The Oregon Model
On election night, Doug McVay abided by his own self-imposed media blackout. “If I had been watching cable news this year, I’d have thrown something really heavy at the TV,” he said. Instead, he hunkered down in his Portland home with his cat Jasmine and old episodes of Stargate SG-1, where the good guys inevitably win in the end. “Sometimes, you just need those stories,” he said. For anyone working to roll back America’s ruinous drug war, boy do they. Until recently, the good guys have been perennial losers in a country of unyielding criminalization, mass incarceration, and D.A.R.E officers peddling propaganda to grade schoolers.
The morning after election night, though, the longtime drug policy activist woke up feeling like decades of work were not in vain: Measure 110, Oregon’s ballot initiative to decriminalize the possession of small amounts of all drugs—including meth, heroin, and cocaine—and redirect funds towards substance use treatment decisively passed 58.5 to 41.5 percent. “Holy mackerel,” McVay said before whistling loudly. He was confident Measure 110 would win but was “blown away” by its overwhelming victory.
In 1984 when McVay was in his twenties, he went out to Oregon with a group of activists to try and pass Measure 5, one of the first attempts to legalize cannabis since a tax implemented in 1937 functioned as an effective ban, thanks in no small part to a racist campaign against Mexican migrants. When Measure 5 went to the voters in 1986, it lost, garnering just 26 percent of the vote. “We got kinda creamed,” he said. Oregon would not vote to legalize weed for another twenty-eight years, when it earned 56 percent of the vote in 2014. Six years later, McVay sees Measure 110 as evidence of how far the movement has come. “I’m just disappointed it took this long. I knew it’d happen . . . because the good guys never give up.”
Decriminalizing all drugs had long been considered a drug policy pipe dream in America, where the story of the drug war is one of perpetual escalation. For over half a century, politicians from both major parties fell over each trying to cook up the most potent batch of draconian punishments that, to this day, have done little but disproportionately harm people of color, rip families and communities apart, and saddle people who use drugs with criminal records that prevent them from obtaining student loans, steady housing, and gainful employment. As a senator, President-elect Joe Biden took a leading role in crafting some of the harshest drug laws on record—laws that activists around the country have since been fighting to undo.
If legislators and representatives are too chickenshit to change America’s punitive drug laws, then the people will simply do it themselves.
Oregon’s vote to decriminalize all drugs, making it the first state in the nation to do so, marks a historic turning point in that struggle. “Oregon showed the world that a more humane, compassionate approach is possible,” said Kassandra Frederique, executive director of The Drug Policy Alliance, a nonprofit advocacy group that spent millions backing Measure 110 and successfully campaigned to legalize cannabis in five other states, bringing the number of states where cannabis is legal to fifteen.
These resounding drug policy wins are proof that the country is often far more progressive on drug issues than its elected officials. Deep red states voted to legalize cannabis; blue cities decriminalized psychedelics and elected reform-minded prosecutors. Voters around the country are showing that if legislators and representatives are too chickenshit to change America’s punitive drug laws, then the people will simply do it themselves. Still, these victories are bright spots in otherwise dark times: overdoses, addiction, and deaths of despair are soaring in a country breaking under economic austerity and an unrelenting pandemic. While criminalization has clearly not served the state of Oregon—where overdose deaths spiked by 70 percent during the months of April and May—now the state faces the daunting task of overcoming structural hurdles to change and proving that treating drug use outside the criminal justice system can bring results. “Passing Measure 110 is one thing,” Haven Wheelock, one of the ballot’s original petitioners who works at a syringe exchange in Portland, said. “Making it actually work is something else entirely.”
Measure 110 is an elegant one-two punch. First, it strips criminal penalties for drug possession and swaps them for a noncriminal $100 citation, no more serious than a traffic ticket, that can be waived if one agrees to a free health assessment conducted by a licensed drug counselor. Second, the measure creates a new funding stream for a statewide network of treatment and harm reduction services by redirecting tens of millions of dollars in cannabis tax revenue, in addition to making use of new savings that will come from reductions in arrests, convictions, and other police spending: according to a report from the Oregon Criminal Justice Commission, the measure will reduce convictions for drug possession by nearly 90 percent, from 4,057 convictions in 2019 to an estimated 378 in 2021. “What we’re doing is totally divorcing the funding stream for treatment and health services from the criminal-legal system,” Lindsay LaSalle, attorney and policy director at the Drug Policy Alliance, said. “I think it’s so important because there are so many subconscious levels of coercion that happen as a result of all the money being funneled through the criminal-legal system.”
