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American Rehab

Oregon’s fleeting experiment with humane drug laws

It has been close to ten years since I’ve ridden a bike through downtown Portland, Oregon. I was born and raised just outside the city, in a quiet suburb called Tigard, and I have vivid memories of taking my father’s bike as a teenager, loading it onto the TriMet bus, and riding an hour north, where I’d deboard and cruise the lush, green streets. I’d stop for water, needles, and dope—before settling down somewhere along the Willamette River to get high. These were some of the best and worst years of my life.

It was around this time that I first got caught using. One day during my senior year of high school, I was yanked out of class on suspicion of intoxication and for acting erratically. They searched my jacket and found a half gram of heroin wrapped in tinfoil, along with some razor blades. I was taken to the principal’s office, where I broke down and sobbed. I was charged with felony possession of heroin as a minor and entered the Washington County Juvenile Drug Court, also known as the Keys to Success Program. The first order from the judge was to complete an inpatient rehab program; I joined a wait list.

Waiting has long been a defining feature of addiction treatment in Oregon, which has the second highest rate of substance abuse in the country—but has ranked dead last for a number of years in terms of access to treatment. Those who want it must navigate a byzantine “continuum of care” that usually includes a combination of detox, outpatient and residential rehab, transitional housing, counseling, peer support groups, and medication. The process of getting and staying sober is different for everyone; there’s no proven path or single, surefire treatment. When it comes to detox and residential rehab, Oregon suffers from a severe shortage of beds, leading to outrageous wait times that can thwart an already tenuous path to sobriety.

By almost every measure, the crisis has only gotten worse in the years since I was struggling with addiction: overdose deaths, many of them from fentanyl, surged an astronomical 1,500 percent between 2019 and 2023 in the state. What did change, at least briefly, was the state’s response. In November 2020, 58 percent of voters backed Measure 110, a first-in-the-nation experiment to end nearly all criminal penalties for drug possession. It would also funnel hundreds of millions of dollars—from legislative appropriations, savings from reductions in arrests, and marijuana tax revenue above a certain point—into maintaining and expanding non-Medicaid components of the continuum of care, including detox and rehab facilities. Together, decriminalization and increased funding for these consistently overlooked services would, supporters of the measure argued, finally begin to staunch, if not reverse, the tide of addiction and death.

The measure met immediate headwinds. Opponents were quick to claim that the easiest and cheapest initiatives to roll out—especially harm reduction services like needle exchanges—did little more than enable it. Scenes of drug use and homeless encampments in downtown Portland were picked up and circulated by the media as indisputable proof that decriminalization had, promptly and perhaps irrevocably, turned the progressive redoubt into a lawless hellhole. Fox News, for instance, seethed that, “homelessness has exploded in Portland, with open-air drug use as common as the tents, trash, drug paraphernalia, and human waste that line once thriving city streets.” Meanwhile, as conservative lawmakers and police launched a campaign to stymie the measure’s rollout, and wealthy Oregonians, including retired Nike cofounder Phil Knight, mounted an effort to repeal parts of it. Earlier this year, they succeeded: in February, legislators voted—by a wide margin—to recriminalize the possession of drugs while retaining the increased funding for the continuum of care. In April, the Democratic governor Tina Kotek signed the partial repeal.

When Measure 110 first passed, I was cautiously optimistic that it would help expand recovery services, decrease the lengthy wait times at detox and rehab facilities, and help people skip the jail cells where I spent months of my life. Three years later, the number of inpatient beds in Portland and across the state is starting to expand, though progress is slow, and the supply remains far short of the demand. More money is needed. But public opinion has wavered, and there’s not likely to be much appetite among lawmakers to advocate for further expanding funding for treatment beds on the scale required to meaningfully address the crisis of addiction. Could things have gone any differently?

Tickets to Write

Jail—and the threat of jail—are a huge part of my story. I can’t be sure where I would be today if I’d never had to experience incarceration and everything that came with it. Some of the most traumatic events of my addiction happened while incarcerated for nonviolent drug crimes: isolation, incessant coldness, malnutrition, extreme acts of violence. Yes, this was rock bottom, a reason to continue on my current path of sobriety. But was it all really necessary? Is it ultimately the reason I was able to get and stay clean in the end?

