As of September 1, 2024, the part of an Oregon law that allowed possession of small amounts of psychoactive substances for personal use only under penalty of a misdemeanor was repealed. The decriminalization, which Oregonians voted for in a referendum in 2020, was intended to reduce the social stigma of addicted individuals, reduce overdose deaths, and ease users’ pathways to rehab.
However, the outcome after 3.5 years is different than anticipated. Drug overdose deaths have increased by nearly 50%, from 1,171 in 2021, when possession for personal use was decriminalized, to 1,683 in October 2023, according to data available from the Centers for Disease Control and Prevention. According to the Oregon Health Authority, opioids, particularly fentanyl, caused most deaths.
Has the idea of decriminalizing psychoactive substances failed in Oregon? And why is the outcome so different from, say, Portugal, where a similar policy has celebrated success, with up to a 75% reduction in overdose deaths from hard drugs between 2001 and 2022, a reduction in the prevalence of both HIV and infectious hepatitis in the country and many addicted individuals receiving adequate professional help?
First, let’s go back many years. Oregon was already a state that was relatively liberal compared to others in terms of access to addictive and other psychoactive substances. As early as 1973, it was the first U.S. state to decriminalize marijuana possession. Although possession of even small amounts of more potent drugs was still a crime punishable by imprisonment until 2021, the sentences imposed were again relatively low compared to other states. In contrast, however, Oregon was until recently one of the states with the worst medical capacity for addiction treatment, and the health and social sector here was significantly underfunded.
With the global societal change that has brought with it a shift in perspective on addiction and mental illness in recent years, and which has liberalized (and in some places rationalized) the view of many psychoactive substances, then even in Oregon residents have begun to welcome the path of decriminalization and “harm reduction” practices. The offense of possession of psychoactive substances for personal use became a mere misdemeanor, and users were to be directed into treatment programs and other supportive social projects instead of being locked up in prison (which can exacerbate the psychological and social situation of some addicts). This decriminalization was supported by 58% of the population in the 2020 referendum.
However, the situation has been greatly complicated by the COVID-19 pandemic, which has led health services around the world to focus on more pressing problems in society. Addiction treatment programs were to be funded by tax revenue from cannabis sales, up to USD 150 million a year, but it was not only the pandemic that made the allocation of these resources problematic, and some decriminalization advocates argued that they were not sufficient anyway, as addiction treatment is a complex problem and often requires long-term inpatient care, followed by even longer outpatient care.
Here again, it is important to note that Oregon started from vast underfunding of such care. Moreover, the entire addiction detention network that was supposed to help with quitting did not begin to be built until almost 18 months later.
Regarding the COVID-19 pandemic, it is also a crucial factor that the pandemic has worsened the social and psychological situation of most of the population, especially the most vulnerable. The number of homeless people in Portland, the state’s largest city, rose to nearly 6,300 in 2023, a 65% increase from 2015. Challenging social and psychological situations always correlate with a greater risk of an individual falling into some form of addiction as a psychological escape from the difficult life situation that has arisen. Moreover, the increase in overdoses in Oregon during the pandemic was consistent with national numbers.
It was the increased incidence of homeless persons on the streets of cities, who were often using psychoactive substances in plain view of ordinary residents, that likely turned public opinion against the decriminalization law. An Emerson poll last year found that 54% of Oregonians believed the law increased the presence of homeless people in their communities. 64% of Oregonians then supported repeal of the decriminalization portion of the law in exchange for maintaining at least a health and social support network for addicts, and 56% wanted a complete repeal and a return to the original criminalization policy.
Unfortunately, the decriminalization law has come at a time when the opioid crisis is growing worldwide (and most of all in the United States), as fentanyl, an opioid 100 times more potent than morphine, has become massively prevalent among addicts since 2020 on the West Coast, causing an even greater risk of death from unintentional overdose in addition to severe addiction.
Adding to the decriminalization problem, according to criminalization advocates, Oregon law enforcement officers have had relatively little time to adapt to the new approach to addicted individuals. During the days of criminalization, they were accustomed to arresting such individuals if they had a psychoactive substance. After decriminalization, they were supposed to offer the addict either a token $100 fine or refer him or her to a treatment program, which required the addicted individual to call a crisis line to assess his or her health and be offered treatment options.
However, not only was this procedure not used much, and the officers’ jobs were greatly complicated, but the effectiveness of this particular procedure is open to further debate. An example could again be Portugal, where up to 90% of addicts ended up in the detention network of support services.
João Goulão, an official who oversees the drug treatment system in Lisbon, attributed Portugal’s success to the continued street presence of police officers and social workers who work together to guide users into treatment.
“The social workers we deploy are there every step of the way. They schedule appointments, drive people to them in person if necessary, and if they refuse treatment, they do everything they can to at least keep them as safe as possible,” he said.
Besides a better safety net for addicts, what else makes the Oregon case so different from Portugal?
It may be reasonable to believe that even if we set aside the reasons that have complicated the decriminalization project (especially the COVID-19 pandemic and the spread of the opioid fentanyl), much more time would have been needed for a better outcome.
The view that the Oregon legislature’s current decision seems premature is shared by Goulão in an interview.
“First of all, you have to be consistent in your approach and give it time to produce results,” he said. “When you embark on something as complex as the opioid crisis, you cannot really expect to see dramatic changes overnight.”
In addition, Goulão believes Portugal has been effective in steering drug users into treatment from the start, but he also said it took three to four years to prove that in the data.
“In order to say something works scientifically, you must let it exist, you must collect data, put it in context… These things take time.”
Tera Hurst also told Politico that the Oregon experiment “was not given the time it needed“; she is the executive director of the Oregon Health Justice Recovery Alliance.
So as of September 1, 2024, part of the decriminalization law has been repealed, and Oregon is going back to criminalizing possession of even small amounts of psychoactive substances for personal use, which carries up to six months in prison. The addiction treatment support network portion of the law remains in place, and each county would now be free to adjust as they see fit (including according to their financial capacity) and continue to send addicted individuals to treatment instead of jail.
Thus, proponents of criminalization defend this approach by arguing that the “harm reduction” policy will largely remain in place. Critics, however, counter that allowing each county to handle the issue in its own way will create an opaque situation throughout the state as to what an incarcerated individual potentially faces as a sanction and what chance he or she has of receiving needed treatment.
In conclusion, Portugal and Oregon are, of course, not only culturally different countries but also countries with different healthcare systems and access. We can only speculate on how the decriminalization project would have turned out in the longer term. Now, however, it is very unfortunate that the failed ‘Oregon case‘, which was influenced by many external negative phenomena, may serve as a loud argument against the liberalization of psychoactive substances in other countries in the future. And in an environment of criminalization, addicted individuals in particular suffer, who may not receive much-needed medical and social care, but instead may be further harmed by stigma and punishment for their behavior.
Written by Tereza Urzová, M.D., a general practitioner and an analyst at the Institut Liberálních Studií.
