Oregon is considering legislation that would recriminalize low-level drug possession, reversing a landmark reform that voters approved in 2020. Although critics of that ballot initiative, Measure 110, cite escalating drug-related deaths, decriminalization is not responsible for that trend.
Opioid overdose fatalities have been rising nationwide for more than two decades. That trend was accelerated by the emergence of illicit fentanyl as a heroin booster and substitute, a development that hit Western states after it was apparent in other parts of the country.
“Overdose mortality rates started climbing in [the] Northeast, South, and Midwest in 2014 as the percent of deaths related to fentanyl increased,” RTI International epidemiologist Alex H. Kral and his colleagues noted at a conference in Salem, Oregon, last month. “Overdose mortality rates in Western states did not start rising until 2020, during COVID and a year after the introduction of fentanyl.”
That lag explains why Oregon has seen a sharper rise in opioid-related deaths than most of the country since 2020. But so have California, Nevada, and Washington, neighboring states where drug possession remains a crime.
Decriminalization under Measure 110 took effect in February 2021, and a 2023 Journal of Health Economics study estimated that it was associated with a 23 percent increase in “unintentional drug overdose deaths” that year. But “after adjusting for the rapid escalation of fentanyl,” Brown University public health researcher Brandon del Pozo reported at the Salem conference, “analysis found no association between [Measure 110] and fatal drug overdose rates.”
Kral and his collaborators concurred, saying “there is no evidence that increases in overdose mortality in Oregon are due to” decriminalization. That is consistent with the results of a 2023 JAMA Psychiatry study, which found “no evidence” that Measure 110 was “associated with changes in fatal drug overdose rates” during the first year.
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