A post-mortem on Oregon’s drug decriminalization efforts

Oregon made history in 2020 when it became the first state in the nation to decriminalize small amounts of hard drugs like cocaine, heroin and meth.

But last month – the state repealed it. What happened?

Today, On Point: A post-mortem on Oregon’s drug decriminalization efforts.

Alex Kral, distinguished fellow at RTI International, an independent nonprofit research institute. He's leading a four-year evaluation of Oregon’s Measure 110.

Tera Hurst, executive director for the Health Justice Recovery Alliance. Her organization is the only one dedicated to the implementation of Oregon’s Measure 110.

Max Williams, co-lead of the Coalition to Fix and Improve Measure 110.

David Baer, public information officer for the Central Precinct Neighborhood Response Team of the Portland Police Department.

Part I

MEGHNA CHAKRABARTI: We start today's show with a moment from Portland, Oregon. You're about to hear a scene from an excellent series of reports by Conrad Wilson of Oregon Public Broadcasting. He spent a lot of time with first responders to witness firsthand the impact of Oregon's fentanyl crisis.

The state has the worst drug addiction rate in the country. And a warning. In this 92 second clip, there is a graphic description of a drug overdose death.

CONRAD WILSON: The call crackled in over Portland Police Sergeant Jerry Cioeta's radio. It was two by cops under his command in Old Town. Someone had overdosed a few blocks away.

POLICE: We deployed Narcan twice now.

WILSON: About one minute later, Cioeta was on the scene. In one fluid motion, he pressed his foot on the brake, put his police cruiser into park and unbuckled. Pausing for a beat to look out the passenger side window to see what he was getting into, and then whispered under his breath, he's dead. There, was a young man splayed out on the red brick sidewalk in the middle of the afternoon.

Even from across the street, it was clear the pink and red had drained from his skin. In their place, a lifeless white face and light blue lips. Down the block, a light rail train rang its bell as Cioeta sped across the tracks towards his officers, the ones who had already given the man two doses of the overdose reversal drug Narcan, they were still trying to save the man's life.

POLICE #1: Boss, how much more Narcan do you have?

POLICE #2: A lot more.

POLICE #1: Fine. Boom.

WILSON: Cioeta got down on one knee, held the man on his side and sprayed a third dose up his nose.

POLICE: Hey, don't die on us. Come on. Come back. There we go. Come on. Come on. Wakey, wakey.

WILSON: This moment, playing out on a Portland sidewalk where life or death is up for grabs, has become routine.

CHAKRABARTI: And that awful moment, reported by Oregon Public Broadcasting's Conrad Wilson. He's been doing really tremendous long-term reporting on Oregon's drug abuse crisis and the state's attempts to do something about it. And this particular story appeared in an episode of OPB's podcast, The Evergreen, back in February.

And that moment also contains the powerful reason and motivation that led Oregon voters to pass a historic referendum, three and a half years ago.

NEWS BRIEF: Oregon is now the first state to decriminalize small amounts of hard drugs. We're talking things like heroin, cocaine, and meth.

CHAKRABARTI: November 3, 2020, voters passed Measure 110, the “Drug Addiction Treatment and Recovery Act,” with 58% of the vote. The measure decriminalized possession of small amounts of drugs. And instead of jail time, people faced a maximum fine of $100. And more importantly, Measure 110 aimed to help people into treatment and recovery by massively expanding Oregon’s treatment and outreach centers.

Three and a half years later, the state’s drug addiction epidemic has only gotten worse. Some 10% of Oregonians struggle with substance abuse. Here’s Portland Mayor Ted Wheeler this past September.

TED WHEELER: Just by virtue  of illustrating how important this issue is. The last time I saw somebody consuming what I believe to be fentanyl publicly on our streets was less than five minutes ago, three blocks from City Hall.

AKRABARTI: As a consequence, Oregonians, like State Representative Christine Goodwin, have soured on Measure 110.

CHRISTINE GOODWIN: Oregonians have been clear. They are ready for this misguided decriminalization experiment to be over.

CHAKRABARTI: Last month, the Oregon state legislature ended the state’s historic decriminalization experiment. Passed with bipartisan support, and signed by Democratic Governor Tina Kotek, House Bill 4002 recriminalizes possession of small amounts of hard drugs. It also includes provisions to offer people a chance to enter treatment after an “encounter” with a police officer.

