Two dozen elected officials, law enforcement officers and substance use treatment providers traveled from Oregon to Portugal recently to learn about the country’s 20-year-old drug decriminalization program, which inspired Oregon’s voter-approved Measure 110. The trip was organized and largely paid for by the Health Justice Recovery Alliance, a statewide advocacy organization focused on implementing M110. The group met with Portuguese policymakers and addiction service professionals to learn how the country built an integrated health care response to its addiction crisis.
Lily Morgan is a Republican state representative from Grants Pass. Kate Lieber is a Democratic state senator representing Beaverton and Southwest Portland and serves as the Senate Majority Leader. They join us to talk about the trip and whether it presented applicable lessons for Oregon.
Note: The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Two dozen Oregonians went to Portugal recently. The group included elected officials, police officers, drug treatment providers, community leaders and others. They all went to learn about Portugal’s 20 year old drug decriminalization effort and to find out if there are lessons from that earlier example that can be applied to Oregon and to Measure 110. I should point out that the trip was organized and largely paid for by a coalition of state and national groups that supported Measure 110 and do not want to see it gutted. I’m joined now by two of the lawmakers who went on the trip. Lily Morgan is a Republican state representative from Grants Pass, that’s House District 3. Kate Lieber is a Democratic state senator from Beaverton and Southwest Portland and the Senate Majority Leader. Welcome to you both.
Lily Morgan: Thank you.
Kate Lieber: Thank you.
Miller: Lily Morgan, first. Why did you want to go on this trip?
Morgan: That’s a good question. It was honestly a surprise to get the invitation. I have been fairly critical of how long it took for the money to get out the door. And how Measure 110 was implemented without it integrating back into our current systems. And so when I was invited, my first question was why did you invite me?
Miller: Oh, not, why should I go, but why did you want me to go?
Morgan: Correct. And, and then it was, no, I do want to go. I want to know that if somebody is critical that what’s being seen has a different lens for which it’s being seen and that there’s somebody else speaking up for both sides when we get back.
Miller: Well, I noted that the organizer and the funder of this trip, the group that paid for the majority of this, it was a group that has been very outspoken in terms of pushing for this measure and, and pushing for it to continue. Given that, what was the answer you got when you asked them why did you invite me?
Morgan: I was told two things. One day, I stopped one of the proponents of Measure 110 in the hallway. And I said, look, we have the same goal. We want to save lives. We maybe just don’t agree on how we get there. And she said that was part of why she invited me to go is because, if we’re not willing to have those conversations when we disagree, then maybe we don’t see the things that we’re missing out. And they said that I ask good questions and they know I care.
So I’m glad that I was included on the trip. There were some pretty amazing people on the trip that had some pretty incredible life experiences. And it is something that is valuable to hear where people come from as they are approaching these topics, even if we disagree.
Miller: Kate Lieber, why did you want to go to Portugal? You theoretically could have read all about it. I imagine you did some research before you went, but why did you want to actually go there?
Lieber: Well, I thought it was incredibly eye opening to see how Portugal has handled it on the ground. And I didn’t agree to go until I was sure that we would have a cross section of people going from the Oregon delegation. It was important to me that it was bipartisan. It was important to me that law enforcement came, including the Department of Justice and the Prosecutor’s Office. And so once that all came together with other lawmakers, I knew that it was a place that I wanted to be to not only see what Portugal has to offer, but to then take those experiences and have really robust conversations with the Oregon delegation about what we’ve seen and where do we go from here.
I also just will note that this didn’t cost taxpayers any money. And I, for one, didn’t actually take any money from the sponsors of the trip because it was important to me that it not be a distraction.
Miller: Let’s dig into, first, what Portugal is doing and why. Kate Lieber, maybe you can start with this. What did you learn about the “why?” What was happening in Portugal 20-plus years ago that led them to decriminalize drugs?
Lieber: Well, that was really a very interesting story. They had a really terrible problem with an addiction to heroin and it was when the AIDs epidemic was really hitting them hard. And the way they told the story was that they’re a country of about 10 million and they said that there was not a single family that wasn’t impacted by what was happening with their addiction crisis and then sort of along with the AIDs crisis. And they knew right then and there that they wanted to do something quite different than that was happening.
I will say a couple of things. One, I do think that Oregon and Portugal come at this problem with a different lens. Portugal really looks at it as we are always going to have drugs, we’re not going to be able to get rid of them and therefore we should do more harm reduction. I think Oregon and I think really the United States looks, at it more from a zero tolerance perspective, from a perspective of, we want to eradicate drugs. And those two perspectives really create differences that I was seeing on the ground and I have to say it was invaluable to see the way Portugal handled those differently.
