The Effects of Drug Decriminalization in Oregon: An Interview with Drug Policy Alliance’s Matt Sutton

Written By Chelsea Boyd

In November 2020, Oregonians passed the Drug Addiction Treatment and Recovery Act (Measure 110), which decriminalized possession of small quantities of formerly illicit drugs. It also set up a funding stream for substance use providers to offer harm reduction services, treatment, social services and other programs to people who use drugs.

For the first biennium, $302 million in cannabis taxes were allocated to hiring staff, building infrastructure and delivering these services. Ninety percent of this money was disbursed in August 2022, and reports from the Oregon Health Authority show that more than 60,000 people have already accessed services.

The first initiative of its kind in the United States, Measure 110 represents a paradigm shift in how society views and addresses drug use. But—as with any major change—it has received criticism.

The Drug Policy Alliance (DPA) worked closely with a diverse set of local organizations to develop and promote a program that responded to community needs. We talked to Matt Sutton, the DPA’s director of external relations and communication strategy, to facilitate a more nuanced conversation about Measure 110’s impact. Having led the DPA’s national communications strategy for the campaign, Sutton is familiar with the details of Measure 110 and the conversation surrounding drug possession decriminalization in Oregon.

Responses have been edited for length and clarity.

Chelsea Boyd: What were the primary goals of decriminalizing small quantities of different drugs in Oregon?

Matt Sutton: The main goal was to replace a criminal approach with a public health approach. The research is clear that criminalizing people does not work—it only adds to the barriers that people face in terms of being able to get the help they need. It's never been effective at reducing demand or the supply of drugs, and it has exacerbated racial disparities within the criminal legal system.

This was a perfect opportunity for us to really go after those things. Overdose is at an all-time high, and arresting people isn’t doing anything to solve that. Research shows that, within a few weeks of people getting out of an incarceration setting, they're much more likely to overdose.

When people end up with a criminal record, then they can’t get jobs, they can’t get housing. All those things make it more likely that they‘ll use drugs and less likely that they’ll get the help they need. So, when we’re looking at the big picture of how do we reduce that, the biggest thing is end criminalization, full stop, and then provide the resources people need to actually get help. That was another critical component of this initiative—to be able to fund those services.

Boyd: Some media outlets have published articles criticizing Measure 110’s implementation—mainly that not enough people are entering treatment. Do you think the public had the same expectations as you did of what Measure 110 would do and how it would help people?

Sutton: Yes, I just think there’s a limited understanding among the general public of what harm reduction services are. I think a lot of people may have latched onto the treatment component. We tried to be very clear that this was treatment, harm reduction and other health services to really illustrate the broad range of services that were being offered. We tried to make it clear that [the measure] supports recovery housing, peer support, recovery services [and] job assistance.

[Harm reduction] is a spectrum—it’s not linear. And people have to be able to access it where they are. Also, in order to get people the help they need, we have to have very low-barrier services. The entry point for most people is harm reduction services. And so that’s really what we’ve seen people take advantage of the most.

The other component is that those services weren’t eligible for other funding, especially federal funding. So a lot of these harm reduction programs—not just in Oregon, but everywhere—have been drastically underfunded and had to rely on private donations and limited state funding. But you’ve always been able to use Medicaid dollars to support treatment. So if somebody was able to bill [a service] toward Medicaid, they definitely billed it toward Medicaid to conserve as much money [from Measure 110] as possible.

When the initial reports came out, it showed something like half the accessed services were harm reduction services. Another big chunk was housing. The treatment component in those reports was not an accurate depiction of the people actually accessing treatment—just a depiction of where the Measure 110 dollars were going. And so media and some of the opposition really got hold of that and they’re like, “Nobody's accessing treatment.”

Anybody that needs and wants treatment in Oregon can access it now. And of course, if they qualify for Medicaid or have private insurance, that’s what’s paying for the treatment. But if they don’t, then Measure 110 will pay for it.

Boyd: How has Measure 110 impacted boots-on-the-ground harm reduction organizations and people who use drugs?

Sutton: Now that [harm reduction organizations are] able to access all this new funding, they’re able to really expand what they’re able to provide. We’ve seen a lot of different [services], like drop-in centers, being created where people who are using drugs are able to access things like clean needles or pipes or even safe-sex stuff [like] condoms. They’re able to access naloxone and all kinds of things. It’s also providing that connection with people that can connect them to treatment and recovery [and] supportive housing. So again, that’s the entry point—we can get them through the door, and then once they’re through the door, we can be making those connections. Our first priority is keeping people alive.

So it’s kind of like, yes, we’re probably keeping more people alive, but also the drug supply is getting more dangerous so people are more likely to die suddenly—even people that are not consistent drug users. So that makes our job a little bit challenging, too, because overdose numbers are continuing to increase everywhere. I think sometimes people look at that as the metric of success, like, we want no deaths. And unfortunately, that’s not realistic until we actually have a safer drug supply. We’re not at that point where we have politicians proposing that, or even overdose prevention centers. I think that’s the challenge we continue to face. But we do know that it’s keeping a lot of Oregonians alive. We definitely see that as success.

Boyd: What would you say to those who criticize the effects of decriminalization in Oregon?

Sutton: If criminalization had ever shown any results of being effective, that would be one thing. But there's been absolutely no evidence to that effect. The evidence has shown that [criminalization has] actually created a more dangerous drug supply and that it’s led to people facing more barriers to accessing services. So it doesn’t make sense that people would say “Oh, you should build out the infrastructure before decriminalizing drugs.” No, because criminalization itself is still a barrier to people accessing services. It still creates harms and is more likely to cause overdose.

We live in a society where criminalization is always going to be that default approach, and until we’re able to get away from that, we’re never going to get away from those harms. So continuing to think that anything else would happen is just a fantasy. There’s been lots of efforts by the legislature and opponents to try to overturn Measure 110 or remove funding from it. And so even with it passed, we continue to fight that battle.

We did just pass a bill that basically strengthens Measure 110, protects a lot of the funding, and provides a little more oversight and increased accountability. Hopefully that will continue to strengthen things and ease some of our opponents’ concerns. But I think any time you’re having a major systems change like this, you’re going to have opposition. We did win by an 18-point margin, so there was widespread support for it, but there was opposition regardless. And just because it passed doesn’t mean that opposition is going to go away.

Boyd: Any final thoughts?

Sutton: The biggest takeaway we’ve discussed here is that it’s not an overnight matter. We’ve had this system in place for over 50 years that has completely been about criminalization. Meanwhile, we’ve been disinvesting in community health and supports. And so, yes, now we’ve passed this. There’s a lot of new funding for it. But again, you have to give it time to allow the infrastructure to be built out.

One of the challenges we face, that people continue to have a problem with, is public drug use. But Measure 110 didn’t change that. There’s always been public drug use, and there’s public drug use in places that don’t have decriminalization. If that’s really the biggest concern, we need to look at opening overdose prevention centers that would provide space for people to use pre-obtained drugs under the supervision of somebody that can intervene in the case of an overdose. It’s really a net positive, because then we don’t have public drug use and we’re also reducing overdose deaths.

There’s lots of people using drugs, but they just have a place to use drugs. If you’re criminalizing public drug use, you’re really just criminalizing homelessness. And so there’s really two options: You either provide housing to everyone, or you provide overdose prevention centers. Anything less than that isn’t going to reduce public drug use. You can criminalize it all you want, but that’s just going to create more barriers for people without actually solving the problem.

Chelsea Boyd
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