Some call it a complete rollback of Measure 110. Others say it’s a much needed reform.

What can the rest of the country learn from Oregon’s experience?

We are joined today by Alex Kral. An epidemiologist with the independent nonprofit research institute RTI International.

He's leading a four-year evaluation of Oregon’s Measure 110. He joins us from San Francisco, California. Welcome Alex to On Point.

ALEX KRAL: Pleased to be with you today.

CHAKRABARTI: Okay, so let's first start off with an understanding of the greater context of the situation in Oregon at the time of Measure 110's passing.

So this is November of 2020. Obviously, we have the pandemic. So how would you describe the pandemic's effect in setting the greater context for Oregon's attempts here?

KRAL: Yes, there were a lot of things that were going on at the time. This is [2021], right? If we're going back to this time, 2021, if we go back to this time capsule the pandemic had a lot of different impacts, both on people's housing and ability to live where they could live, people are isolating. And then one of the biggest pieces that's really relevant to M110 is policing and also the legal system.

And so the legal system really had a buildup of cases and a limited ability to move people through a legal system, as well.

CHAKRABARTI: Explain that a little more about the buildup of cases.

KRAL: Yeah, and so because we had to isolate in place, you couldn't have large courtrooms.

You couldn't have a lot of the kinds of things that you would need to for legal cases to be tried. And there's people who, people are not working as much as they were working before, either. There was a lot of different things that impacted whether you could actually bring cases through court systems.

CHAKRABARTI: I see. Okay. So you're saying that the entire justice system at the state slowed down because of COVID. That's very, that's understandable. I think we saw that in other places too. Now you said 2021, because the measure went into effect February 2021, just for clarity there. The other thing that happened, as far as I can understand, we started with that very sad and disturbing moment of a fentanyl overdose death in Portland, but fentanyl, the availability of it, really rose in Oregon in 2020.

Can you tell me about that?

KRAL: Yes. That clip is really disturbing. That CDC just released figures a couple of weeks ago. For 2023, and there were again over 100,000 deaths, overdose deaths in the United States. This is something that's been on the rise for two decades, but particularly for the last decade.

And the reason why it's been on the rise has been because of the entry of fentanyl into the unregulated drug markets. Now the thing that's important to note there is that fentanyl entered the drug markets on the East coast about 10 years ago. But didn't enter the drug markets on the West coast until around 2019 or 2020.

And Oregon is not unique among West Coast states, in terms of rising overdose deaths due to fentanyl. But it is unique compared to what was going on the East Coast, because that really started a few years earlier.

CHAKRABARTI: Okay. So good point. And actually, I appreciate you saying that basically COVID and fentanyl, these are common challenges.

Catastrophes really, that not just Oregon, but neighboring states also experienced at the time. So in a sense, from a research point of view, that gives you a really clear comparison between what happened in a state that experimented with decriminalization and what happened in a state that did not. Yes?

KRAL: Yeah. In order to evaluate anything that happened with M110, you have to compare Oregon to other states, and the question that becomes the difficult evaluation and research question is, what are the states that are relevant to actually provide us controls? And if you're looking at overdoses, that's just very clear.

It would need to be states that are west of the Rocky Mountains. And if you compare Oregon to Washington, Nevada, Colorado, Idaho, those are the appropriate places. And if you look at overdose deaths during the time 2021 to 2023, what happened in Oregon is exactly the same rates, the exact same increases as happened in the neighboring states.

CHAKRABARTI: Okay, but quick clarification here, did not Washington state and correct me if I'm wrong, but pass a sort of partial decriminalization around the same time.

KRAL: Yeah, Washington had a partial decriminalization for almost a year in there as well. And so if we don't compare it to Washington, if we just compare Oregon to California, Nevada and Idaho, it's the exact same rates.

What's interesting is that if you actually look at the Washington rates during the time they've now recriminalized just like Oregon is about to do, for a couple of years. And rates have continued to go up in Washington, as well. And really whether you decriminalize or not, the data are very clear.