Miller: Where would you put yourself? You’re talking about our state or our country’s view of drugs, zero tolerance versus Portugal’s, they’re going to be here [and] we’re going to have to deal with it somehow. Where do you put your own point of view? And then Lily Morgan, I’m going to ask you the same question.
Lieber: Well, I’m a former prosecutor. I believe that we have a system that needs carrots and sticks. I also believe that what the voters voted on when they voted for Ballot Measure 110 is that they wanted to treat addiction like a public health crisis, which it is. It is a public health crisis and people who are addicted have public health needs that we should pay attention to.
One of the biggest sort of takeaways that I saw around Portugal was they have these methadone vans that go and meet people where they are and their whole view of it is, we’re going to treat the medical problem of addiction with medicine and give medicine to those who need it, when they need it. I think that we, as Oregon, can do a much better job of doing that and I think that’s what the voters really wanted when they voted in Ballot Measure 110 because addiction is a health problem.
What’s happening on the streets right now, especially in Portland is unacceptable. We cannot have open air drug markets. We have a homeless population that is really suffering with both mental health and addiction problems. And we have to make sure that people feel safe in their home and on their streets and that they can walk down the street with their six year old and not have to explain why someone is slumped over. So we have to do all of those things. And I think the biggest thing for me is we’ve got to continue to make sure that we have addiction treatment for people who need it, when they need it.
Miller: Lily Morgan, I’m curious what you made of the stark sort of philosophical difference that Kate Lieber has just described – we’re going to have to live with this stuff, it’s going to be with us forever – versus a desire to somehow eradicate it in this country or in this state?
Morgan: Well, there’s definitely some differences that I feel than what was said. First off, the question before the voters for Measure 110 was not, is this a public health problem? The voters didn’t have that as an option to vote for. They were given the option to vote for, do you want them to be in jail or do you want them to have treatment? And overwhelmingly, our voters said we want them to get treatment and as treatment was defined when that vote happened, that meant helping people get clean and sober. Yes, there is a health component to addiction in that while you are in that addiction, the cravings are overwhelming, the thought process and how things work are not what they were when you’re not on the drug.
I also spent the majority of my career in the criminal justice system. As Senator Lieber was a prosecutor, I was a parole and probation officer. I helped facilitate groups. I was certified in cognitive behavioral therapy and I helped supervise at times the drug court program and the mental health program. I’ve also been a legal guardian to someone in the mental health world and I still volunteer in the recovery community. Through this process in Oregon, as Measure 110 has been implemented, I have been in regular contact with the recovery community in my area, getting their feedback on how things are going. And as I have heard through the course of my career, that addiction is a disease. Just limiting to that sentence takes out the element of human responsibility and choice. There are people that have been in recovery for decades and still say I’m in recovery. There is still that disease component, but they also have implemented a choice to not use or to seek the help to stop using.
Not everybody facing that addiction is able to face that choice without help and that’s where that treatment component and that process of coming alongside somebody to help them work through that process matters. I would say one of the other glaring pieces of this though is that fentanyl and methamphetamine, two of the most shocking drugs that have hit Oregon, are not seen in Portugal today.
Miller: I’m so glad you brought that up. It was maybe the biggest surprise to me of everything I’ve read about this trip. I just would have assumed that international drug traffickers would have figured out how to bring fentanyl from China all over the world to any place where there are people who would be susceptible to opioids, which I guess is just everywhere, we’re humans. Did authorities there have theories as to why that hasn’t happened?
Lieber: I don’t think I heard any theories. Representative Morgan, did you hear any theories about that?
Morgan: I had not heard. They had talked about their prescription programs and the change in their health component with socialized health that they weren’t prescribing different opioids, so they didn’t have the proliferation of opioid pills that America had with how we prescribed freely for so long. They also have direct access to the original products through opium coming into the country and stuff.
But no, they did say where they started decriminalization with a heroin issue today though, it’s not just a heroin issue in Portugal, they also have a crack cocaine issue and they said one of their leading substances they’re struggling with how to deal with is actually cannabis, marijuana.
Lieber: Yeah.
Morgan: So they have expanded what drugs there that they’re facing now versus what they were. But fentanyl and methamphetamine, the synthetics, were not either of them.
Lieber: But they are gearing up for them.
Miller: They are gearing up for them.
Lieber: Yeah, they’re worried and I was surprised too, Dave that fentanyl hadn’t hit their shores the way it hit the United States.
Miller: Well, Kate Lieber, to what extent does the lack of fentanyl in Portugal affect the way you think about how useful the Portuguese example is for Oregon today? I guess I’m just wondering if given everything we’ve heard - and we’ve learned about fentanyl and its unbelievable potency - if that potency in and of itself changes the picture?
