Mike Marshall is the co-founder and director of Oregon Recovers. He says he's concerned the state is failing to expand addiction treatment capacity in a strategic way. "So we put the cart before the horse," he says. Eric Westervelt/NPR hide caption
Mike Marshall is the co-founder and director of Oregon Recovers. He says he's concerned the state is failing to expand addiction treatment capacity in a strategic way. "So we put the cart before the horse," he says.
Last fall Oregon voters decriminalized possession of small amounts of almost all hard drugs, taking a groundbreaking step away from the arrest, charge and jail model for possession that's been a centerpiece of American drug policy since President Richard Nixon declared his War on Drugs 50 years ago this week.
Oregonians overwhelmingly passed Measure 110 that makes possession of small amounts of cocaine, heroin, LSD and methamphetamine, among other drugs, punishable by a civil citation akin to a parking ticket and a $100 fine. That fee can get waived if you get a health screening from a recovery hotline.
The measure, a major victory for advocates pushing for systemic change in U.S. drug policy, expands funding and access to addiction treatment services using tax revenue from the state's pot industry as well as from expected savings from a reduction in arrests and incarceration.
For years Oregon has ranked near the top of states with the highest rates of drug and alcohol addiction and near the very bottom nationally in access to recovery services. And while critics everywhere have long called the drug war a racist, inhumane fiasco that fails to deliver justice or health, Oregon is the first to take a leap toward radically changing those systems.
"What we've been doing for the last number of decades has completely failed," says Mike Schmidt, district attorney for Oregon's most populated county, Multnomah, which includes Portland. Schmidt, who publicly supported Measure 110, says he firmly believes the health model not criminalization is the best way to battle the disease substance use disorder.
"Criminalization keeps people in the shadows. It keeps people from seeking out help, from telling their doctors, from telling their family members that they have a problem," Schmidt says.
Moving to emphasize health care over incarceration, supporters hope, will also start to remove the stigmatizing obstacles that often follow, including difficulty landing jobs, housing and student loans, and getting a professional license in a variety of fields.
Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance, says the state's decriminalization marks bold systemic change. "We can't nibble around the edges on this," she says. Oregon Health Justice Recovery Alliance hide caption
"The War on Drugs has been primarily really waged on communities of color. People's lives have been destroyed," says Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance, which campaigned last year to pass decriminalization and is now pushing to see it's fully funded and implemented. "We can't nibble around the edges on this. It's really important to me that we smash the stigma on addiction and drug use. And this helps get us closer to that."
But five months since decriminalization went into effect, the voter-mandated experiment is running into the hard realities of implementation. Realizing the measure's promise has sharply divided the recovery community, alienated some in law enforcement and left big questions about whether the Legislature will fully fund the measure's promised expansion of care.
Even many recovery leaders here who support ending the criminalization of addiction are deeply concerned the state basically jumped off the decriminalization cliff toward a fractured, dysfunctional and underfunded treatment system that's not at all ready to handle an influx of more people seeking treatment.
Advocates for decriminalization "don't understand the health care side, and they don't understand recovery," says Mike Marshall, co-founder and director of the group Oregon Recovers.
"Our big problem is our health care system doesn't want it, is not prepared for it, doesn't have the resources for it and honestly doesn't have the leadership to begin to incorporate that [expanded treatment]," says Marshall, who is in long-term recovery himself.
"My drug of choice from beginning to end was alcohol," he says, "but the last 10 years was dominated by crystal meth."
Oregon supporters of decriminalization point to Portugal as a reform model. In 2001, Portugal dramatically changed its approach and decriminalized all drugs. The nation began treating addiction as a public health crisis. There, anyone caught with less than a 10-day supply of any drug gets mandatory medical treatment.
But Marshall and others point out that Portugal took more than two years to transition carefully to a new system and replace judges, jails and lawyers with doctors, social workers and addiction specialists.
"So we put the cart before the horse," he says.
In fact, Marshall and others worry the treatment and harm reduction horse isn't even on its feet in Oregon, which is leaving too many stuck in a dangerous pre-treatment limbo and at potential risk of overdosing.
"There were no resources and no mechanisms in [Measure] 110 to actually prepare the health care system to receive those folks," Marshall says.