I met with a medical specialist and was given Subutex throughout the day to help with detoxing—a miserable process even with the help of medication.

Measure 110 sought to chart a different path for those struggling with addiction. After it was enacted, the possession of small amounts of street drugs went from being a crime that often led to jail time to something more akin to a parking violation. Police were instructed to hand out $100 tickets to anyone caught possessing small amounts of cocaine, methamphetamine, heroin, or fentanyl. Officers were then supposed to inform the person cited that the fine would be waived if they called a hotline printed on the ticket and completed an appointment with a treatment specialist. (If you didn’t pay the fine or make the call, the citation would eventually wind up in collections, but it wouldn’t accrue fees and would rarely, if ever, lead to jail time.) Supporters hoped the decriminalization component would immediately benefit racial and ethnic minorities, considering they are disproportionately arrested and jailed for low-level drug crimes—and, indeed, the number of Black Oregonians arrested for drug possession has decreased by 77 percent since the law took effect.

In Portland, these citations were often handed out by the police department’s bike squad. In February, I met with officer David Baer, a five-year veteran of the bike squad, to join him on his rounds, revisiting after so many years the streets of downtown Portland. Baer, who is tall with dark hair and blue eyes, operates the team’s social media accounts, which regularly feature videos of detainments and police chases. (I’m glad I was able to get sober long before being humiliated and further ostracized from the community by being featured in one of his Instagram posts.) This footage is some of the city’s most effective pro-police propaganda, and the message when Measure 110 was in full effect was clear: decriminalization had hamstrung the police’s ability to combat the drug crisis.

As Baer and I mounted our bikes and began heading up Southwest Main Street, he looked over to me as if he had just remembered something. He asked if I’d ever been convicted of a felony. I admitted that I had: in 2013, I’d been arrested for possession of heroin and charged as an adult. I pled guilty to a Class B felony charge that still follows me around to this day. (The previous charge from when I was in high school had been expunged.) Baer abruptly stopped his bike in the middle of the bike lane. He called his supervisor, who indicated that department policy barred me from the ride-along because of a crime that I committed more than ten years earlier and that the state of Oregon no longer considered a crime. Baer understood the irony, but he threw up his hands; there was nothing he could do. He allowed me to ask him some questions before he departed.

“You got 95 percent of what you needed,” Baer told me. “The only thing you would see is me finding someone smoking fentanyl, saying, ‘Here’s the ticket, here’s the card with the number. Alright, have a nice day,’ and then move on.”

This conversation, however, was not 95 percent of what I needed. I wanted to witness the citation process because I believed the Portland Police Bureau’s role in introducing addiction treatment to the most downtrodden citizens in Rose City was integral to making sure Measure 110 worked as intended. It was also one of the less effective parts of the measure over the last three years. Police, arguing that decriminalization took away one of their only tools to fight drug crime, handed out few citations, presumably because they found them pointless: cops in Oregon gave out only around twenty-five hundred citations a year in the time Measure 110 was active, compared to the roughly ninety-five hundred arrests they made annually in the years before.

“Those are statewide numbers that you’re talking about,” Baer told me. “The bike squad has issued seven hundred since May [2023]. It’s the law, and it’s what my boss expects me to do. I write so many tickets that I pre-fill them in the morning.” He went on: “I can see why other agencies who are even more strapped than us in terms of staffing are going to be frustrated because it does feel frustrating sometimes.”

The original tickets were also confusing. The language describing the hotline wasn’t clear, and almost no one used it: there were only 119 callers in the first fifteen months of the measure’s enactment, at a cost that worked out to an astounding $7,000 per conversation. Some people I spoke to in the field of addiction recovery knew little about the hotline. A local addictions counselor, Dave Crosby, said he’d never even heard of the hotline in his work, let alone spoken to anyone who’d been referred to services from calling the hotline in the nearly three years it’s been in place. “I don’t know where those calls are going to, and I don’t think that was communicated very well,” he told me.