The shift in priorities will result in Oregon’s biggest public investment in health and social services to treat drug use—a unique opportunity to overhaul a broken health care system and envision a new approach that no longer hinges on ultimatums and coercion. Instead, care providers, treatment centers, and organizations like the Miracles Club, which provide addiction recovery services to Portland’s Black community, will be able to apply for grants from the state to build out programs that serve people who have been harmed by the drug war.
A new way of doing things in Oregon is desperately needed. Another report from the Oregon Criminal Justice Commission gives a blunt assessment of where the state currently stands on treating addiction: “Oregon now ranks among the most challenged states in the nation for substance abuse and mental health problems, while at the same time ranking among the worst states for access to care.” In fact, it sits in forty-seventh place in access to addiction treatment despite the fourth highest addiction rate in the country. The report goes on to describe a fragmented network of public and private services with “very little data to measure outcomes.” In other words, Oregon spends roughly $235 million per year on treatment and prevention services that few people can access, and among those who do, it’s largely unclear whether they’re actually benefiting in any meaningful way.
“Oregon doesn’t have a lot of treatment options right now,” Brent Canode, executive director of the Alano Club of Portland, a recovery services nonprofit, said. “What you end up with are long waiting lists, and we know waiting lists are death lists when it comes to substance use disorder. If you are on a waiting list for three to six weeks, there’s a good chance you might not be around when your number is called.” Oregonians voted overwhelmingly to change all of this. Now, those who fought tirelessly to pass it feel a mandate to deliver a new approach that voters want. Decriminalization officially activates on February 1, 2021, but it will take much longer to actually create the infrastructure that will save lives.
To that end, three “working groups” have been convened to build Oregon’s post-decriminalization world. One group will focus on racial equity, ensuring organizations that serve communities of color are prioritized and given adequate funding and support for their programs. Another group is focused on policing and the criminal justice system, and will work to ensure, among other things, that police change their habits and stop viewing drugs as a pretense to make arrests. The Oregon Criminal Justice Commission estimates that racial disparities in drug arrests could drop by 95 percent and that convictions of Black and Indigenous individuals could plummet by 94 percent because of the measure. But given that law enforcement officials like district attorneys, chiefs of police, and sheriffs organized against the measure, it remains to be seen if the racial disparities in policing will decline as projected. Research by Leo Beletsky, a drug policy expert, finds that changes to drug laws must be followed up with intensive police training and monitoring—otherwise police could undermine reforms by using reasons other than drug possession to initiate stops and make arrests.
Wheelock and Canode both belong to the third working group tasked with reshaping addiction, recovery, and harm reduction services across the state. Canode hopes to see a much broader spectrum of care become accessible. “We know that it’s really fucking hard to stay in recovery when you don’t have safe and supportive housing, when you have felony convictions and are unable to gain sustainable and meaningful employment,” Canode said. “We can now address these social determinants through Measure 110 programming.” He argues that not everyone necessarily requires treatment in a residential setting. Services that help people get their lives back can run the gamut, he said, from housing to job training to record expungement (the measure does not automatically expunge prior convictions, but it’s possible for the state legislature to pass legislation that does).
One of the biggest challenges to building new health care infrastructure in Oregon is the fact that such limited data exists about the efficacy of the current system, both public and private, despite a years long effort to more effectively measure outcomes. This will hopefully change under Measure 110, which will be audited and evaluated every two years to track both outcomes and spending. While there’s a degree of flying blind until that first evaluation occurs, there is strong evidence that harm reduction strategies save lives.
Implementing decriminalization and building out a new suite of services while increasing support to those that already exist will be an experiment yet to be undertaken at this scale anywhere in the United States.
