Analysis shows: Oregon's drug law did not lead to an increase in overdose deaths

A new Study found that drug Decriminalization in Oregon not lead to an increase in overdose deaths in the state – thereby refuting a view often held by opponents of decriminalization.

By tracking the influx of fentanyl into Oregon’s unregulated drug market, the authors of the study, published September 5 in the Journal of the American Medical Association (JAMA)—could explain the increase in overdose deaths that coincided with the introduction Measure 110.

“I think this study plays a role in the postmortem of Measure 110,” said Michael Zoorob, the study's principal investigator and consultant at Rhode Island Hospital filter“Many people falsely attribute the increase in overdose deaths in Oregon in recent years to Measure 110, but that contradicts the available evidence.”

Oregon voters passed Measure 110 in 2020. It decriminalizes the possession of small amounts of all prohibited drugs and significantly increased funding for treatment, harm reduction and other social support. It came into force on 1 February 2021 and was the first measure of its kind in the United States.

On March 1 2024, according to public and political backlashOregon Legislature passed Bill 4002which Drug possession was criminalized again. This took Effective 1 Septembermaking possession of small amounts a misdemeanor punishable by up to 180 days in prison.

A Press release of the Drug Policy Alliance called HB 4002 “a return to the failed approach where the primary response to people struggling with substance use disorders is law enforcement and the criminal justice system rather than reaching out to health and service providers.”

A closer look at Measure 110 and overdose mortality

The JAMA study confirms what Dr. Zoorob says is already “obvious” to many advocates: The increase in overdose deaths in Oregon during the period in question is due to changes in drug supply, particularly the increasing prevalence of fentanyl.

In contrast, the authors concluded that “no association was observed between M110 and the incidence of fatal overdoses.”

This was the first study to examine the circumstances of Measure 110. in this way.

“In many studies, we take fentanyl intake into account when we talk to participants in smaller-scale qualitative studies,” said Saba Rouhani, assistant professor of epidemiology at the NYU School of Global Public Health. filter“But we did not systematically take into account that fentanyl appeared at different times in these different states.”

Dr. Rouhani, who was not involved in the new study, said: The methodology was extremely rigorous. “They took a core technique and replicated it with four different causal inference models; they were even able to reproduce the results of conflicting studies that were published.”

The research group used drug seizure data from the National Forensic Laboratory Information System to first geographically model the spread of fentanyl in the U.S. “The first result is the east-west pattern that people have been talking about,” Zoorob said.

“The tipping point in Oregon where fentanyl comes onto the market is roughly the same point where Measure 110 goes into effect.”

The group used a statistical technique called change point analysis, which looks at the point in time at which there is a dramatic change in the level of a variable, in this case fentanyl in the drug supply.

“The tipping point in Oregon where fentanyl comes to market is roughly the same as when Measure 110 takes effect,” Zoorob said. A chart in the study shows that by the time Oregon reached that point in early 2021, more than 40 other states had already done so.

Next, the researchers used a regression model to quantify how much drug overdose death rates have changed across states over time. were due to fentanyl exposure. “We show that fentanyl exposure explains more than half of this variation, which is crazy,” Zoorob said.

Thirdly, Zoorob’s team succeeded in replicating the results of an earlier studypublished in Journal of Health Economics, It found that decriminalization was responsible for a 23 percent increase in overdose deaths in the state.

When they controlled fentanyl, the effect of decriminalization was negated.

“If you ignore the transition of drug supply, we find that Measure 110 has a statistically significant effect that contributes to overdose,” says Zoorob explains. “But what's really happening here is that there's this confounding variable: fentanyl exposure. When we take that into account, the effect of Measure 110 or drug decriminalization shrinks to zero.”

Evaluations of Measure 110

A new alliance on drug policy report States that decriminalization in Oregon was aimed at reducing the harms of drug criminalization, and that there had been significant progress towards achieving this goal under Measure 110. Proponents did not claim that decriminalisation per se, as opposed to legal regulation, would make the drug supply significantly safer.

With Measure 110, the state envisaged a reduction in arrests for drug possession and Hundreds of millions of dollars in treatment. The report finds that decriminalization also saves Oregon nearly $40 million in criminal justice costs and a significant increase in the number of people accessing substance use disorder treatment and other services.

However, a state Audit published January 2023 was critical of Measure 110, and pointed to a number of shortcomings in implementation. One problem it highlighted was that the citizens' panel that oversees funding for new treatments had been slow to provide funds and that the Health Authority had not provided sufficient support to the panel.

“The fact that the money and resources to really focus on health outcomes were not available until later did not help the public perception of this policy.”

Lawmakers also refused to fund the $50,000 police training that was intended to simplify the new ticket system designed to get people into treatment – ​​a problem that later became apparent in several other reports, However, many advocates have said that involving law enforcement would likely not make people feel safe about seeking treatment.

“The policy actually consisted of two parts,” as Rouhani noted on Measure 110's Decriminalisation and financing elements. “The second part took longer to implement. The fact that the money and resources to really focus on improving health outcomes were only available later did not do much good for the public's perception of this policy.”

The majority of the funds to expand services were not disbursed by the Oregon Health Authority until after August 2022. 18 months later the law came into force.

Supporters Critics of decriminalization accused Oregon politicians of scapegoating widespread public problems in Measure 110, thereby further damaging public perception of the law.

As noted in the Drug Policy Alliance report, external factors such as the increase in evictions and homelessness—in part due to the lifting of COVID-19 eviction protections in June 2021 and increased economic uncertainty during the pandemic—all of this exacerbated Oregon’s housing crisis. From 2020 to 2022, the report said, the state’s homeless population grew by 23 percent.

“Re-criminalization has been done,” Rouhani said, “but I think it is important that we really look closely at the historical facts and reflect on what happened with this policy.”

The future of decriminalization research

Rouhani believes that we will not be able to see – nor measure – the positive health effects of policy changes such as decriminalization until they are implemented over the long term.

“Given that these measures are now being lifted, our ability to see the impact of decriminalisation on promoting supportive treatment pathways for drug users is really limited,” she said. “But we know that arresting drug users does little to prevent future use or crime and increases the risk of a cascade of negative health consequences.”

Criminalization and arrests are connected with a higher risk of overdose, create Obstacles to employment and housing and disproportionately affect people of color and other marginalized populations. “We would expect that [removing criminalization] would in turn have a positive long-term impact on health,” Rouhani said.

As for future research, Rouhani said Zoorob's study could not only shed light on what happened around Measure 110, but also have implications for how researchers conduct “outcomes research broadly” in the context of such a volatile drug market.

“If this happens to coincide with changes in drug supply, people may mistakenly attribute changes in public health to a particular policy.”

Zoorob believes that it is beyond the scope of this paper to make suggestions as to whether or not other states should tackle decriminalization. But he said that He hopes that the study can help in the analysis of other drug policy decisions and would like to see more studies on the impact of drug policy reforms on individual health.

“I think we need to be modest about how much we can learn from an intervention in a single state over a short period of time or from a single study,” Zoorob added.

“But the most important finding is that Measure 110 not “The cause of this increase in overdose deaths,” he stressed, referring to his latest research, “we're probably always going to have this problem when we discuss public policy. If it happens to coincide with changes in the drug supply, people may mistakenly attribute changes in public health to a particular policy when it's actually about these broader macro problems.”

Photo (cropped) by Neon Tommy via Flickr/Creative Commons 2.0

The Influence Foundation, the filterpreviously received a dedicated grant from the Drug Policy Alliance. filterThe guidelines on editorial independence apply.