Experts tell state lawmakers Oregon’s novel approach to drug addiction has holes
A day after the Oregon Health Authority declared a new era in the state’s approach to drug addiction had begun, experts warned legislators that the state’s drug epidemic is worsening while its new approach lacks crucial elements to stem the crisis.
Keith Humphreys, director of the Stanford Network on Addiction Policy, based at Stanford University in California, said the state’s shift away from prosecuting people with addiction problems toward boosting medical and social services lacks a push for people to stop using drugs and seek treatment.
“We need treatment and prevention policies that actually reduce drug use, as well as harm reduction programs that recognize the need to protect communities from the harms of drug use,” Humphreys told the Senate judiciary committee on Wednesday during an informational hearing.
Harm reduction programs, including clean needle exchanges and giving people the medication naloxone to reverse an overdose, aim to keep people alive, not deter them from drugs.
“If Oregon continues on its current path of not complementing effective harm reduction with strong prevention and treatment initiatives, and of focusing harm reduction only on people who use drugs, it should expect rising drug use, addiction and harms to communities,” Humphreys said.
Measure 110, passed in November 2020, made Oregon the first state nationwide to decriminalize possession of small amounts of illicit drugs while funneling hundreds of millions of dollars toward medical and social support. The state announced Tuesday it had distributed more than $260 million to set up addiction and social services support in every county – a year later than scheduled. In the meantime, deadly pills laced with fentanyl along with methamphetamine are pouring into the state, attracting and killing a growing number of teenagers.
Dr. Todd Korthuis, head of addiction medicine at Oregon Health & Science University, told the committee that the drug addiction toll in the state is mounting.
“Fentanyl and methamphetamine, which is often contaminated with fentanyl, are now the most common illegal drugs that people use in Oregon,” Korthuis said. “This is leading to a health crisis that is worsening before our eyes.”
As an example, he said in the 12 months ending in April 2022, a total of 1,114 Oregonians had died of an overdose, a 19% increase over the year before and double the number of motor accident fatalities. Teen overdose deaths tripled between 2019 and 2021, from 10 to 31, including some who popped counterfeit pills, which come in rainbow colors to draw younger people.
“Those who survive experimentation can quickly become addicted,” Korthuis said.
He said hospital staff have seen a six-fold uptick in the number of patients with infections caused by dirty needles in the past decade, costing $150 million a year.
“Despite the best efforts and good intentions of many, our addiction treatment system has been outpaced by these trends,” Korthuis said.
Oregon’s treatment system remains underfunded and understaffed, experts say. More than half of the state’s addiction treatment programs cannot meet the demand, and none of Oregon’s four residential facilities that treat teenagers offer medication like buprenorphine to treat opioid addiction, Korthuis said.
He pointed out that Measure 110 had decreased drug-related arrests by nearly 90% but said that was not accompanied by an increase in demand for treatment.
Under the measure, those arrested for a small amount of drugs are issued a citation, not charged with a crime, and fined $100. Courts dismiss the citation if the person seeks a treatment evaluation and shows that to the court within 45 days. They’re given a hotline number to help them get evaluated.
The system was supposed to keep those with addictions out of jail and encourage them to get treated. But that hasn’t happened.
Phillip Lemman, Oregon’s deputy state court administrator, told the committee that only 8% of the nearly 3,500 violations between Feb. 1, 2021 and Sept. 19, 2022 had been dismissed.
Most people ignore the process. About 70% of people are convicted because they don’t show up in court, Lemman said.
Sen. Kim Thatcher, R-Keizer, expressed dismay.
“It doesn’t feel like it’s working,” Thatcher said.
Patrick Allen, director of the Oregon Health Authority, urged lawmakers to give the system time to work. He said the state had just finished funding networks in each county to provide harm reduction, treatment and housing and employment support. Those services are free and directed towards people of color and underserved communities, but they won’t pay for treatment or medication that are supposed to be funded by Medicaid or commercial insurance.
Humphreys said one of the main problems with Oregon’s approach is it removes law enforcement from the picture. He said addiction is a medical disorder but unlike sickle cell anemia or chronic pain comes with a neurological reward such as a feeling of euphoria or relief from withdrawal.
“Addicted people usually do not seek treatment and recovery without external pressure from family, friends, employers, health care providers or the law,” Humphreys said. “This matters because Oregon has removed all legal pressure to stop drug use and seek treatment.”
Addiction also affects the community, with drug-related crime and people lashing out at others in a drug-induced psychosis, he said.
“Harm reduction for people who use drugs does not necessarily translate into harm reduction for everyone else,” Humphreys said. “We need treatment and prevention policies that actually reduce drug use as well as harm reduction programs that recognize the need to protect communities from the harms of drug use.”
He called for Oregon to use law enforcement to shut down “open-air drug markets,” or people who congregate in neighborhoods and sell drugs.
“This policy would also put legal pressure on persons who become addicted and get arrested for something other than drug possession, such as car theft, catalytic converter theft, robbery, assault or vandalism,” Humphreys said.
“Swift, certain and fair models of community supervision can be used to reduce substance use with or without treatment,” Humphreys added.
But Sen. James Manning, D-Eugene and a former corrections officer, said a police crackdown on people seen gathering in neighborhoods and suspected of selling drugs could lead to racial profiling, something that Humphreys agreed would not be good.
The chair of the judiciary committee, Sen. Floyd Prozanski, D-Eugene, said he was heartened by Measure 110’s support of peers and Korthuis’ testimony that peers, or people in recovery from addiction, were “highly effective at engaging people who use drugs in treatment.” He urged lawmakers to continue refining Measure 110 and give it time.
“This is an opportunity for us to work together, smooth out some of the rough edges and hopefully in another year or two we will see results that voters intended and that we will in fact have better results than we currently show,” Prozanski said.
CORRECTION: The state judicial department has not tracked why 8% of Measure 110-related violations have been dismissed. A previous version of this story misstated that they had been dismissed because they sought an assessment.