"Most places that have successfully done decriminalization have already worked on a robust and comprehensive treatment system," says Dr. Reginald Richardson, director of the state Alcohol and Drug Policy Commission. "Unfortunately, here in Oregon, we don't have that. What we have is decriminalization, which is a step in the right direction."
There's also shockingly little state data to determine what programs work best or to track treatment outcomes and share best practices. There's also no agreed upon set of metrics or benchmarks to judge treatment efficacy, both in Oregon and nationally.
And the pandemic struck and decimated a treatment system that was already struggling, experts here say. Because of social distancing and other pandemic protocols, Oregon, like many states, had to reduce the number of treatment beds and services. That's left the system reeling just as decriminalization programs try to take flight.
"We've got significant trouble in terms of workforce, having the right people, qualified people and enough people to provide services to folks who struggle with addiction," Richardson tells NPR. "And we've got underfunding by about a third to treatment providers."
Indeed, even some closely involved with implementing the new measure are privately voicing growing concerns. "I really hope we don't spend the next 10 to 12 months with open air drug markets and nowhere to send" those seeking help, said one official who asked not to be named because he wasn't authorized to speak publicly.
Complicating implementation is that Oregon can't get matching federal Medicaid money, a key funding source for states, to expand treatment under Measure 110 because it's using tax revenue from the legal sale of marijuana, which the federal government still classifies as a Schedule 1 illegal drug.
Today, anyone across Oregon caught by police with small amounts of hard drugs is issued a civil citation like a traffic ticket not a criminal charge. So if you're found holding, among other drugs, up to 2 grams of methamphetamine or cocaine, 40 hits of LSD or oxycodone, up to a gram of heroin, you get a citation and a $100 fine. That fine goes away if you agree to get a health screening through an addiction recovery hotline, an assessment that might lead to counseling or treatment.
Measure 110 did allocate millions in new treatment funding money funneled from the state's marijuana tax along with expected savings from reductions in arrests and incarceration.
But Marshall and others are alarmed that it did not require those funds be spent in a strategic way to expand capacity for a system that has too few detox beds, not enough residential or outpatient treatment and recovery chairs, not enough sober housing and too few harm reduction programs.
These are all services that will be desperately needed, Marshall says, as more people get pushed out of the criminal justice system and into the health system.
Mike Schmidt, district attorney for Multnomah County, Ore., strongly supports the decriminalization shift underway. "What we've been doing for the last number of decades has completely failed," he says. Eric Westervelt/NPR hide caption
"Many times the only way to get access to recovery services is by being arrested or interacting with the criminal justice system. Measure 110 took away that pathway," he says.
"I know that it takes an intervention for many of us to be saved" from addiction, says Jim O'Rourke, a Portland lawyer who opposed Measure 110 and who is also in long-term recovery.
Arrest, he says, can give people the push they need to finally get help.
"The threat of having to go through a judicial process gave them the external motivation they needed to do something that their internal motivation wasn't strong enough to get done," O'Rourke says. Addiction is a disease "that takes over the brain, it takes over your executive function." A citation and a potential fine, he believes, "just isn't strong enough."
Opponents say that's especially true since there's basically no consequence if anyone now cited for possession simply ignores the ticket.
"If word on the street is it's only 100 bucks and you don't go to jail, boom, chances are they're going to toss it," says Pam Pearce, founder of Oregon's first high school dedicated to youth recovery. She is also in long-term recovery.
"If it's like a parking ticket, what is the person's motivation [to get help]?" asks Pearce, who's now executive director of Community Living Above, an Oregon substance abuse prevention organization. "We're talking heroin, meth, cocaine and acid it's not child's play."
But decriminalization advocates counter that jail pathway to potential treatment was so flawed, biased and ineffectual for so long it had to be taken away.
The percentage of arrestees who successfully followed through on addiction treatment was low. And on average a huge percentage of those convicted of drug possession in the state were rearrested within three years.
"When you look at recidivism rates," says Schmidt, the Multnomah district attorney, "70% and 80% were getting rearrested. That's a complete and utter failure."
