Last September, as Oregon faced an ever-increasing rate of fatal drug overdoses, a new study concluded the state’s first-in-the-U.S. decriminalization policy was not to blame.
The study found that based on similar overdose rates in other states before and after the first year of decriminalization, overdose deaths in Oregon would have risen at essentially the same rate with or without the policy.
By then, however, it seemed minds were made up. The move to decriminalize personal possession of hard drugs — enacted in early 2021, after voters approved a ballot measure the previous November — had coincided with a rise in public drug use and overdoses fuelled by toxic fentanyl, sparking a public backlash. Meanwhile, the policy’s effort to replace criminal citations with a push toward treatment saw fewer people take advantage of services that were still ramping up to respond to the growing need.
Six months after the study was published, Oregon lawmakers passed new legislation that rolled back decriminalization. Starting Sept. 1, possession of small amounts of drugs will be illegal once again.
Drug addiction researchers and advocates for a comprehensive, health-based approach to the overdose crisis in North America are lamenting the collapse of the Oregon experiment. They also fear a similar situation is playing out in British Columbia, which is facing calls to scrap its decriminalization pilot project as it, too, faces spikes in public drug use and overdoses.
At the same time, the impacts of public drug use and overdoses on downtown cores and communities have spurred safety concerns and discussions about how to balance the roles of police and addiction workers in responding to public safety calls.
Those in favour of keeping the project say decriminalization can still work as part of a multifaceted response to addiction as long as it’s given the necessary time, support, and compassion to do so. They’re urging policymakers not to give up too soon.
“If you work in the cardiology wing and somebody dies, nobody thinks of closing the cardiology wing,” said Eugenia Oviedo-Joekes, a University of British Columbia professor and the Canada Research Chair in Person-Centered Care in Addiction and Public Health. “But when you talk about drugs … people go into fear mode and push it back into the shadows.”
What happened in Oregon?
Nearly 60 per cent of Oregon voters approved Ballot Measure 110, which replaced criminal penalties for possession of small amounts of drugs with US$100 fines. The fine would be waived if users called a treatment hotline number, which was provided by police along with the ticket.
The measure also allocated US$100 million per year toward expanding the state’s addiction treatment services, money that would be sourced from recreational cannabis tax revenue.
From the beginning, the execution of decriminalization was beset with problems. Poor communication between state and local governments, health authorities and police hampered the citation system, with no new training provided to officers tasked with handing out tickets.
In the first year of the new measures, a January 2023 state audit found only one per cent of people who received citations for possessing controlled substances sought help via the new hotline. Another audit in December found citation-related hotline calls averaged just 10 a month, out of about 200 citations issued.
When Global News visited Portland earlier this year and called the hotline to connect to treatment services, the operator could only provide an emailed list of detox facilities to call.
No one Global News spoke with on the city’s streets had tried to get into the treatment programs. Some pointed out that only users who had already made the decision to try and get clean would use them anyway.
It also took 18 months for money to begin flowing into the state’s treatment service sector to boost spaces and access, which has been ranked the worst in the U.S. despite Oregon having the country’s second-highest addiction rate.
As facilities waited for the money to arrive, “Our organization was engaging with service providers who were on the ground saying, ‘We’re going to close our doors, I’ve already maxed out all my personal credit cards, I can’t keep this going any longer,'” said Tera Hurst, executive director of the Health Justice Recovery Alliance, who helped lead the effort to implement decriminalization.
Hurst says decriminalization came during a perfect storm for Oregon. By the end of 2020, the state was still reeling from the pandemic and was coming off its worst wildfire season on record. There had also been months of sometimes-violent protests over racial reckoning after the murder of George Floyd, including clashes with police that Hurst said “fractured” the relationship with the community and made consultations on a radical shift in enforcement difficult.
The pandemic also exacerbated the housing crisis in the state. Between 2020 and 2022, Oregon saw one of the largest increases in homelessness in the U.S., growing 22.5 per cent according to federal data. More than 60 per cent of documented unhoused people were living in unsheltered locations.
The state has estimated it is short 140,000 homes, the fourth-highest housing need nationwide.
With more people on the streets, public drug use grew. Overdose deaths in Oregon, meanwhile, rose 41 per cent between 2022 and 2023, and reached a record high last year.
The CDC, state health authorities and researchers say fentanyl is the “primary driver” of overdoses, and have warned of an increase of street drugs like cocaine and heroin mixed with toxic levels of the synthetic opioid. The U.S. Drug Enforcement Administration says drug dealers use mixing to keep costs down and increase the potency of their products.
But the rising deaths and instances of public drug use — in front of businesses, in parks and elsewhere — led to a revolt against the new decriminalization policy. Suddenly, lawmakers who once supported the change were voicing opposition to it and looking for ways to roll it back.
“Measure 110 became the scapegoat,” Hurst said.
What happened in B.C.?
Although B.C. had more time than Oregon to plan out and implement its own decriminalization regime, it’s now seeing many of the same problems and sparking the same public and political blowback.
Police forces that had called for the new approach were now warning of a rise in open drug use in public spaces ranging from parks and beaches to hospitals.
In January, the chief coroner reported a new record high in overdose deaths for 2023, the first year of decriminalization: at least 2,511 lives lost.
After a legislative effort to ban drug use in many public places was blocked by the courts, B.C. asked the federal government for an amendment to its decriminalization request in April — a request that was granted days later.
But by then, opposition parties in Victoria and Ottawa had seized upon decriminalization, claiming it had only made the opioid crisis worse.
