A delegation of more than two dozen Oregon officials and advocates returned this past weekend from a trip to Portugal, where they studied the country’s health-focused response to substance abuse disorders.
The visit comes on the third anniversary of Oregon voters’ passage of Measure 110, which decriminalized all drugs in the state and funneled millions of dollars in marijuana tax revenue toward expanding addiction recovery services.
“My main takeaway from this trip is that seeing is believing,” state Rep. Rob Nosse (D), a member of the delegation, said in a statement about the visit. “There’s no real disagreement between policymakers and law enforcement leaders in Portugal when it comes to this law—they are united in the belief that people struggling with addictions are better served as patients needing healthcare, and they’ve built out the integrated system to get people the care they need.”
“There is much from their program and approach that we can apply to our work here in Oregon,” Nosse added.
The trip, sponsored by the drug reform organization Health Justice Recovery Alliance (HJRA), included visits with healthcare professionals, law enforcement, lawmakers, harm reduction organizations as well as João Goulão, the chief architect of the Portugal’s 2001 drug decriminalization program.
“We learned about Portugal’s patient-first approach and discovered that much of their work is relevant to what is happening here in Oregon,” said Tera Hurst, the advocacy group’s executive director. “We saw firsthand what a health approach to substance use looks like after more than 20 years of implementation.”
HJRA said six main policy imperatives were “clear for all who attended.” Among them are fully funding treatment services and adopting a perspective of health care rather than punishment.
“When Portugal cut funding for treatment, drug use and overdose rates rose again,” the group said in a press release. “That’s why Portugal is now working to reinvest in treatment funding and…doubling down on funding a public health response to addiction.”
“Portugal decriminalized addiction to address the overdose crisis they were facing due to increased heroin use, much like [what] we are experiencing here with the synthetic opioid fentanyl,” the organization added. “This trip reminded each of us, no matter where we stand on Measure 110, that we all want to see addiction treated as a public health issue—not a crime.”
Other findings included that “system-wide integration is key,” with coordination between health officials, addiction recovery services, state-run detox and treatment facilities, nonprofits, law enforcement and others, and that neither drug users nor police should be seen as “the enemy” in policy debates.
“In Portugal, law enforcement work alongside addiction experts to respond to addiction,” HJRA said. “We must give law enforcement the support they need to do the same. Rather than shutting them out of the process, we need to work together to create relationships and trust so we can partner in seeking solutions that will work in our communities on the ground.”
Janie Gullickson, executive director of the Health and Addiction Association of Oregon, said that “we all must work together, and that includes law enforcement, to address the suffering we see daily on our streets.”
“We need to support law enforcement in the reality they are often the first line of response to someone in crisis,” Gullickson said. “The Portugal trip helped us break down a lot of the walls that have been built up between providers and law enforcement. This isn’t political; it’s about helping people. Law enforcement and providers are both in this line of work because we care about our communities.”
Ultimately, HJRA’s findings conclude that Measure 110’s decriminalization of simple drug possession “remains the right thing to do,” but the group said the reform “didn’t go far enough in creating a comprehensive healthcare approach to addiction.”
“We need to identify multiple funding sources and policy solutions to build out a full system of care, rather than relying on any one policy solution to be the answer,” the group said. “When Portugal passed its decriminalization package in 2000, decriminalization was but one of nearly 70 policy solutions proposed to address the addiction crisis. Portugal’s decriminalization program also included extensive public health resources to educate the population around prevention, and to engage people with addictions with vital services.”
HJRA also said more needs to be done to discourage drug use in public.
“Law enforcement needs non-criminal, pre-arrest strategies and procedures that will enable law enforcement to be an effective partner in reducing public use,” it said. “We need to give our law enforcement clear mandates if we want them to be part of the effort to stop public drug use on our streets.”
The delegation’s trip comes as some in Oregon are working to undo parts of Measure 110—specifically its decriminalization of drug use and possession. In September, a group of business and political interests announced two versions of a would-be ballot initiative that would undo key provisions of the voter-approved law.
One version of the proposal would make it a misdemeanor crime to possess certain “hard” drugs, including fentanyl, methamphetamine, heroin, cocaine and others. It would also create a new misdemeanor criminal offense for using unlawful drugs in public.
A second version of the measure would go further, increasing penalties for manufacture or delivery of substances in cases where a person is a repeat offender or where drug use causes death. The expanded version would also make possession of tableting or encapsulating machines a felony and broaden the definition of drug “delivery” to include possession with the intent to transfer.
