Oregon is considering legislation that would recriminalize low-level drug possession, reversing a landmark reform approved by voters in 2020. Although critics of that ballot initiative, Measure 110, cite an increase in drug-related deaths , decriminalization is not responsible for this trend.
Opioid overdose deaths have been increasing nationwide for more than two decades. This trend has been accelerated by the emergence of illicit fentanyl as a enhancer and substitute for heroin, a development that has hit Western states after it had become evident in other parts of the country.
“Overdose death rates have started to increase [the] In the Northeast, South and Midwest, the percentage of fentanyl-related deaths increased in 2014,” noted RTI International epidemiologist Alex H. Kral and his colleagues at a conference in Salem, Oregon, last month. “I Overdose death rates in Western states have not increased will begin to increase until 2020, during COVID and a year after the introduction of fentanyl.”
That lag explains why Oregon has seen a steeper increase in opioid-related deaths than most of the country since 2020. But so have California, Nevada and Washington, neighboring states where drug possession remains a crime.
The decriminalization provided for by Measure 110 came into force in February 2021, while in 2023 Journal of Health Economics The study estimated that that year was associated with a 23% increase in “unintentional overdose deaths.” But “after accounting for the rapid increase in fentanyl,” Brandon del Pozo, a Brown University public health researcher, reported at the Salem conference, “the analysis found no association between [Measure 110] and fatal overdose rates.”
Kral and his collaborators agree, saying there is “no evidence that the increase in overdose deaths in Oregon is due” to decriminalization. This is consistent with the 2023 results JAMA Psychiatry study, which found “no evidence” that Measure 110 was “associated with changes in fatal overdose rates” during the first year.
The expectation that decriminalization will increase overdose deaths is based on the assumption that it encourages drug use. However, a study by RTI International of 468 drug users in eight Oregon counties found that only 1.5 percent of them had started using drugs since Measure 110 took effect.
Since Measure 110 did nothing to address the uncertain quality and unpredictable potency of illegal drugs, it is not surprising that overdoses have continued to increase, in line with trends in other Western states. These problems are created by drug prohibition and exacerbated by enforcement efforts.
When drug users don’t know what they’re getting, as is typical in a black market, the risk of a fatal mistake is much greater. This risk has been amplified by the crackdown on painkillers, which has pushed non-medical users towards more dangerous substitutes, replacing legally produced and reliably dosed pharmaceuticals with products of uncertain provenance and composition.
Worse, the crackdown coincided with the rise of illicit fentanyl, which is much more potent than heroin and thus made dosing even more complicated. This development was also driven by prohibition, which favors highly potent drugs that are easier to hide and smuggle.
The perverse consequences of these policies soon became apparent. The opioid-related death rate, which doubled between 2001 and 2010, nearly tripled between 2011 and 2020, even as opioid prescriptions dropped by 44%. In 2021, the Centers for Disease Control and Prevention counted more than 80,000 opioid-related deaths, nearly four times the 2010 number.
While it is difficult to make much progress in reversing these depressing trends without addressing the underlying legal regime, harm reduction tools such as fentanyl test strips, naloxone, and supervised consumption facilities can impact the death toll by preventing or reversing the overdose. Treating drug users like criminals, by contrast, compounds the harm caused by prohibition by unfairly punishing people for behavior that violates no one’s rights.
“It’s not 2020 anymore,” Albany, Oregon, Mayor Alex Johnson told state lawmakers last week, urging recriminalization. “The world has changed. Fentanyl has become a death grip.” Before following Johnson’s advice, lawmakers should reflect on how this happened.
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