“There’s nothing in 110 that prepares the health care system, or expands capacity,” he said. “They simply deconstructed one system,” the pathway through treatment through the criminal justice system, “without recognizing the health-care system isn’t prepared for them.”

Marshall said that previously when people got arrested or written up for possession, many were court-mandated treatment. The system wasn’t perfect, but it helped some people get into recovery. Now, Marshall said, a lot of people will be cut off from that support because small level possession will be treated as essentially a speeding ticket.

“I think the largest unintended consequence is that the overdose rates are going to shoot up,” Marshall said. “There’s going to be more people on the street using drugs, and no mechanisms to either interrupt that or direct them out of that.”

A new system

Haven Wheelock runs a health services program for drug users in Portland called Outside In. She works with people in the community who are often homeless, and primarily inject heroin and meth. Outside In runs one of the oldest syringe access programs in the country.

Wheelock was one of the chief petitioners for Measure 110, and is thrilled the measure passed.

“When people tell me they’ve spent the last five years constantly scared, constantly looking over their shoulder because of their substance-use disorder, and they tell me they feel like they can breathe a little bit? That’s a win—just decriminalizing simple possession is a huge win,” she said.

She said Mike Marshall is right, that treatment systems are not quite prepared for Measure 110. But Wheelock thinks doing anything is better than nothing.

“We do have more work to do—we are really going to need to continue to build out this system. The system has been left in disrepair,” she said. “I’m really hopeful for what this means for our community and for our state. And if we can show that this is working, hopefully Oregon being brave will lead other places to be brave too.”

According to Kassandra Frederique of the Drug Policy Alliance, that organization is campaigning in many other states to replicate Oregon’s ballot measure, including in Washington, Colorado, California and Virginia.

“This is the same thing we did years ago, where we had conversations with a bunch of folks and said, ‘Who’s ready?’” she said. “We plan to do this again and again and again.”