Which is why decriminalization may create a much more welcoming climate for innovative harm reduction services, like checking street drugs for the presence of illicit fentanyl and creating supervised consumption sites. “I’m really excited about the collateral benefits decriminalization can bring to other harm reduction efforts,” Canode said, noting that if a supervised consumption site is approved it can be funded through Measure 110’s grant program. While there are underground safe consumption sites operating throughout the United States, none of them are sanctioned by the government. In 2019, a judge ruled that consumption sites do not violate federal law, but no city has yet to take the leap and officially open one. Joe Biden’s Department of Justice could drop any pending appeals in that case, signaling they would let a site open—or they might not.
Which programs and organizations will receive funding—and how much—ultimately rests with a newly created group called the Oversight and Accountability Council, which is made up of doctors, epidemiologists, and social workers appointed by the Oregon Health Authority. Perhaps most importantly, though, people who have been impacted by addiction and drug enforcement will also serve on the council, a clear recognition that people who know the horrors of drug criminalization must have a seat at the table where decisions are being made.
Implementing decriminalization and building out a new suite of services while increasing support to those that already exist will be an experiment yet to be undertaken at this scale anywhere in the United States—and many things could go wrong. “The most dangerous period is the transition period,” said Morgan Godvin, a commissioner on Oregon’s Alcohol and Drug Policy Commission, who became an advocate after spending time in federal prison for selling heroin that led to her best friend’s fatal overdose. “Public opinion and the narrative could be warped in detrimental ways. Even if it’s not real, people will try to insinuate that decriminalization is causing a spike in drug use.”
Now that uber-potent, illicitly manufactured fentanyl is making its way to Portland from the East Coast and Midwest, overdose deaths could keep rising, for instance. “It will be important to urge caution in early interpretation of the effects of Measure 110,” according to Andy Seaman, an addiction medicine physician and researcher in Portland. “There has been an increase in overdose of 70 percent since April associated with fentanyl. There will be claims that Measure 110 is causative if this trend continues.” The measure may likewise face opposition in rural parts of the state, which voted by wide margins against it. “More conservative counties can sabotage implementation,” Godvin said. “We’re going to be battling against this.”
Wheelock feels the pressure to get it right and build a system that works. “This isn’t just about Oregon for me,” she said. “It’s so important to me that we do this right because if we don’t, it’s going to be really hard for other states to replicate it. And our opposition has pushed back on this. But I don’t need to worry about saying that out loud anymore now that we won. The truth is, I want decriminalization nationally.” The dominos are lining up: with cannabis now fully legal in fifteen states, what’s stopping them from also ending the criminalization of other drugs and funding treatment with new tax revenue? Oregon’s victory has put wind in the sails of Washington State’s Treatment First campaign, which, like Oregon, aims to end unnecessary drug prosecutions and fund treatment. Oregon took the first step so that other states may follow suit.
During the 1990s, Portugal’s drug problems looked a lot like America’s do now: opioid overdoses were rampant, and at one point, the country had the highest HIV transmission rate in the European Union. Portugal’s drug laws were likewise harsh, with roughly half of people in prison there for drug-related offenses. The American way––criminalize, criminalize, criminalize––utterly failed to bring results in Portugal, so they ran in the opposite direction. In 2001, Portugal became the first country in the world to decriminalize all drugs and invest heavily in treatment and social services. The country has made remarkable progress in the years since, and what became known as the “Portugal model” is celebrated by activists around the world.
What’s happening in Oregon is “the Portugal model on a state level,” McVay said. “We’ve seen it work successfully in another country for twenty years. Treating people who use drugs as others, stigmatized and brutalized, is what causes the real drug problems. We’re getting people to understand that.”
There’s an important lesson for Americans to take away from Portugal’s story: decriminalization was only the first step. Shifting the culture is what ultimately transformed the country and led to the drop in incarceration and addiction rates. Instead of being considered criminals and junkies, people struggling with drug use and addiction began to finally be treated with dignity and respect. You cannot humanize people you deem to be criminal. Oregon has taken the first step, but it will take an unshakable commitment—and years of follow through—to enact change in the systems of policing and health to finally treat people with addiction like they’re no longer criminals. “It’s a slow process,” McVay said, “but hey, in 1984, the Oregon ballot measure didn’t work. Back then, people thought we were crazy for even trying.”