By the time I met Baer, he was carrying around something like a business card that he was handing out with the ticket; it included the hotline number and clear instructions on how to get the fine waived. In the wake of Measure 110’s repeal, anyone caught with small amounts of illicit drugs will face up to six months in jail. However, individuals still have the option to pursue drug treatment over incarceration: the PPB’s rounds continue, and if a person given a citation attends an appointment with a specialist, the misdemeanor case will be expunged. If not, police will submit the case to prosecutors, who will treat it similarly to diversion offered for first-time drunk drivers. The person will be placed on probation, and treatment will be mandated. The backstepping is likely to further increase the workload of a historically understaffed public defender system: in March, the Oregon Public Defense Commission requested $29 million it says will be necessary to hire new attorneys to take on the additional case load.

But even for those who do decide to make the call and try to get treatment, the system—despite years of Measure 110 funding—remains ill-equipped to offer it. “People were getting these tickets saying to call this line,” Chloe Meola, who until recently worked for a residential rehab treatment provider in Oregon, told me before the measure’s repeal. “But there wasn’t a ton of ‘OK, well, what’s the next step from there?’”

The Detox Queue

One of the biggest hurdles to my sobriety was finding an open bed at a detox facility and, later, at an inpatient rehab. The process was—and remains—a labyrinth of telephone calls, online portals, and weeks-long games of phone tag. I was lucky to have family help me navigate the system; others aren’t so fortunate. Once you make contact, it can often take anywhere from a few days to two months to get a bed. The pandemic only exacerbated an already grim situation. Too much delay can lead once-willing addicts to wind up relapsing. Of the sixteen thousand people who used services—such as housing assistance or syringe exchanges or other harm reduction methods—in the first year of decriminalization, less than one percent entered any form of treatment; one can only assume problems of access played a role.

Even as funding continues to flow into expanding the range of treatment options, the balance has been tipped back toward incarceration.

Until recently, Portland only had two detox facilities, and both report regularly having to turn people away. Hooper Detoxification Stabilization Center, run by the nonprofit Central City Concern, is the largest, with fifty-five beds. They don’t offer a wait list but will take anyone regardless of insurance, so every weekday from 6:45 to 7:45 a.m., people line up outside in hopes of getting a bed. I went there in early 2011. It was my second time going to an official detox center, and it took me days of waking up every morning before dawn and traveling to Hooper to stand in line before a bed opened up. Waiting with the other detoxing souls was always jarring; each of us wanted to get in, but we all knew that we could potentially go get dope together if there wasn’t room that day.

Once I finally got in, I found what looked like an army medical dorm: rows of small twin beds, with only a few feet between them. The staff, for whatever reason, had blackout blinds on all the windows, enveloping us in the dark no matter the time of day. My days were spent reading and attending mandatory group therapy sessions. I met with a medical specialist and was given Subutex to help with detoxing—a miserable process even with the medication.

In 2022, Hooper served 2,762 people—but had to turn away about 2,100. A spokesperson for Central City Concern said the organization estimates that it alone needs two to three hundred more beds in order to meet the current demand. “Visible change will not come until services are present and available,” a spokesperson told me. “We need other organizations—many funded by dollars from Measure 110—to be part of a holistic system that moves people from detox to recovery services at the right level, in the right setting, for the right duration of time, both inpatient and outpatient.” (CCC did not apply for Measure 110 funding for Hooper, which does accept private insurance and so was ineligible for funding, although they did apply on behalf of other programs and succeeded in getting grants.)

A draft report commissioned by the Oregon Health Authority and released in January confirmed that the shortage is a statewide problem: in order to meet the current need, Oregon needs to add roughly twenty-seven hundred more residential detox and rehab beds—an increase of nearly 138 percent—to the tune of $500–800 million over the next five years. (And this only includes start-up costs.) Confirmed funding falls far short: in 2021, lawmakers allocated $1.35 billion for Oregon’s behavioral health system, intended to be a “transformative” investment through 2023. Measure 110 was one of six major categories this money was spent on, according to an OHA report. Of those funds, $67 million was specifically set aside to increase the number of behavioral health beds across the state, including but not exclusively at detox and rehab facilities. During last year’s legislative session, lawmakers also gave the green light to an additional $164 million to expand behavioral health treatment—although only a sliver of that funding will go toward residential addiction treatment services.

