Measure 110: Oregon’s New Drug Law is Heading Toward Failure

A few weeks ago, Portland Public School parents received a disturbing email from the district. Over the prior weekend, two PPS students died of an overdose of fentanyl. The teens were found with counterfeit pills that look like common prescription medications, such as Percocet, Oxycontin and Xanax. A few days later, the U.S. Attorney’s Office for Oregon announced federal agents had seized approximately 115,000 counterfeit oxycodone pills suspected to contain fentanyl, 41 pounds of methamphetamine, and more than 57 pounds of heroin.

According to the Oregon Health Authority, overdose deaths in Multnomah County from fentanyl and methamphetamine began to skyrocket around 2017. From 2016 to 2019, deaths from meth increased 86% and fentanyl deaths tripled. Last year, 126 homeless people died in Multnomah County. Nearly two-thirds of those deaths involved drug use.

Oregon has a drug problem and Measure 110 was supposed to help solve it. Early evidence indicates the measure will be a colossal waste of time and money and may worsen the state’s addiction crisis.

Substance use disorder is a medical condition, not a lack of willpower

Alcoholism and drug addiction are chronic medical conditions known as substance use disorder. As with many chronic conditions, such as diabetes, high blood pressure and coronary artery disease, there is no single cause. In addition to personal choices, genetics and environment can lead to or worsen these conditions. Like other chronic diseases, substance use disorder follows a pattern of remission and recurrence, in which case the goal of treatment is to control the disease, rather than to cure it.

Much like common chronic diseases, many Americans do not seek treatment for substance use disorder. For example, the CDC estimates about one-quarter of U.S. adults have untreated high blood pressure. One reason is that so many people don’t know they have it. That’s why high blood pressure is called the silent killer.

The American Medical Association estimates 90% of people with substance use disorder do not receive treatment. The most common reason they don’t get treatment is they don’t seek treatment because they don’t know — or don’t think — they need it.

Long-term alcohol and drug use cause changes in the parts of the brain that control impulses, motivation and decision-making. A comedian once remarked that when he drinks a little, he becomes a different person, and that person likes to drink a lot. That’s not a joke. Many people with substance use disorder overestimate their abilities to control their usage. They think they know “when to stop,” or simply have no desire — or ability — to stop. In fact, one of the criteria for substance use disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is continued use despite the knowledge of physical or psychological harm.

Another reason people don’t seek treatment for substance use disorder is because of the enormous stigma American society attaches to it. We call them alcoholics, boozers, addicts, druggies, junkies. We treat alcohol or drug addiction as a moral failing. We assume people with substance use disorder merely lack the willpower to stop using substances, just like you or I might lack the willpower to avoid the doughnuts sitting in the break room. As a result, we judge people with substance use disorder. In turn, they feel judged, and they stay away from treatment out of the fear and embarrassment of further judgment.

On top of these factors is a lack of treatment options. Last month, the U.S. Department of Health and Human Services reported that Oregon has the second highest addiction rate in the country and ranks last in the availability of treatment options. Patients who are uninsured or under-insured (i.e. covered by insurance but without money to pay the out-of-pocket costs) may be unable to enter, remain in, or complete treatment. Even worse, Oregon’s outdated certificate of need laws have created a shortage of service providers. Advocates helping patients look for treatment options often report long waiting lists for new patients.

Measure 110: All carrots, no sticks

In 2020, Oregon voters approved Measure 110 by a wide margin. Much of the campaign promoting the measure focused on the parts that decriminalized personal and non-commercial possession of many drugs, including meth, heroin and fentanyl. Persons caught with a small amount of these drugs would receive a citation for a $100 fine. The fine can be wiped out if the person submits to a health “screening.” However, there is no obligation to seek or receive any follow-up treatment for substance use.

This part of Measure 110 has been so successful, that it looks like it’s succeeding itself into failure.