That in these Western states, overdose deaths have been skyrocketing since the advent of fentanyl coming into the drug market supply, which just so happened to be around the same time that M110 was enacted.

CHAKRABARTI: It just sounds like there's so many terrible confounding factors that come into play that very year, 2020, 2021.

Overdose deaths cannot be a good measure of Measure 110 success or failure. Point well taken there. What then would you look to, to assess whether in the three and a half years that it was given, whether Oregon's attempt to decriminalize, small possession of small amounts of hard drugs worked or not?

KRAL: Yeah, I wouldn't say that we can't use overdose as a benchmark. We can, right? It's just what we're finding so far is that M110 hasn't had an impact on overdose deaths in Oregon when you compare it to other states. It could have gotten worse or it could have gotten better. And it would have been fine to do that as long as we're always comparing it, right?

And so if you're in Oregon and only looking and thinking about Oregon, you're going to say, Oh, my God, these overdose deaths have gone up. Why is it? It must be because of M110 or something similar. But if you talk to people in California, they're saying the exact same things. It's the same in Washington, right?

And so they all happen at the same time. But I think the other piece that's a contextual piece that's really important beyond the entry of fentanyl into drug system is really what's a housing crisis, and that's also on the West Coast.

Part II

CHAKRABARTI: I'd like to now introduce into the show Tera Hurst. She's joining us from Portland, Oregon. She's an epidemiologist. Executive Director for the Health Justice Recovery Alliance, and her organization is dedicated to the implementation of Measure 110.

Tera Hurst, welcome to On Point.

TERA HURST: Thank you so much for having me.

CHAKRABARTI: So as you heard Alex say, in terms of the reduction of overdose deaths, excuse me, Measure 110 really can't be looked at as a factor of, in terms of the increase, or ideally we would have had a decrease, but we didn't. It had no impact on that.

But what the measure did promise essentially was along with decriminalization of possession. The idea was that would allow the state and law enforcement and most importantly treatment and recovery centers to expand addiction services and social supports through some very important redirected state funds, which we'll talk about in a second.

And that would get a lot more people into treatment and recovery than was ever available before in Oregon. Did that happen?

HURST: It did happen. Measure 110 wasn't given enough time, and it wasn't fully implemented as it was intended to be. You had mentioned that we had the high, we have the highest addiction rates.

We also have the lowest access to care in the country. Oregon was really walking into multiple crisis as we've talked, as you've talked about before, including the one that I think is missing in that list is also the wildfires that destroyed entire towns in our state which left even more of a housing, but also a behavioral health crisis.

So the voters wanted things to change and unfortunately the law was not set up for success. A lot of that is due to all of the once in a generation scale of crises that we were facing. The state didn't get the services money out the door quickly. It took, it was at about a 18-month lag.

But I think what's really important for listeners to know is that once that money got out the door, people were receiving help. Immediately. And it took time. We have a behavioral health workforce crisis, which the entire country is facing. So hiring, buying buildings, getting houses, Measure 110 was really about funding the services that Medicaid doesn't cover, so that people don't fall through the cracks.

It covered peer support and outreach services, housing and permanent housing, but also transitional housing and emergency housing, so that if we didn't have a treatment bed available, at least we could get somebody off the streets and under a roof and safe.

CHAKRABARTI: Can you help me understand something then?

Because something's not clear to me. We'll talk about the money not getting out of the door in a timely manner, because that's a really important factor here, the implementation. But in terms of expanded services, you're exactly right. I don't think the point can be made enough that Oregon had basically the worst availability of services prior to Measure 110 passing, but I was looking at an Oregon, an OHA and Oregon health.

I think it's the health association.

HURST: Authority.

CHAKRABARTI: Sorry, I was looking at an OHA data report, which was part of what the requirements were for Measure 110, and it was for the fifth quarter after Measure 110 had passed. And this data report showed that, or at least reported that the treatment partners who were key to the expansion of services across the state, that in that fifth quarter, only 35% of them had said they had expanded services or increased the number of clients served, which is a little different than you saying there was this massive expansion.

HURST: I think it's important to look at treatment in a more holistic perspective. Sometimes we have this vision that treatment is just a 20-day, 28-day program. You go inpatient and then you come out and you're in recovery and you're going to meetings. And ultimately, the best evidence, it shows that there are multiple stages, and that's what Measure 110 really tried to get its arms around, in terms of the funding.

