America’s most radical experiment with drug decriminalization has ended, after more than three years of painful results. Oregon Governor Tina Kotek has pledged to sign legislation repealing the principal elements of the ballot initiative known as Measure 110: Possessing hard drugs is again a crime in Oregon, and courts will return to mandating treatment for offenders. Oregonians had supported Measure 110 with 59 percent of the vote in 2020, but three years later, polling showed that 64 percent wanted some or all of it repealed. Although the measure was touted by advocates as a racial-justice policy, support for its repeal was especially strong among African American and Hispanic Oregonians.
The key elements of Measure 110 were the removal of criminal penalties for possession of small amounts of drugs such as methamphetamine, heroin, cocaine, and fentanyl, and a sharper focus, instead, on reducing the harm that drugs cause to their users. More than $260 million were allocated to services such as naloxone distribution, employment and housing services, and voluntary treatment. The original campaign for the measure was well funded by multiple backers, most prominently the Drug Policy Alliance, based in New York. Supporters hoped that ending penalties—and reducing the associated stigma of drug use—would bring a range of benefits. Once drugs were decriminalized and destigmatized, the thinking went, those who wanted to continue using would be more willing to access harm-reduction services that helped them use in safer ways. Meanwhile, the many people who wanted to quit using drugs but had been too ashamed or fearful to seek treatment would do so. Advocates foresaw a surge of help-seeking, a reduction in drug-overdose deaths, fewer racial disparities in the health and criminal-justice systems, lower rates of incarceration, and safer neighborhoods for all.
But disappointments stacked up rapidly. Measure 110 failed because its advocates misunderstood addiction, and also because they misunderstood the culture and political history of Oregon. Both of these misunderstandings should be of keen interest to other states and municipalities contending with the fentanyl crisis, and to the federal government. An appreciation of what went wrong can help other places land on a drug policy that is both humane and effective, instead of veering toward one extreme or another.
Measure 110 did not reduce Oregon’s drug problems. The drug-overdose-death rate increased by 43 percent in 2021, its first year of implementation—and then kept rising. The latest CDC data show that in the 12 months ending in September 2023, deaths by overdose grew by 41.6 percent, versus 2.1 percent nationwide. No other state saw a higher rise in deaths. Only one state, Vermont, ranks higher in its rate of illicit drug use.
Neither did decriminalization produce a flood of help-seeking. The replacement for criminal penalties, a $100 ticket for drug possession with the fine waived if the individual called a toll-free number for a health assessment, with the aim of encouraging treatment, failed completely. More than 95 percent of people ignored the ticket, for which—in keeping with the spirit of Measure 110—there was no consequence. The cost of the hotline worked out to about $7,000 per completed phone call, according to The Economist. These realities, as well as associated disorder such as open-air drug markets and a sharp rise in violent crime—while such crime was falling nationally—led Oregonians to rethink their drug policy.
Both of us have spent the better part of our careers studying and working on drug policy. Both of us watched this deterioration in Oregon’s public health and safety with dismay, and tried to help stanch the damage. We testified before the Measure 110 legislative implementing committee in 2022 in the hopes that the spirit of Measure 110 could be maintained if some reforms were allowed, such as the elimination of open-air drug markets and the resumption of mandated treatment for those suffering from severe addiction. But tweaking the measure proved very difficult. Last year, one of us, Rob Bovett, began working closely with a number of groups trying to reform Measure 110 through legislation, including a bill based on a proposal developed by Oregon’s city governments, sheriffs, police chiefs, and district attorneys, and a bill based primarily on a petition filed by a coalition of Oregonians that had grown weary of the measure’s ongoing failure. He testified before the Measure 110 reform committee and participated in negotiations that led to the reform package that just passed.
We were not surprised that a trivial pressure to seek treatment was ineffective. Fentanyl and meth addiction are not like depression, chronic pain, or cancer, conditions for which people are typically motivated to seek treatment. Even as it destroys a person’s life, addictive drug use by definition feels good in the short term, and most addicted people resist or are ambivalent about giving that up. Withdrawal, meanwhile, is wrenchingly difficult. As a result, most addicted people who come to treatment do so not spontaneously but through pressure from family, friends, employers, health professionals, and, yes, the law.
But it wasn’t just that the measure’s proponents misunderstood addiction. They also did not understand Oregon, a state in which the measure’s biggest funders did not live. Branding Measure 110 as a rebuke to the War on Drugs made no sense, because Oregon had never fought such a war. In 1973, it became the first state to decriminalize possession of marijuana. When federal and state mandatory-minimum sentences for drug crimes flowered in the ’80s and ’90s, Oregon went the other way, making it impossible for someone to go to prison for simple drug possession. Overall, the state had the country’s lowest rate of imprisonment for nonviolent crimes. Short local-jail sentences for drug possession were permitted, but diversion programs, including drug courts and community supervision with drug testing, were widely used. However, after Measure 110 was passed and the threat of jail time eliminated, the flow of people into these programs slowed.
Does the repeal of Measure 110 mean that drug-policy reform is dead? Oregon’s drug policy attracted national and international attention, and its high-profile failure will likely discourage other states and countries from pursuing maximalist decriminalization policies, at least for a time.
But the lessons from Oregon’s troubles should not be overdrawn. One thing Measure 110 got right, at least in principle, is that Oregon’s addiction-treatment system was grossly underfunded, with access to care frequently ranking at the bottom of national indicators. The mechanism that the measure created to manage new spending was clumsy and didn’t work well, but the new law acknowledges the problem and provides extensive new funding for immediate needs, including detox facilities, sobering centers, treatment facilities, and the staff to support those services.
Though our polarized politics tends to frame policy choices as on-off switches, in truth they are more like a dial with many intervening settings. That dial can be productively turned in many parts of the country. Many states are far more punitive toward drug users than Oregon was before Measure 110 passed. They overemphasize incarceration of people who use drugs, they do not provide adequate, publicly funded health treatment and health insurance, and they do not use criminal justice productively to discourage drug use (for instance, by using arrests and probations as leverage to get people into drug courts and treatment). If these states could be persuaded to dial down their criminal-justice approach to approximate what Oregon had before Measure 110, except with adequately funded, evidence-based prevention and treatment, substantial gains in public health and safety would likely follow. The future of successful drug-policy reform is not greater laxity in states that are already quite progressive in their approach to drug use; it is using criminal justice and public health together in a balanced, pragmatic fashion, as Oregon is now poised to do.
