Oregon’s bold drug decriminalisation sees some success – but use still rising

Callers to the Measure 110 hotline, which was set up a year ago, after Oregon became the first state in the US to decriminalise personal possession of drugs including meth and heroin, may hear Martin Lewis Lockett’s deep, reassuring voice.

Lockett, who is in recovery, first assesses the callers, who can use the hotline if they have received a police citation for drug use. He uses an evidence-based screening tool to determine if someone has substance use issues, and connects them with nearby help. In one case, a man called the hotline after relapsing, but told Lockett his drug use was just a hiccup. “I know minimisation when I hear it,” Lockett said. By the end of the call, the man realised he needed help, and Lockett linked him to services.

But Lockett says the hotline isn’t as busy as he hoped. “We just don’t get a lot of traffic on that line,” Lockett said. Not enough people are calling for help, and even when they do Lockett said it’s tricky to find detox and residential treatment beds. Many can wait weeks.

The hotline is one of the central elements of Oregon’s bold decision, one year ago, to decriminalise drugs. In November 2020 the state’s residents voted to pass Ballot Measure 110, which, inspired by Portugal’s decriminalisation 20 years before, recognised substance use disorder as a health issue and halted the incarceration of drug users. Anyone in Oregon now caught with small amounts of drugs – including meth, heroin, LSD and cocaine – receives a ticket for $45 to $100, and a card with the number of a hotline. If they call the hotline, they can complete a substance use disorder screening to get their ticket waived. The hotline, staffed by counsellors like Lockett who are themselves in recovery, also aims to connect people with help if they need it. Advocates and lawmakers are now pushing for similar bills and measures in six more states.

One year in, there have been some successes. There is new funding for harm reduction, which the evidence suggests has saved lives, and police are no longer arresting people for carrying small quantities, meaning they will not face incarceration or blemishes on their records, which can prevent them from finding housing and employment.

At the same time, however, substance use is rising in Oregon. It ranks second in the US for substance use disorder, according to a December 2021 analysis, and 50th out of 50 states – dead last – for the percentage of teens and adults needing but not receiving treatment for substance use disorder. Across the US, overdose deaths are increasing – and the same is true in Oregon, where medical examiner data showed drug toxicity deaths continued to inch up in 2021.

Experts say decriminalisation is not the problem. What the new measure lacks, they say, is a proper pathway to recovery amid the growing overdose crisis.

Before Measure 110, personal possession carried a misdemeanour charge, punishable by up to a year in jail and thousands in fines. Those who were eligible could choose between the traditional criminal system or drug courts, which give judges the power to order treatment, require drug testing and impose punishment or incentives.

But Measure 110 allows people caught with small amounts of drugs to avoid the criminal justice system, meaning those people instead are routed to the hotline via the citations.

These were meant to be a “golden ticket” to health assessments and services, explained Mike Marshall, executive director of Oregon Recovers.

Instead, of the 1,885 people who received tickets for personal possession in the first year, only 91 called the hotline, according to its non-profit operator, Lines For Life.

“Virtually no one is calling the hotline, so that referral process is a failure,” Marshall said.

He believes Oregon should have followed Portugal by creating an effective pathway to help before decriminalising drugs. “We did the complete opposite: we decriminalised and stopped intervening in people’s drug use through the criminal justice system, but then are still deciding on funding for that alternative pathway,” he said. “That’s not the way to go.”

In contrast to Oregon’s citation method, under Portugal’s system, people caught with small amounts of drugs are sent to local “dissuasion commissions” that assess whether they have substance use disorder, and can refer them to treatment, impose fines or require community service.

“At least through the criminal justice system, someone had a pathway to recovery, as flawed as that was, and as stigmatising as that was,” he continued. “There’s a whole bunch of people who are no longer given a pathway to recovery if they choose it.”

Even for those people who do call, finding detox and residential treatment beds is difficult because the services are historically underresourced – and the pandemic just made the situation worse, according to data provided by the Oregon Council for Behavioural Health. Measure 110 did nothing to change any of that.

People aren’t calling because there are no consequences for ignoring the ticket, explains Dwight Holton, CEO of Lines For Life. He urged states looking to copy Oregon to consider whether they already have effective pathways to connect people to help. “The most important thing that people who are looking at us can learn is that it’s imperative to build better connections to recovery – the sooner the better,” he said. “We’re playing catch-up.”

Some are defending the decision to decriminalise drugs without first firming up a pathway to recovery.

Immediate decriminalisation was necessary to decrease stigma and prevent thousands of arrests each year, especially in communities of colour, said Tera Hurst, executive director of Health Justice Recovery Alliance. While she conceded the citations were not the best intervention, she argued coercing people into treatment through drug courts undermines their dignity and autonomy, and noted that opioid users face high risk of overdose when they are first released from jail.

“I don’t think we have time to do this in a slow and steady way as some people suggest. In theory that’s fine, but in reality, we don’t invest in things until we have to. Decriminalisation created a space where we have to start investing in these services,” Hurst said.

Measure 110 did create a new funding stream, doling out $30m in grants in its first year for harm reduction, housing and employment assistance, peer support and clinical assessments. That money helped more than 16,000 people. Max’s Mission, a non-profit in southern Oregon, received $215,000 of that money which it used to buy naloxone, which reversed 111 overdoses.

Another $270m will be distributed this spring to create a Behavioural Health Resource Network – entities in each county that assess drug users’ needs, create intervention plans and link them to care. (The grants have faced delays due to internal conflict between members of the Measure 110 Oversight and Accountability Council, which is responsible for handing out the money.)

Heather Jefferis, executive director of the Oregon Council for Behavioural Health, said the next stage of Measure 110 will fund a “robust continuum of care” for people with substance use disorder. “Oregon has never had that,” she said.

She believes it’s too soon to cast doubt on Measure 110. After the grant funds are handed out, she looks forward to data on what new services became available, how many people are referred to services, and other numbers that will show if Measure 110 is having an impact.

Back at the hotline, Lockett thinks Measure 110 will succeed after the Behavioural Health Resource Network is in place. Each county’s network is required to have a hotline, and some will partner with Lines for Life, making their hotline busier.

“If the goal is to reduce the amount of people using drugs … then it’s going to take a concerted effort by all of us, clinicians, police officers, county behavioural health systems – across the board it’s got to be a concerted effort,” he said. “Anything as large scale as this for Oregon, it’s gonna take time. But there’s certainly hope on the horizon.”

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