A key selling point to Oregon voters was that decriminalization would significantly reduce or even eliminate racial and ethnic disparities in convictions and arrests. Blacks make up just over 2% of Oregon's population. But as in the rest of the country, they've experienced far higher arrest rates for drug possession here than whites. Oregon Blacks are 2.5 times as likely to be convicted of a possession felony as whites, who make up 76% of the population.
The Oregon Criminal Justice Commission estimates that Measure 110 will reduce those disparities and result, overall, in about 4,000 fewer Oregonians a year getting convicted of felony or misdemeanor possession of illegal drugs.
Julia Mines is executive director of the Miracles Club, the state's only place targeting the African American recovering community. At most treatment centers, she says, "When we come in, there's nobody that looks like us." Julia Mines hide caption
Julia Mines is executive director of the Miracles Club along Martin Luther King Jr. Boulevard in northeast Portland. It's the state's only place targeting the African American recovering community.
"At the beginning of this, I wasn't for it," Mines says. "It took me to go to prison to get my, you know, get on the right track."
Mines had gone far off-track because of a cocaine addiction. She lost jobs, friends and two children one to foster care and one to adoption.
"Because I chose crack over my children," she says.
Mines eventually went to prison for selling the drug, though she now chuckles at the "major dealer" moniker she was given in court following a police sting that caught her selling less than 1,000 feet from a school.
"Like they really put a big dope dealer off the street!" she says with a laugh. "I wasn't no dope dealer; I was a user, come on now!"
Mines says she changed her mind on Measure 110 when she realized it might mean a chance to end the criminalization of addiction that continues to ravage people in her community. She's now on one of the measure's implementation committees.
"I made my voice loud and clear: I'm here representing the African American community, and that if we're going to implement this, that we need to have resources for the people that are just getting those citations," she says.
Mines says she hopes new resources eventually help her turn Miracles, now mostly a place to hold recovery meetings, into Portland's first full-scale treatment facility tailored to people of color.
"When we go to treatment centers, when we come in, there's nobody that looks like us," Mines says, "and nobody's willing to take a look at our culture and try to understand the historical and generational trauma."
This month her program took a step in that direction. The Miracles Club was among 48 groups statewide that shared $10 million under the first wave of Measure 110 funding. Mines says she'll now be able to hire three new peer mentors as well as additional support staff.
"But this funding is only for six months. So what's coming down the line after this?" she asks. "You know, that's the question mark right now, actually, a big question mark."
Mines says she has yet to see anyone come in to one of Miracles' thrice daily recovery meetings because of a possession citation and health screening under the new decriminalization policy.
That sluggish start is mirrored statewide. So far Measure 110's new 24/7 addiction recovery help line where people who get a possession citation can call is mostly quiet. Nearly five months in, just 29 people who've been issued a possession citation by police have called the line for an addiction health screening, according to Dwight Holton, CEO of Lines for Life, the Oregon nonprofit that runs what's formally called the Telephone Behavioral Health Resource Network.
"I'm excited about helping Oregon law enforcement see this tool as a bridge to recovery," Holton says. "That's what it needs to be."
A proposal in the Legislature would address some of Measure 110's implementation challenges and sharpen rules and oversight. But that, too, has stoked controversy. Among other things, the bill proposes doing away with that $100 fine for possession, arguing that the fee would adversely affect low-income folks with a substance use disorder. The bill would also change the addiction health assessment for those caught with hard drugs into what critics call a less rigorous screening.
Meanwhile, many Oregon police leaders, while mostly staying out of the public fray as implementation debates roil, are privately worried.
"They're frustrated, they're annoyed, they're concerned," says Jim Ferraris, immediate past president of the Oregon Association Chiefs of Police. He spent more than four decades in Oregon policing.
The state's Criminal Justice Commission records show about 9,000 people were arrested each year in Oregon for simple drug possession before Measure 110. Despite the drop in arrests, Ferraris says, "People are still committing crimes to get money, to buy dope, to support their habit. So how is this [decriminalization] going to impact that cycle?"
Jim Ferraris is the immediate past president of the Oregon Association Chiefs of Police. "We're going to see more and more people needing help because drugs are going to be more readily available and there's no one keeping it in check," he says. Jim Ferraris hide caption
Efforts to stop large-scale trafficking in Oregon continue as usual. Local and multiagency and regional drug interdiction task forces say their work goes on apace.