Conservative Leader Pierre Poilievre was kicked out of the House of Commons for calling Prime Minister Justin Trudeau “wacko” for approving decriminalization in B.C., and has pressed him in the weeks since on whether he will approve similar requests from Toronto and Montreal.
Trudeau has said it’s up to provinces, not municipalities, to request criminal exemptions under the Controlled Substances Act. Ontario said this week it is “100 per cent opposed” to Toronto’s request.
Mental Health and Addictions Minister Ya’ara Saks rejected Toronto’s request on Friday, citing “concerns with feasibility and ability for law enforcement to implement the proposed model, protection of youth, and lack of support from key players including the Province of Ontario.”
Quebec Premier Francois Legault has said he has no plans to follow B.C.’s path.
Officials and researchers have stressed that, like Oregon, fentanyl and homelessness are the true culprits behind the rise in public drug use in B.C. Fentanyl is now detected in more than 80 per cent of illicit drug deaths in the province, up from just four per cent in 2012.
The 2023 Homeless Count in Greater Vancouver found the number of unhoused people in the region rose 32 per cent since the last count in 2020, the largest increase on record. Province-wide, homelessness is estimated to have risen by eight per cent from 2020 to 2021.
“Decriminalization was never set up to solve large social problems,” said Mark Haden, an adjunct professor at UBC’s School of Population and Public Health.
Meanwhile, provincial audits released this year found “deficiencies” in how B.C. has implemented overdose prevention and supervised drug consumption sites. Those include failing to address barriers to provincewide accessibility, including “municipal resistance, the lack of infrastructure, and health-care staffing.”
The audits also found problems with the province’s rollout of regulated drug supplies, a key measure to combat the explosion of fentanyl.
Together, they suggested asking the province, among other questions: “How can government improve public information and education about complex health programs and issues in order to reduce stigma and build public confidence?”
With the combination of all those issues contributing to the overdose crisis, the prospect of recriminalizing personal drug possession fills researchers like Oviedo-Joekes with frustration.
“It’s an awful message,” she said, becoming emotional. “Instead of improving the things that we were not doing, or not working on, we apply more restrictions.”
Caleb Banta-Green, a research professor in the School of Medicine at the University of Washington, says when he speaks to lawmakers in his state and elsewhere who want to criminalize drug possession, he often finds himself pressing them on one key question: “And then what?”
“It’s literally like a chess game where people are only thinking one play at a time and not thinking about the second play or the third play,” he said. “It’s just reactionary.”
What now?
Poilievre has vowed to ensure drugs remain criminalized and push the so-called “Alberta model” that prioritizes treatment and recovery over regulated drug supplies and safe consumption sites.
Alberta saw its highest-ever rate of opioid overdose deaths last year. However, monthly deaths have ticked down since peaking in April 2023.
The Conservative leader has also spoken out against safe consumption sites, which federal data shows have seen zero fatal overdoses across all facilities that report to Health Canada. Opponents of those facilities have raised concerns they bring crime and unsafe behaviour into communities. Research compiled by the Canadian Substance Use Resource and Knowledge Exchange Centre says most evidence suggests that is not the case.
“Most of the available peer reviewed research on supervised consumption services (SCS) suggests that SCS do not increase crime and may help improve public order in their surrounding communities,” said a 2022 evidence brief on the topic.
Those researchers also noted there can be challenges with the methodology used in tracking that data.
“Police data typically rely on recorded offences or calls for service, and can therefore be dependent on other factors such as changes in policing patterns (e.g., increases or decreases in the number of patrols),” said the brief.
“Further, surveys are based on subjective perceptions and may not accurately capture the level of crime and disorder before SCS opened in their neighbourhoods, or people may be more likely to notice or report crime after SCS have opened.”
But researchers say treatment can only bring down fatalities if other supports are also in place for users who may not be ready to recover, but can still benefit from harm reduction.
The ongoing labour shortage in Canada is also affecting the ability to expand treatment services due to a lack of addiction workers, B.C. Premier David Eby acknowledged last September.
More jurisdictions seek to connect substance abuse treatment to housing. B.C. launched a complex care-housing program in 2022 that provides primary, mental health and addiction care to substance users facing homelessness. A flurry of bills passed by Washington state last month includes funding for short-term housing for people with substance-use disorders, and Oregon is funnelling another US$18 million into “recovery housing.”
But many of those same laws also reflect a retreat from decriminalization. Washington elected to retain criminal penalties for drug possession, making it a gross misdemeanor punishable by up to six months in jail for the first two offenses and up to a year after that. And while Washington and Oregon’s possession statutes urge police and prosecutors to defer cases toward treatment whenever possible, Hurst says she’s heard first-hand from users that they’re scared of being restigmatized.
“Some believe that people are already starting to go back into hiding,” she said. “And we know with fentanyl that that is a life sentence.”
As many advocates for decriminalization do, Hurst points to Portugal as a guiding example of what’s possible and why patience is needed. The country saw a 75 per cent drop in heroin users between 2001, when its decriminalization policies were implemented, and 2017. In 2021, 63 people died of an overdose the entire year.
And because drug policy has been treated as a health-care issue for decades, rather than a criminal one, Hurst says she heard from Portuguese officials during a visit last fall that the country is “ready” to address the arrival of fentanyl, which has not yet flooded the drug market there.
Researchers say solving the crisis will require changes in policy that will take years to show results — far beyond the political lifespan of many leaders who enact those changes.
“We have this fundamental issue where people want quick fixes,” said Banta-Green. “And then we have politicians who are incentivized to look like they’ve done something … and it’s going to fix the problem, and invariably it does not. Those interim things don’t work. Because if this were easy, we would have solved it already.”
—With files from Global’s Paul Johnson and the Associated Press