So it looked at, we know that with harm reduction, the Center for Disease Control says that you're five times more likely to enter into treatment and recovery if you are working with someone through harm reduction. So it funded harm reduction. We also understand that especially with fentanyl, making sure that we have access to withdrawal management is so important, especially with people going into withdrawal after 30 minutes or an hour, we need to get people right away into withdrawal management. And then when they're getting into withdrawal management, one of our only detoxes in Portland, we turn away 200 people a month and 58% of those folks go back into the streets.

So housing and that kind of making sure that we're filling those gaps, so that people, if they can't get into that treatment program that moment, they are going along the continuum to make sure that they have the support.

CHAKRABARTI: And I would say this is actually one of the reasons why I think there's so much to be learned about how Oregon tried, and I know, I want to hear more from you about failed to implement what the ideals in Measure 110 were.

But I want to just get back to one thing. Again, this idea that the structure for building expanded treatment in Oregon wasn't there or it wasn't adequate to begin with. There was a very weak foundation to begin with. I'm listening to you talk about the wait times and the real dire need for immediate sort of emergency treatment not being available in Oregon.

There were groups who even before this measure passed, like during the campaign for the measure, pointed that out as a significant flaw in Measure 110. I was looking at some statements from Oregon Recovers, which is a non-profit advocacy, recovery-advocacy organization. And back in 2020, they said, Measure 110 is so poorly written, it will lead to additional unnecessarily deaths, but further destabilized Oregon's fractured and incomplete behavioral health system.

And then they say, it dismantles one system of intervention before building a new one, similar to the effort 40 years ago to address our growing mental health crisis by closing the outdated mental hospitals without first building the outpatient services that were needed. So that was before the measure passed.

I guess my question is, was Oregon the right state to attempt this very well-intentioned trial for decriminalization if the infrastructure just wasn't adequate to even build on at the time?

HURST: It's a good question, and I think that Oregon was absolutely the right state, and I'll say that because every day I'm hearing stories from the ground of people who are getting connected to life saving treatment services, whether that's the 41 families down in southern Oregon who have permanent housing now, and used to have to rely on the justice system or the foster care system as the only way they could get help.

And now, because of Measure 110, they're able to just be able to get the services that they need. I think it's also really important to recognize that decriminalization did what it was supposed to do, right? It reduced the stigma of addiction, and it made people feel safer to ask for help. So it reduced the barriers and harms that criminalization creates.

I don't think that we had a system that was effectively helping people who are struggling with addiction prior to 2020. Putting someone in jail is not the answer, and we see the abysmal rates of our drug courts. Some work and that's great, but ultimately it was not serving a purpose, the larger population of folks who are struggling.

So no, we did not have the infrastructure. We are building out more infrastructure and quite frankly, we're having more conversations in the legislature than ever before around addiction, around substance use and around how we actually fund it. Our legislature had made a decision to not fund behavioral health for the past couple decades.

Measure 110 really pushed their hand to make sure that those funds went into behavioral health and really started funding the services that are so critical. I think Oregon recovers, after the passage, they would be by our side pushing for those funds to continue to go into these incredible programs.

So I think a lot of times we say, Oh, we should have waited for a perfect, or even a better health care system before we stopped criminalizing people, and saddling them with criminal records, which makes it harder to access housing and employment.

CHAAKRABARTI: Yeah. I'm sorry, I didn't mean to interrupt you there. But I should say that this is why, actually, there's so much, so many important lessons for the rest of the country to learn from what happened in Oregon.

I do want to just make two quick observations, though. One is we'll talk about this more in a minute, but we should not ignore the fact that it was a national group, a national nonprofit group that really funded to the tune of almost $6 million dollars, around $6 million dollars, the effort to get Measure 110 passed in Oregon.

For them, the Drug Policy Alliance, maybe that question would have been better served for them about whether Oregon was the right place, but about making it safer to ask for help.

Definitely, I see how decriminalization does that, right? Because you just, you can pick up the phone and say, I need help and not be afraid that when the police show up, you're going to end up in jail.

