• Posted September 28, 2023

Oregon Decriminalized Possession of Small Amounts of Drugs. Fatal ODs Didn't Skyrocket

Critics of a law that decriminalized drug possession in Oregon have blamed the policy for rising overdose deaths in the state, but a new study finds no evidence of that.

Researchers discovered that while drug overdose deaths have risen recently in Oregon, it appears the trend has no relation to a law popularly known as Measure 110.

Passed by Oregon voters in 2020, the policy decriminalized the possession of small amounts of previously illegal drugs like heroin and cocaine. Instead, people caught with those substances are now issued a citation and a fine -- which is waived if the person undergoes a health screening.

Some critics have blamed Measure 110 for a rise in the state's overdose deaths between 2021 and 2022.

The new study, however, paints a different picture: Oregon's overdose deaths have risen, but to no greater degree than in similar U.S. states where drug possession remains a crime.

While that is reassuring in one sense, it's disappointing in another, said senior researcher Corey Davis, of the Center for Opioid Epidemiology and Policy at NYU Grossman School of Medicine in New York City.

Advocates of Measure 110 have hoped that decriminalization would actually reduce overdose deaths.

They reasoned it would make people more likely to call 911 when an overdose happened, since the fear of arrest would no longer loom. Plus, it would keep drug users out of jail, which itself is associated with an increased risk of fatal overdose, Davis said.

But that is not how things played out in the first year.

"I don't think these findings will make either side happy," Davis said. "But that's what we found."

The study, published Sept. 27 in the journal JAMA Psychiatry, cannot say why overdose deaths weren't affected by the law.

But Davis said he suspects the key factor is fentanyl, an extremely potent synthetic opioid that has been widely blamed for the nation's worsening drug crisis.

In 2021, more than 106,000 Americans died of an overdose, according to the U.S. National Institute on Drug Abuse. Synthetic opioids -- mainly fentanyl -- were the main culprit, with a sevenfold increase in those overdose deaths between 2015 and 2021.

"Fentanyl is just so prevalent and so deadly," Davis said. "Any single intervention would have to make a huge impact to reduce overdose deaths."

Judy Grisel, a professor of psychology at Bucknell University in Lewisburg, Pa., who specializes in researching the causes of addiction, did not see the findings as positive.

"In this case, no news is not good news, because the researchers failed to find evidence of reduced deaths from reducing arrests," said Grisel.

A major limitation of the research, though, is time. Decriminalization went into effect in 2021, and the researchers were only able to track what happened over the next year.

"We don't know whether the intended benefits will take more time to realize -- or worse, will be offset by more use of lethal substances enabled by decriminalization," Grisel said.

Measure 110 did, however, do more than decriminalize drug possession.

It also allocated hundreds of millions of dollars to improve people's access to substance abuse treatment, noted Alexandria Macmadu, a substance use epidemiologist at Brown University School of Public Health in Rhode Island.

"But rollout was very slow, and most of those funds were not released until after this study period ended," said Macmadu.

Given that, she said, "we might expect to see an increase in treatment access and reductions in overdose deaths in the coming years."

For the study, Davis and his colleagues tracked fatal overdoses in the year after decriminalization in Oregon and in Washington state, which made a similar policy change around the same time that has since been rescinded.

The researchers compared each state's trends with those in a "control group" of other states -- 13 that had similar overdose rates to Oregon in recent years, and 18 whose rates were similar to Washington's.

In the end, Davis said, there was no evidence that decriminalization made a difference either way.

"Overdose deaths were going up everywhere, and continued to go up everywhere," he said.

In another recent study, the researchers found that, not surprisingly, arrests for drug possession dropped dramatically after decriminalization in both Oregon and Washington.

At the same time, Davis said, there was no increase in arrests for violent crime -- another worry that has been raised by opponents of decriminalization.

As for overdose deaths, Davis said time will tell, assuming decriminalization lasts. A coalition of political and business leaders in Oregon has reportedly filed two ballot measures to amend Measure 110.

More information

The U.S. National Institute on Drug Abuse has more on treating opioid addiction.

SOURCES: Corey Davis, JD, MSPH, assistant clinical professor, Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine, New York City; Judy Grisel, PhD, professor, psychology and neuroscience, Bucknell University, Lewisburg, Pa.; Alexandria Macmadu, PhD, postdoctoral research associate, epidemiology, Brown University School of Public Health, Providence, R.I.; JAMA Psychiatry, Sept. 27, 2023, online