Notably, the broader version would also transfer control over Measure 110 funding, which comes from state cannabis tax revenue, to the state Alcohol and Drug Policy Commission.
Amid the ongoing overdose crisis and visible homelessness, public support for decriminalization in Oregon is flagging. While 58 percent of voters cast ballots in favor of Measure 110, polling recently released by opponents found that 61 percent of respondents now feel the measure has been a failure.
One member of the delegation, drug policy researcher Morgan Godvin noted that Portugal’s crisis “was so urgent because it was affecting so many, much like ours.”
“They responded to their opioid crisis so well that they effectively no longer have one, consistently showing some of the lowest overdose rates in Europe,” Godvin said. “In Oregon, we must expand our services so that no one who needs treatment is locked out of care. If we expect people to make better choices, we must first present them with better options. This is not an impossible task by any stretch; it simply requires steadfast commitment to health and human rights.”
Members of the delegation included, according to the Health Justice Recovery Alliance release:
Rep. Rob Nosse (D)
Rep. Lily Morgan (R)
Sen. Floyd Prozanski (D)
Senate Majority Leader Kate Lieber (D)
Sgt. Aaron Schmautz, Portland Police Association (PPA)
Detective Scotty Nowning, Salem Police Employee’s Union (SPEU)
Kimberly McCullough, Oregon Department of Justice (DOJ)
Channa Newell, Multnomah County District Attorney’s Office
Multnomah County CEO Jessica Vega Pederson (D)
Monta Knudson, Bridges to Change
Mark Harris, Oregon Black Brown Indigenous Advocacy Coalition (OBBIAC)
Shannon Olive, Women First Transition & Referral Center
Mercedes Elizalde, Latino Network
Janie Gullickson, Mental Health & Addiction Association of Oregon
Paul Soloman, Oregon Criminal Justice Commission
Fernando Peña, NW Instituto Latino
Andy Ko, Partnership for Safety & Justice
Morgan Godvin, drug policy researcher, Oregon Alcohol & Drug Policy Commission, Measure 110 Oversight & Accountability Council
Joe Bazeghi, Recovery Works NW
Theshia Naidoo, Drug Policy Alliance
Iris Chavez, Equity Action Partners
Tera Hurst, Health Justice Recovery Alliance
Ron Williams, Health Justice Recovery Alliance
Devon Downeysmith, Health Justice Recovery Alliance
Diana Nuñez, Health Justice Recovery Alliance
An analysis of drug overdose rates found earlier this year that decriminalization in Oregon and other jurisdictions had no significant impact on fatal overdoses despite critics’ predictions that the policy would lead to an increase in dangerous drug use.
“Our analysis suggests that state decriminalization policies do not lead to increases in overdose deaths,” Corey Davis, an adjunct professor at the Department of Population Health at the New York University (NYU) Grossman School of Medicine and a senior investigator for the new report, said at the time.
The findings, published in the journal JAMA Psychiatry in September, came on the heels of another recent study co-authored by Davis that found that decriminalization in Oregon and Washington State resulted in reduced arrests for drug possession and did not lead to an uptick in arrests for violent crimes.
“These two studies show that drug decriminalization measures in Oregon and Washington reduced arrests and did not increase overdose deaths,” Davis said. “Taken together, these findings signal reduced harm to people who use drugs and possibly their communities as well.”
Researchers noted, however, that Oregon’s increased funding for treatment and recovery services didn’t actually take effect until after their study was concluded.
Oregon’s rollout of approximately $287.3 million for behavioral health services “was slow and most was distributed between April and September 2022, after our study period,” the study said. “Funded programming has the potential to decrease risky drug-related behaviors and support pathways to addiction recovery, which can reduce nonfatal and fatal drug overdose.”
Oregon had the 34th highest fatal overdose rates in the country, respectively, according to U.S. Centers for Disease Control and Prevention data from 2021, the most recent available.
Legislators already made some adjustments to the state’s decriminalization law this year, passing a package of reforms in June to provide an oversight council with more staff and administrative aid from the Oregon Health Authority (OHA).
A January audit of the measure by the secretary of state found that OHA needed to provide more support and better coordination. It concluded at the time that it was too soon to tell whether Measure 110 programs could curb the state’s drug problems.
Photo courtesy of Flickr/Marco Verch.
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