An audit of Measure 110 funding released in December showed that out of the $264 million awarded in grants from the law’s enactment through the end of last year, $57.4 million went to organizations that provide detox or residential treatment, which doesn’t necessarily mean that funding went toward those programs in particular. This includes at least five projects that will result in added detox or withdrawal management beds, including two that expand inpatient treatment capacity. It didn’t help that the state’s review and handling of the first round of grant applications was chaotic, inspiring confusion among applicants about necessary documentation and deadlines. According to the audit, initial funds were less likely to be directed to expanding treatment beds than they were toward low-barrier housing, outreach, and community-based staff—essential services by any measure. Residential treatment is not a silver bullet, of course, and every point along the continuum of care needs to be bolstered, especially given how little we know about the most effective course of addiction treatment.

One of the organizations that did receive grant funding from 110 to expand the availability of detox is the nonprofit Recovery Works Northwest, which received $3.3 million in 2022. About a third of this went into purchasing and retrofitting a new sixteen-bed detox facility in Southeast Portland (additional funds also came from nearby Clackamas County). Unveiled last August, it is the first of its kind in the state to open with Measure 110 backing, according to Recovery Works. This brings the number of detox beds available in Portland—a city of more than 650,000 people—to ninety, an increase of roughly 18 percent. But at this rate of spending, it will take decades to bring online the number of detox and rehab beds that Oregon needs now. Julia Mines, the executive director of The Miracles Club, a recovery services program based in Portland’s east side, said the repeal is nothing but a return to the tactics of the war on drugs. “And who do you think has the bullseyes on their back?” Mines asked. “Black, brown and indigenous folks; those are the ones that are going to start going back to jail.”

Halfway Home

Measure 110’s decriminalization component went into effect in 2021, but money didn’t start flowing into the continuum of care until over a year later. That means the measure had vanishingly little time to prove its usefulness before opponents—backed by the media and big-pocketed donors—pronounced the experiment an unqualified failure. “It’s not going to change overnight,” Mines told me.

The Miracles Club received more than $3.2 million in Measure 110 funding to operate three existing transitional living houses, which are like halfway houses that help people transition from treatment or jail back into society. With the help of this money, they also opened up a new stabilization center in Gresham, just east of Portland, in February. A stabilization center is a place someone can go to dry out long enough to be able to make an informed decision about whether or not they need detox or treatment; prior to the measure, jails often served this purpose, however poorly. (Had a place like this been around when I was struggling with addiction, I imagine it could have provided me with the space to decide to get clean much sooner.) Mines hopes the new center will remove jail from the equation by providing a place for people to go and receive peer support and lodging while waiting for a detox or inpatient treatment bed to open up, making it less likely for an addict to go back to the streets, and maybe to jail. “We’re doing phenomenal work, but they aren’t publicizing that,” she said of the measure’s opponents and the media. “They’re just talking about all the flaws. Everybody doesn’t have to go to jail to get clean. That doesn’t have to be everybody’s story.”

This very question—whether criminalization, prosecution, and incarceration are essential tools in fighting the addiction crisis—became the central point of concern, to the exclusion of other issues. The complexities of the continuum of care and the slow-moving effort to improve its functioning were shunted to the sidelines; in their place, visions of unchecked drug use and lawlessness fanned the flames of a backlash to Measure 110 that led to its partial repeal.

What I went through—the stints in jail, the fines and criminal charges, the purgatory of waiting for treatment—is bound to be the norm once again now that Oregon has decided a jail cell should be a key component of addressing the addiction crisis. Even as funding continues to flow into expanding the range of treatment options, the balance has been tipped back toward incarceration.

An Emergency Bed

The current state of downtown Portland—the drug markets, the armed fentanyl dealers, the shuttered businesses, the tent cities—is not a direct result of Measure 110, despite apocalyptic reports from the media. It’s the direct result of a combination of forces, including a national opioid crisis instigated by lax governmental oversight, greedy pharmaceutical companies, and an insatiable American consumer drug market. This is why it’s so absurd to criminalize possession of small amounts of drugs that our society creates the demand for in the first place.

