By Michael J. Zoorob,; Ju Nyeong Park,; Alex H. Kral,; et al

Importance: With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl-a substance that is known to drive fatal overdose-to Oregon's unregulated drug market.

Objective: To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon's unregulated drug market.

Design, setting, and participants: In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024.

Exposures: Measure 110 took effect in Oregon on February 1, 2021.

Main outcomes and measures: The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market.

Results: In this analysis, rapid spread of fentanyl in Oregon's unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], -0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result.

Conclusions and relevance: In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon's unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.  

JAMA Netw Open. 2024;7(9):e2431612. doi:10.1001/jamanetworkopen.2024.31612

By Drug Policy Alliance

In 2020, Oregon voters overwhelmingly approved Ballot Measure 110. This made Oregon the first state in the U.S. to decriminalize possession of small amounts of all drugs, while greatly expanding addiction services and social supports. But in 2024, state leaders recriminalized drug possession after a disinformation campaign led by drug war defenders and backed by corporate interests. Statewide criminal penalties for drug possession returned on September 1, 2024. Promised deflection programs were not ready, meaning people will be arrested and prosecuted because of their addictions. As before, drug use will be used as an excuse to arrest Black and Brown Oregonians at higher rates (they are statistically more likely to face incarceration and harsher sentencing due to targeted policing and enforcement). Oregon’s public defender shortage continues. People who are arrested will likely have their cases dismissed for lack of counsel. In a return to the failed war on drugs, people will cycle through the criminal legal system without connection to services. The successes of Measure 110 should neither be downplayed nor contributed to H.B. 4002. Measure 110 provided over $300 million for addiction services, including a program where police connect people to care without arrest. Policymakers must focus on implementing a thorough public health approach to drugs and real solutions to other pressing issues, not on the false promises of criminalizing drug possession.

New York: Drug Policy Alliance, 2024. 5p.

By Mark McMullen

Although it is particularly pronounced in Oregon, there is no question that the fentanyl epidemic is imposing severe economic costs across the nation. The current report quantifies some of these costs and describes the state policy environment. Public policy regarding drug use is evolving rapidly in Oregon as we speak. As with all CSI does, the primary goal of this report is to educate and inform Oregonians on policy issues such as this that impact their lives. Key Findings • The economic cost of Oregon’s fentanyl crisis is more than $31 billion annually, up from $5.88 billion in 2017. • Enough fentanyl was seized last year to kill every Oregonian more than 20 times over. • Most western states have seen above-average growth in fentanyl use during recent years. Even so, Oregon’s experience stands out relative to its neighbors. Since the pandemic began, fentanyl-related overdose deaths in Oregon have increased by over 1,000%, more than in any other state. Alaska’s experience is the only one that even comes close. • Although Oregon’s decriminalization experiment cannot be blamed for all the disproportionate local impact of the fentanyl epidemic, it is clearly playing a role. When decriminalization went into effect in February 2021, Oregon ranked 38th out of 48 states with available data in the rate of fentanyl related overdose deaths. By January 2024, Oregon’s rank rose to 13th. • Many voters and policymakers quickly experienced regrets associated with the decriminalization effort and are making some efforts to improve the law. During the 2023 legislative session, legislators enacted House Bill 4002, which created a new misdemeanor for simple drug possession. The new law gives leeway to counties on how to implement it locally, and we are likely to learn much as the different programs evolve.

Greenwood Village, CO: Common  Sense Institute 2024. 

By Michael J. Zoorob, ; Ju Nyeong Park, ; Alex H. Kral,  et alBarrot H. Lambdin, PhD3; Brandon del Pozo, PhD, MPA, MA1,2

IMPORTANCE-  With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl—a substance that is known to drive fatal overdose—to Oregon’s unregulated drug market. OBJECTIVE -  To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon’s unregulated drug market. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024. EXPOSURES Measure 110 took effect in Oregon on February 1, 2021. MAIN OUTCOMES AND MEASURES The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market. RESULTS In this analysis, rapid spread of fentanyl in Oregon’s unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], −0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result. CONCLUSIONS AND RELEVANCE In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon’s unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

  JAMA Netw Open. 2024;7(9):e2431612. doi:10.1001/jamanetworkopen.2024.3161

By Sarah S. Shin, Kate LaForge, Erin Stack, Justine Pope, Gillian Leichtling, Jessica E. Larsen, Judith M. Leahy, Andrew Seaman, Daniel Hoover, Laura Chisholm, Christopher Blazes, Robin Baker, Mikaela Byers, Katie Branson & P. Todd Korthuis

Background

Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade.

Methods

We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes.

Results

PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers.

Conclusion

PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

Harm Reduction Journal volume 19, Article number: 76 (2022)