The Atlantic: What Happens When Hard Drugs Are Decriminalized

Today John Goodman posted the Danger of Drug Laws and the unintended consequences of making drug abuse illegal. Because drug abuse is illegal, illicit drug users don’t have the support system that medical pharmaceuticals have. For example, fentanyl has both legitimate medicinal uses and non-medical uses. It has a low therapeutic index when used for pain relief. That means it is inherently risky. According to the journal Pharmaceutical Research:

[F]entanyl has a low safety margin, implicating that fentanyl needs to be titrated with caution.

Titrated means patients should start the medication on a low dose and gradually raise the dose stepwise. This is from the Cleveland Clinic:

In titration, the medication is started at a low dose. Every couple of weeks, the dose is raised (“up-titrated”) until the maximum effective dose (“target dose”) has been achieved or side effects occur.

Not everyone can tolerate a full dose. It’s safer to ease your way up.

The drugs mentioned above lower blood pressure and heart rate by blocking neurohormonal and adrenaline pathways. These are innate mechanisms designed to safeguard humans — and the reason why titration is essential.

Fentanyl is the leading illicit drug involved in overdose deaths. Among the risks for illicit drug use is consuming and even injecting products manufactured by sketchy people you wouldn’t trust to service your expensive German car, and probably wouldn’t even trust enough to assemble your Subway sandwich. Yet drug users trust them to manufacture, dilute, adulterate and sell products that can easily kill – all without purity tests or instructions for use. In theory this could change under drug legalization.

The state of Oregon is a case study in drug decriminalization (not to be confused with legalization).

Three years ago, while the nation’s attention was on the 2020 presidential election, voters in Oregon took a dramatic step back from America’s long-running War on Drugs. By a 17-point margin, Oregonians approved Ballot Measure 110, which eliminated criminal penalties for possessing small amounts of any drug, including cocaine, heroin, and methamphetamine. When the policy went into effect early the next year, it lifted the fear of prosecution for the state’s drug users and launched Oregon on an experiment to determine whether a long-sought goal of the drug-policy reform movement—decriminalization—could help solve America’s drug problems.

How is Oregon’s experiment in drug decriminalization going? Not very well according to the latest data.

Early results of this reform effort, the first of its kind in any state, are now coming into view, and so far, they are not encouraging. State leaders have acknowledged faults with the policy’s implementation and enforcement measures. And Oregon’s drug problems have not improved. Last year, the state experienced one of the sharpest rises in overdose deaths in the nation and had one of the highest percentages of adults with a substance-use disorder. During one two-week period last month, three children under the age of 4 overdosed in Portland after ingesting fentanyl.

Ballot Measure 110 was intended to test new ideas, mainly that the role of law enforcement was not productive in reducing drug use. The measure also dedicated tax revenue from cannabis sales for drug treatment centers. One has to wonder if the tax revenue supporting treatment centers was supposed to mitigate the increase in drug use by making it less risky.

[T]he Drug Policy Alliance… issued a statement calling the vote a “historic, paradigm-shifting win” and predicting that Oregon would become “a model and starting point for states across the country to decriminalize drug use.”

But three years later, with rising overdoses and delays in treatment funding, even some of the measure’s supporters now believe that the policy needs to be changed. In a nonpartisan statewide poll earlier this year, more than 60 percent of respondents blamed Measure 110 for making drug addiction, homelessness, and crime worse. A majority, including a majority of Democrats, said they supported bringing back criminal penalties for drug possession.

The new law didn’t make it legal to possess drugs, under Measure 110 drug use became a minor violation that was supposed to lead to a small fine or diversion to a treatment program. In the end, violations often led to neither.

First, minor drug possession was downgraded from a misdemeanor to a violation, similar to a traffic ticket. Under the new law, users caught with up to 1 gram of heroin or methamphetamine, or up to 40 oxycodone pills, are charged a $100 fine, which can be waived if they call a treatment-referral hotline.

Second, the law set aside a portion of state cannabis tax revenue every two years to fund a statewide network of harm-reduction and other services.

After Measure 110 was passed Police began writing far fewer tickets for drug possession, probably thinking their efforts were of little consequence. Calls to the treatment referral hotlines were also few and far between. The cost of running the call hotline divided by the low number of calls meant each call cost the state about $7,000.

State officials, advocates for drug reform laws and Oregon residents are left wondering whether Measure 110 needs small reforms, is merely experiencing growing pains or should be scrapped altogether.