"Measure 110 has not affected our work at all," says a regional spokeswoman for the Drug Enforcement Administration.
The Oregon Legislature in 2017 had already made possession of small amounts of hard drugs here a misdemeanor, not a felony. But some say full decriminalization has had a demoralizing effect on that work.
"We're already hearing of people coming into Oregon to use because they know they can do drugs and sleep outside and police can't do anything about it," says a frustrated central Oregon officer who asked not be named because of his work in drug interdiction.
Preliminary state numbers show that opioid overdoses were up sharply in 2020, though officials say that likely has more to do with the deadly pandemic's social, emotional and financial impact than decriminalization.
Still, the experiment here has launched with the pandemic's shadow still very much hanging over the recovery community. Several organizations contacted by NPR said the number of people relapsing, anecdotally anyway, has skyrocketed.
In fact, some groups say they're having trouble finding enough peer counselors because so many are back using.
"The relapse numbers have gone up so much," says Eli Staas with the 4th Dimension Recovery Center in Portland. "For a lot of people the [pandemic's] isolation especially is what took them back out" of sobriety.
Now with decriminalization, one law enforcement official who asked not to be named because he wasn't authorized to speak publicly predicts within a year Oregon "will be inundated with (more) folks who have substance use disorder."
A key person to help lead Oregon through this rocky transition is 36-year-old old Tony Vezina, who founded 4th Dimension in Portland, the state's first youth-oriented recovery program. He's also the new chair of Oregon's Alcohol and Drug Policy Commission, which is tasked with improving treatment services.
"Been in and out of jail since I was, ya know, about 14 years old," Vezina says. "My roots are in trailer parks of Pocatello, Idaho. A history of crime and trauma and poverty on both sides of my family. Ya know, and I was a product of all that."
Now more than nine years sober from what he calls a crippling meth and heroin addiction, Vezina says as commission chair he's committed to having tough conversations across a treatment community that remains divided over the best way to implement Oregon's bold, voter-mandated experiment.
Tony Vezina, executive director of 4th Dimension Recovery Center and chair of the Oregon Alcohol and Drug Policy Commission, is nine years sober. "Now we need to rapidly design a new system strategically," he says. "But Oregon doesn't operate strategically around this issue." Eric Westervelt/NPR hide caption
"We haven't built anything new, so now we need to rapidly design a new system strategically. But Oregon doesn't operate strategically around this issue. So we don't have a new intervention system. We don't have a recovery-oriented system of care," Vezina says. "We've just decriminalized."
"We all need to work together to make sure that people get the intervention and the support they need to change their lives because it's really hard for people," he says, adding, "It's really hard for me."
Some police, however, are predicting darker days ahead.
"We're going to see more and more people needing help because drugs are going to be more readily available and there's no one keeping it in check," says Ferraris, recently retired as police chief in Woodburn, Ore. "Overdoses will go up, crime will go up and cartel drug dealing will continue to flourish up and down the I-5 corridor."
But supporters of decriminalization say that is largely last-gasp fearmongering by unreconstructed drug warriors who won't accept that the interdict, arrest and jail model has failed.
"We all need to be along for a long-term systems change," says Hurst of the Oregon Health Justice Recovery Alliance. She and other advocates say it's far too early to make any judgments about Oregon's experiment. The metrics to watch over the coming years, she says, is how well Measure 110 expands access to detox and treatment services statewide.
"There are so many centers across our state that don't just need investments, they've been starved," she says.
Still, those involved helping that system change take flight are keenly aware the nation will be carefully watching what Hurst hopes will become a model for other states looking to stop arresting and charging people with a substance use disorder.
"This could make or break kind of the movement on some level if Oregon wasn't able to pull it together. But I don't think that will happen," Hurst says. "I hope other states take notice, and they watch. And we're going to learn a lot."
"Maybe there would have been a better way to glide path this [Measure 110] on," prosecutor Schmidt says of implementation. But the Multnomah County district attorney says a jolt was needed. Merely tinkering with drug and addiction policy wasn't working.
"Sometimes you just need to stop the way you're doing it," Schmidt says, "to put some urgency behind fixing the systems that need to come into place."
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