But one of the important aspects of 110 was that officers would be able to issue tickets, which we'll talk about in a minute, to ideally, to people who are suffering from drug addiction. And then in terms of dealing with that ticket, people had the option of seeking a health assessment instead of having to pay that $100 fine.

So there was this really big door opening for people to say, yes, I want to seek treatment now. I saw some data that said in 2021, only seven, in seven cases, seven, did defendants submit to get that health assessment instead of paying the fine. So that doesn't seem like an overwhelming success in welcoming people into the treatment system.

HURST: Oh, I totally agree. I think that part of the implementation failures was that, and again, I'm going to continue to say that we were under multiple crises. Had we implemented this law in a different time, who knows what would have happened, but the hotline that was set up and really, we relied on a hotline, because at the time we were all in lockdown. And we were recognizing that telemedicine really was a necessary thing to have at that point. And making sure that everybody had access, because this is a statewide program, but that hotline was never advertised. The hotline was not printed on the Measure 110 citation because the Measure 110 citation was never created. And so I think that ultimately, we look at that data and say, Oh it didn't work.

No, it didn't get implemented. So the fact that anybody called the hotline could be seen as a win. The tickets were never implemented, police and peers and outreach workers were not connected until we finally did that in December, on our own. And we are seeing really good results from that.

So I think that, ultimately, again, it's not the policy that was at the problem here. The real issue was not enough time for implementation. And the amount of kind of devastation that we all experienced during COVID. And then after, as people were coming out of their houses and seeing more people living on the streets. Because of Alex, what Alex said around our cost of living, in our housing crisis on the West coast, and people dying, as we heard at the beginning.

And these are people's kids and their community members. And overdose deaths are actually preventable. So we should all be working around the same table trying to solve this. And when you're in decriminalization, what was really refreshing was being able to have a conversation around health and access and not around jail and how do we keep people out of jail.

It was about how do I connect this person to the care that they need, whether or not it's culturally specific or linguistically specific care, and then let's fund those services. And that's really the heart of what's happened. And that's the heart of what people aren't hearing about. Which is the first African American female recovery house that was opened through this.

There's so many of those examples where people are getting staffing up to a level that they've never been able to. And really working with the community members on a case-by-case basis, because that's really what this takes.

CHAKRABARTI: Yeah, no, your point well taken, but I have to say, it's those specific examples, thank goodness, because Oregon needs them, but I'm still a little confused about, and yet the implementation wasn't ideal.

The money didn't roll out on time. And I don't necessarily, in my mind, separate implementation as a completely different animal than the original policy. Because one does help drive the other. So Alex, I know you're still there. Hang on for a second. I will come back to you. But I want to actually bring in Max Williams into the conversation now, because I do want to hear about what contributed to the recent passage of the state legislative bill that rolled back Measure 110, and he's the co-lead of the Coalition to Fix and Improve Measure 110. Max, welcome to On Point.

MAX WILLIAMS: Thanks for having me.

CHAKRABARTI: Okay, so was your goal to just recriminalize small, possession of small amounts of hard drugs, or was there a sort of, was there a deeper reason why you felt Measure 110 failed?

What was really the ideal here?

WILLIAMS: Sure. There was, Tera pointed out a number of the positives, outcomes of Measure 110. There was a lot of talk, given the crisis situation that Oregon was in, following Measure 110's passage about repeal. And as a former state legislator myself, I felt like a repeal was a bad idea. The good part of Measure 110 was that it captured Oregon's cannabis tax revenue, directly routed that money into treatment and recovery services, as Tera commented about. And Oregon has been woefully underfunded in that space, as we've already talked about on the show.

We were 49th out of 50 in access to treatment services, so a complete repeal would have unhooked those resources again and made them available for lots of other things, besides treatment and recovery. And that would have been a terrible mistake. But the goal was really about trying to get more people into more treatment, more quickly.

And what Measure 110 did, and its policy was, disconnect the previous system as imperfect as it was. It was actually getting people who were really struggling with difficult addictions into active treatment with the motivation of the criminal justice system. And so the goal was to use the minimal amount of criminal justice resources necessary to help motivate people who were otherwise not responding to different types of outreaches to get back into the criminal justice system and through that system into treatment and recovery.