When I entered treatment for the fifth and final time, at Serenity Lane in Eugene in August 2014, I had no conception of what being sober even looked like.

When I, like so many young people, began experimenting with marijuana at age fifteen, the next drug that was readily available was prescription opiates like Vicodin and oxycodone. Had it been five years earlier or five years later, I don’t know if this would have been the case. I was a freshman in high school at the tail end of what experts call the first “wave” of the opioid crisis, which started in 1999 and was marked by the over-prescription of opiates that led to a precipitous rise in overdose deaths. The second wave began in roughly 2010 and was likewise marked by rising deaths, many from heroin. The third and most fatal wave is the one we’re in now, which flooded our illicit drug supply with fentanyl. On a national level, deaths involving fentanyl and other non-methadone synthetic opioids have continued to rise, unchecked. Last year, 112,000 died from overdoses—a new peak—according to the Centers for Disease Control.

When I entered treatment for the fifth and final time, at Serenity Lane in Eugene in August 2014, I had no conception of what being sober even looked like. My grand plan was to go to rehab, stay sober long enough to get off of post-prison supervision, and start working in the cannabis industry. But something was different that time. It wasn’t the threat of more jail time that finally got me clean. Yes, I had been desperate, and at a perpetual rock bottom for the previous six years, though what got me clean this time was a perfect set of circumstances that seems out of anyone’s control. I met a good group of young people at Serenity. But when it came time for me to leave after thirty days, I wasn’t even close to being ready for the “real world.”

My counselor told me to interview at a local Oxford House, part of a network of over three thousand sober living houses—akin to transitional housing—across the United States and in a few other countries. I knew it was full, and that if I didn’t get in, I would go back to Portland and continue fucking up my life. For some reason, the men at that house gave me an “emergency bed,” which was just a twin-sized mattress that they put in the corner of the kitchen. It’s where I slept for my first month out of treatment, in between six hours of outpatient groups a week and a robust schedule of Alcoholics Anonymous meetings and sober outings. It’s this level of community and sober living immersion that I needed to free myself from a yearslong cycle of destruction. Recovery doesn’t end once you get into detox, or rehab, or even transitional housing like Oxford. It’s something that I’ll be working on for the rest of my life.

Measure 110 was never meant to be a panacea. It was intended to create funding for services that build environments that make it more possible for a struggling addict to get lucky like I did. The state needs to help people find things they don’t want to lose, a life that actually feels worth living—a life that’s appealing enough that it would make someone leave everything they know for something new. And that’s a large factor to getting sober that many people overlook.

In an evaluation of Measure 110 in The Journal of Urban Health, published in February 2022, researchers found a “rush to judgment” in the media, and a lack of attention to the voices of those most affected by Measure 110, making public opinion particularly difficult to change. Ricky Bluthenthal, a professor of population and public health sciences at the Keck School of Medicine of University of Southern California who participated in the study, told me earlier this year that one of the hardest parts about implementing Measure 110 was that it asked people to change their operating assumptions of the world. The war on drugs was a pronounced failure, and we need to take a different tack than pursuing criminalization at the expense of treatment. “If you can acknowledge that your previous behavior has failed you, do you have the wherewithal to change? And then do you have the clinical will to stick with it long enough to have it rolled out and implemented in a meaningful way? It sounds like the answer is probably no, at least in the short term,” Bluthenthal said, “but I think we have to keep on making the same points, which is that there are very successful alternatives.”

This kind of change—in public perception, in treatment infrastructure—takes time. The United States has spent nearly fifty years advancing the policies of the war on drugs, spending billions to build out a massive prison system and then filling it with disproportionately Black and brown nonviolent drug offenders while starving social services of resources. We shouldn’t have expected everything to be fixed in Oregon within three years of Measure 110’s enactment. The media and lawmakers have framed 110 as a resounding failure, which only gives credence to common misconceptions and prejudices about how addiction works. There is no winning and there is no losing; there is only the meaningful—but slow—work to increase access to treatment.