The Drug Policy Alliance reports a nearly 60% decrease in the number of people who have been arrested for any drug offense since Measure 110 went into effect. Proponents of Measure 110 call that a huge success.

At a meeting of the state’s Behavioral Health Committee, it was reported that law enforcement handed out approximately 1,500 citations in the first 10 months of the program. Nearly two-thirds of the people who got citations skipped their court dates. In the end, less than 5% underwent a “screening” and only 11 people were connected to services. That’s not a typo — only 11 people out of nearly 1,500.

Measure 110 was based on flawed thinking that users would be willing to seek treatment once we remove the stigma of “criminalizing” illegal drug use. Instead, this portion of Measure 110 has turned out to be a failure. Law enforcement has little interest in handing out citations. Users who are issued citations see the system as a joke — the fine is laughable and the screening process is little more than a minor inconvenience.

Nevertheless, these early results highlight an important point: Most people with substance use disorder don’t think they have a problem or don’t want treatment. Less than 1% of the people who’ve had a run-in with the law for possession of “hard” drugs under Measure 110 asked to be connected to treatment services.

The other key provision of Measure 110 mandated the establishment and funding of “addiction recovery centers” by October 1, 2021. These centers — funded with marijuana tax revenues — would provide drug users with triage, health assessments, treatment and recovery services.

To be fair, it’s still way too early to evaluate the success or failure of these centers, but early information points in the direction of failure. Information prepared by the Oregon Health Authority earlier this year reports that more than 16,000 individuals accessed services through the centers. Nearly 60% of them sought harm reduction services such as clean needles and Naloxone to treat opiate overdoses. A little more than 10% sought peer support. Less than 1% entered treatment.

Put another way, nearly 60% accessed an “addiction recovery center” to seek services that would allow them to more safely continue with their drug use rather than control it or treat it. About 10% sought the first steps to recovery, and less than 1-in-100 entered treatment.

Sure, there is a public health aspect to harm recovery efforts, but when does harm reduction turn into enabling? For example, needle exchanges reduce the number of needles discarded on the streets or in city parks. At the same time, it sends a message that it’s okay to inject illegal drugs. Even worse, it does nothing to reduce the community harm that comes from illegal drug use — theft to fund the addiction and crimes committed while addled under the influence of the drugs.

San Francisco is going through this right now. Earlier this year, the city set up a “linkage center” for homeless people that included a safe injection site for drug users. The result was the spread of open-air drug markets just outside the site. Many San Franciscans decided this program crossed the line from harm reduction to enabling.

When open-air drug use and discarded needles render our public spaces unsafe, the rest of the community is denied the use of those spaces our tax dollars are paying for. Open drug use, theft, assaults are not victimless activities — they deprive us of our public spaces and our rights to safety.

While Measure 110 decriminalized possession of small amounts of drugs, drug trafficking is still a felony. The PPS students who died earlier this month and the thousands of others using illegal substances are getting their drugs from somewhere. If 115,000 fentanyl-laced pills, 41 pounds of methamphetamine, and more than 57 pounds of heroin seized by the feds barely makes a dent in the supply of these deadly drugs, then we’ve got a problem that requires an all-hands-on-deck approach to stifle the supply and reduce the demand.

Law enforcement and prosecutors need to shut down the dealing of these drugs on our streets, in tents and tarps, and on social media. Open drug use should be prosecuted. Individuals who commit crimes while under the influence of narcotics should be given the stark choice of rehab or jail. Most Oregonians don’t care if someone is using drugs at home or out of sight, but when that drug use leads to theft to pay for the drugs or violence because of the drugs, that’s when individual liberty threatens community safety.

By design, Measure 110 does nothing to reduce the supply of deadly narcotics. And its all-carrots-no-sticks approach to treatment looks like it will do almost nothing to decrease demand.

The only way public policy can help with substance abuse is to help those who want help, and be firm with those who don’t. “Rehab or jail” may not be the right policy, but it is the right policy for right now, before things get even worse.