Part III

CHAKRABARTI: I'm going to come back to all of you in just a second, but because we've been talking about the role that law enforcement should play when it comes to the substance abuse crisis in places like Oregon.

And Max, you had mentioned this interesting phrase, which I want to ask you more about in a second, about minimal contact with the law enforcement community. Let's just get the voice of someone who's actually doing this work. Before the COVID pandemic, Portland police officer David Baer was looking for a better shift for his family, one where he could work during daycare hours and wouldn't have to work on the weekends.

And for him, that gig was on the downtown Portland bike squad.

DAVID BAER: It was like a ride bikes in the park, wave at people. Pick up drunks, people steal chip jars and food carts. That's what it was. It was a nothing gig. Like when I tried to get to this unit, the commander called me and was like, are you sure about this?

COVID happens. Most other specialty units get disbanded. They forget about us. And we were the last unit standing in downtown. That's how we ended up as this like de facto drug enforcement unit at the street level.

CHAKRABARTI: Not only had COVID hit Portland like the rest of the country, but as we've been talking about, at the same time, so did fentanyl, which began flooding Portland's streets.

BAER: You look at overdose numbers, it got to the point where we were leaving the station every morning with five and six doses of Narcan in our pockets, which, before Measure 110, I didn't even have Narcan. And now every day it's, 'Oh, how many Narcan's do you have? Oh, you have four? Nah, throw a couple more in the bag.'

And so it's become this basically epidemic on our streets.

CHAKRABARTI: Meanwhile, Measure 110 was also in effect, meaning instead of arresting people for possessing illicit drugs such as heroin, meth, and cocaine, Officer Baer was now supposed to hand out tickets, essentially traffic violations.

BAER: It was frustrating because, we would see people who were obviously extraordinarily addicted, right?

And we would write them a ticket, because they're smoking fentanyl on the sidewalk. And they'd be like, 'Yeah, man, I want to quit.' And we're like, 'Great, call this number.' And they're like, 'That's it? It's just a number I call.' And I'm like, 'Yeah, call the number. They'll pay the ticket for you. And you do this health screen.

They can hopefully get you some resources.' And they're like, 'I want resources now.' And I'm like, 'All I have is this card.' That's it. It was a number, statewide. It was really impersonal. And I just, people that wanted to get help, I had nothing for them.

CHAKRABARTI: Officer Baer says he followed the law under Measure 110 and will now follow the new law, HB 4002, which repeals decriminalization, which will kick in September.

But he says when it comes to drug addiction, law enforcement has really been in a tough spot.

BAER: And people get upset with us. And we're like, this is passed by the Oregon voters. We're trying to spend what limited resources we have. My team is four people, right? Like we're trying to spend what resources we have on targeting drug traffickers and people bringing in huge volumes of drugs and being involved in gun crime.

This, it's been made clear to us by the voters that this is a public health issue. Unfortunately, we've also been made the vessel for treatment in terms of handing out these tickets that have these cards attached to them. It can be frustrating explaining to business owners and community members, you know, that especially now with 4002 coming into effect, that also, hey, this doesn't even start till September and then they ask, 'What is that going to look like in September?' And I go, 'I don't know yet.'

CHAKRABARTI: That was David Baer, member of the Central Precinct Neighborhood Response Team at the Portland Police Bureau in Portland, Oregon. Tera Hurst, let me get your view on this, because you were central in trying to advocate for a better rollout, better implementation of multiple aspects of Measure 110, including what police officers were supposed to do in those moments of contact with people suffering from drug addiction.

I hear that you tried to five or six times approach the people in the governor's office saying here's how we need to roll that out, but never got any, like, significant response from them?

HURST: Yeah, that's right. And I think that and Officer Baer, I actually cornered him in December at the Attorney General's fentanyl crisis convening and said, can we just have coffee?

And figure out how to do this better, because this isn't working. And so he, myself, Officer Baer and Janie Gullickson from the Mental Health Addiction Association of Oregon sat down and we basically, he said, 'What do you want?' And we said, 'We want to do this better. What do you guys need from us?'

And just as you heard from him, he says, 'I'm handing out this card. I don't know, it doesn't go anywhere.' And we said, 'Yeah, that was a failed system.' He said, 'Ultimately, I just want an outreach worker or somebody to come because I don't know how to connect these people to care.' And I think that's the crux of it right there.