Lieber: I think that the fentanyl crisis that we have does change the picture and I think it did really happen. We switched over from Black Tar heroin being the sort of drug of choice to fentanyl pretty quickly from the pandemic on. My understanding is that it’s really switched over pretty quickly. I do think that the potency of this makes it so much more dangerous. One of the biggest lessons that I took is that Portugal also has a very robust prevention system that is in their school school systems that I thought was really very interesting and also more comprehensive. But they have not had to deal with the fentanyl issue that we have where one pill will kill and I think that, for me, creates much more urgency around making sure that we have the right response because we’re losing people.
Miller: So let’s turn more specifically to the really clear lessons that you both took from this trip and if and how they might translate to legislative policies, what you might push for. Lily Morgan, first. Are there specific takeaways from your four or five days in Portugal that will lead you to push for specific policies?
Morgan: Thank you for that question. And I will agree completely with Senator Lieber that we do have to do something now because of the intense outcome of people dying in our state. The prevention program that Portugal did is absolutely essential, that Oregon continue to support and expand our prevention efforts. Prevention costs one-eight of the cost of treatment and that was before the fentanyl crisis in Oregon. And so it is worth the investment.
They also, initially when they started and they put their system into place, you could get same day access to treatment. However, over the course of the 22 years since Portugal has been decriminalized, they cut back funding when they had economic struggles as the rest of the world did in 2008. And they have not built those back up. So both the Portugal contingent and the Oregon contingent were saying how we need to be able to have same day access, that if somebody is at that place that they want help, that there’s some place for them to go that day so they don’t get kind of sucked back into the system of use.
And I would say one thing that surprised me that I thought was beneficial is that their medical staff in medical school gets about six months of training in addictions as part of their schooling. And in the United States, that’s not a consistent program that’s taught nor for any substantial amount of time. So if we did see the portion of it as a public health issue, we have to prepare our doctors and our medical system on how to respond to that addiction in a way that is helpful.
Miller: And what about the very basic question of whether or not you would vote to overturn, I would say, half of Measure 110? The proposal would be to keep cannabis money going to pay for treatment, but to recriminalize user amounts of drugs like fentanyl and meth.
Morgan: I am a proponent and advocate for drug court systems diversion programs. I have helped people through that process. I still attend drug court graduation even though I’ve not been a parole officer in several years. If there’s a recriminalization, I want there to be a path of accountability with treatment or drug court, where when somebody uses, where somebody has a violation, they’re not thrown out of the program. They’re brought around with peer support, they’re brought around with others checks and balances in the system. And I will say that is key. Jail alone doesn’t change behavior. I’m not looking for people to have criminal histories. I’m looking for people to have accountability in getting treatment.
I had a bill earlier this session to kind of create a civil hold, similar to that you would do with mental health, for families to be able to have a resource when their loved one is in, in addiction. And Kentucky has passed that. It’s called Casey’s Law and they’ve tweaked it a little bit more recently as well to keep it current with where things need to be. But that is something that Oregon has not been willing to look at, a mandatory treatment. That’s something the Swiss model has, when they decriminalize, they have a mandatory treatment with accountability. Portugal, even if referred to treatment, there was really no consequence if somebody chose not to get involved. In Oregon if we are going to recriminalize, we need to make sure there’s a path to treatment and a path to expungement in that process, but allowing that process of accountability to be in place.
Miller: And Kate Lieber, we’re running out of time, but what are you going to be pushing for in the legislature with respect to Measure 110 and as a result of this trip?
Lieber: I agree with much of what Representative Morgan has to say. I mean, I think that she and I see eye to eye on a lot of this. I think we need a more robust treatment system. Portugal had a much more robust treatment system when they decided to decriminalize. There’s also a better relationship between the police and the public in Portugal that I think that we need to really take a hard look at and make sure that we’re supporting our police in the way that they should be supported and make sure that we can give them the tools they need. Portugal can confiscate drugs without having it being a crime and we need to really look at the ability to confiscate drugs, what that means and what tools the police need to do that. And I completely agree that we have to get accountability in the system. We have to make sure that people have the treatment they need, when they need it. And we need to make sure that we are giving tools to both police and to the medical personnel who are going to treat people for addiction going forward.
I think poverty plays a huge role in drug use and we need to continue to also make sure that we are employing people at the right wages and making sure that we give them pathways out of poverty and away from drugs as we think about what kind of systems we need to continue to invest in.
Miller: Kate Lieber and Lily Morgan, thank you very much.
Morgan: Thank you.
Lieber: Thank you.
Miller: Kate Lieber is a Democratic state senator from Beaverton and Southwest Portland and the Senate Majority Leader. Lily Morgan is a Republican state representative from Grants Pass, but she announced recently she’ll be stepping down from the legislature to become the city manager of Gold Hill in Southern Oregon.
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