So we decided to just create a pilot project that was very small at the beginning. And it's officer Baer and his patrol. It was also because of Governor Kotek, was creating more patrol down in downtown. So the state police were also going to be down there. And we launched a pilot with Measure 110 outreach workers and providers and the police.

So the police would say, do you want help? The person says, yes, they call a cell phone. It was very low tech, and it still is. They call a cell phone and say, 'We need outreach workers on 4th and Gleason.' So we send out two peers, they come out, the police leave, and the peers start working with folks.

We've served over 200 people so far through this pilot. And, unfortunately, because resources are so scarce, we can't do it every day, but ultimately what you're seeing on the street is police are walking away. Outreach workers are starting to work with folks and we're not talking about people who are treatment resistant or need a criminal justice nudge.

What we're talking about is people who have stood in line for detox at 6 a.m. for three days and still are getting turned away. And so the outreach workers are bringing them back to a resource center and we all work together to try and find a bed for this one person. And that has had really great success because the person is ready.

And we know that when people are ready for care, they do much better and they're able to get into long term recovery instead of being pushed and coerced.

CHAKRABARTI: The question of when are people ready? Max Williams, let me turn back to you on this, because I think that question is really at the heart of the philosophical debate over decriminalization, right?

Because as Tera has mentioned, there is quite a bit of evidence that the war on drugs for many decades now, for half a century, has been a failed policy, right? Drug abuse disorders are as high as ever. There's been disproportionate incarceration of certain groups of Americans, etc.

But on the other hand, I'm seeing here that there are, at least in Oregon, there were quite a few people from the mental health and substance abuse and health care world who were saying there does need to be some role for potential incarceration to help people get ready to ask for help.

Dr. Paul Coelho of the Salem Health Hospitals and Clinics back in 2020 said the framers of Ballot Measure 110 portray individuals with active addictions as actors who will naturally seek out and accept treatment. He said, as a frontline provider, he says that's just not true, nor is the levying of a token $100 fine.

He's just saying that some kind of threat of incarceration is necessary. But if that's the case, then, you are talking about minimal contact with law enforcement. Are we trying to have six of one, half a dozen of the other, and nothing will really change?

WILLIAMS: No I do think that, and as Tera has described, some of those programs are not going to change or wouldn't need to change, and in fact should be implemented under the new 4002.

Really, what the new legislative piece does is create a graduated approach. There are multiple off ramps for a person who gets in contact with law enforcement with the possession of these drugs. The first is a deflection program that is prearrest and can work exactly as Tera described it.

The second is more of a conditional discharge program that is like a diversion program for someone who's gotten a DUII and can be managed through the drug court. And then eventually, if that person can't succeed through either of those strategies, you can move to essentially a supervised probation-based program.

Where the person actually gets credit for their engagement in treatment. So the whole system remains designed as to keep someone out of jail and with minimal engagement, to the degree that they're actually actively participating in treatment and recovery. And I think to some degree, that may be the philosophical difference. That some folks want it just to be that, someone's going to naturally be coaxed into treatment with no consequences.

And we know that does work for some people and they don't need the criminal justice system to find treatment avenues. They're being encouraged by family members or by their employer, or by some other motivation. But for some people, particularly people who are really wrestling with severe fentanyl and meth addiction, these other motivations can play a part.

And I think there's a lot of data to suggest that has helped many people. And I certainly know that from my own experience, of people who come to me and said, 'If it wasn't for my law enforcement contact, if it wasn't for the justice system contact, I would have never ultimately sought treatment.'

So what we're trying to do is create a system. And I would say, even with Oregon's recriminalization of, you know, these misdemeanor charges and our off ramps, we are still perhaps the most progressive state in the nation with respect to dealing with people who are in possession of these lethal street drugs. So it's not like we rolled back, and reinstituted some war on drugs philosophy.

This is a very thoughtful philosophy. It's got its own implementation challenges. And Tera and I both have strong feelings about the poor implementation approach that often happens in Oregon. And this is going to go into effect in on the 1st of September. And I think it's going to be successful in some counties, and it's going to have struggles and others try to figure it out.

But we didn't try to roll back all of Measure 110. What we tried to do is create a system that balances both the individual needs and the one part that we haven't talked about is the community aspect of this.

CHAKRABARTI: Can I just jump in here? Because I'm afraid, I'm just running out of time, Max. And you got to forgive me.

But just to clarify what you said that the deflection program, is a law enforcement deflection program is going to be rolled out on a county-by-county basis voluntarily. So some counties may choose not to participate in it, but we have to wait and see on that. Alex Kral, you've been incredibly patient here and I'm very grateful for it.

But again, to zoom out a little in terms of what the rest of the country can learn from what happened in Oregon, I'm seeing several themes here. There was just a terrible, perfect storm of events around the passage of Measure 110, right? COVID, fentanyl, increasing homelessness in Oregon. But also, I would still say an inadequate extant infrastructure to really, to build a rapidly growing system of treatment and recovery.

Just because Oregon did rank 49th out of 50th, as we've talked about. Lots of people look to a completely different place on how to roll out these things differently. They look to Portugal, right? The entire nation, which decriminalized drugs, but it took them longer, four to five years, before they started seeing the fruits of those efforts.

At the same time, from my understanding, they also started with a better treatment system nationwide in Portugal, did they not, Alex?

KRAL: Yeah, I think the key here is, and as part of our 4-year evaluation, we conducted a couple of years ago, two studies, one in Oregon with law enforcement and one with people who use drugs.

And I think one of the things that's not been mentioned here is that you had 50 years of criminalization and it's going to take time to change that piece, right? It doesn't happen culturally over time. We heard from law enforcement officers where they were against M110 to begin with.

They thought it would fail. They weren't bought into it. And so a lot of the systems that people are talking about is, you're trying to involve police in a system, where people who use drugs, they're not credible sources for them. And so here you are, you're a person of drugs.

And for 50 years, people have been arresting you. And that's been the only thing to have, to all of a sudden think that those law enforcement are going to be credible sources, whether that be through these citations or whether it be through some of these deflection programs that are now being planned.

I think there's a question about that. Because I don't think that, they're not trained, law enforcement is not trained to be social workers and to help people into that. And they're not seen as such by people using drugs. That's what our data found. But if you are talking about Portugal, yeah, it is a very different system. If, you know, they have now allowed that system, their decriminalization has been now over 20 years.

And as you pointed out, the first few years, we didn't really see, the evaluations didn't really see any benefits, but after 4 or 5 years, they started to see that and some of that has to do with a socialized medicine type system, whereby you do have more access to treatment and where people are credible sources for treatment. Where they feel like people who are in government are actually there to help them in some form.

Whereas that's not necessarily the case after 50 years of having governmental agents in Oregon, basically think of its people using drugs, as arrests and jail being the only solution.

CHAKRABARTI: That's not the case anywhere in the United States. So social context is really different, right?

It's not just Oregon. Just continue. I just want to also just emphasize that this measure was passed in November of 2020. We were already deep in the grips of COVID, but the Drug Policy Alliance based in New York, they spent $5 million of their own money. An overall $6 million went into getting this measure passed.

In Oregon, the "no" team spent $167,000 just as a point of reference here. But it just makes me wonder, even though we knew COVID was going on, we knew that the fentanyl crisis was hitting hard, et cetera, this group continued to push to get Measure 110 passed in the middle of a perfect storm. I'm just asking a counterfactual, sort of for the sake of asking it.

None of you have to answer. What would it have been like if maybe they held back and waited a couple of years to try to pass it in a time where the perfect storm wasn't going on? Nobody can answer that yet, I know. But, Tera Hurst, we have 15 seconds-ish left. I'm just wondering what you think Oregonians need, right?

The people who are suffering from the drug addiction crisis. I'll give you the last 10 seconds here, now more than ever.

HURST: We really need to be focused on setting up our system of care. We should not be distracted by creating a new criminal justice on ramp and off ramp and recognizing that people of color are the ones that are most harmed and least helped by the criminal justice system. And the racial impact statement on this new law is, already shows that it's going to be harsher on Black and Latinx communities. So I think what we need is to be getting around the table and really talking about, 'How do we get people connected to care and what care do we need?' So that we can have rapid access to care.