“Treatment over incarceration.”
In November 2020, Oregon voters embraced that slogan by passing Measure 110, which decriminalized unlawful possession of small amounts of any drug for personal use, including fentanyl and methamphetamine, across the state. Beginning in February. 2021, the groundbreaking law replaced jail time with a $100 citation or a cost-free pathway into rehab.
However, Measure 110 has failed to live up to the expectations of the activists, policymakers, and voters who originally supported it. After the law went into effect in 2021, Oregon struggled to dole out grant funding to treatment centers to hire staff and expand services. Instead, the state saw disproportionately higher numbers of homelessness and drug use centered in poorer neighborhoods. While drug-related arrests dropped significantly, new treatment services went unused.
Hotlines to schedule medical assessments received few calls while police continued handing out citations to the same residents. Local companies, law enforcement, and community groups that once supported the transformative measure turned against the now broadly-unpopular directive. This year, Oregon’s state legislature reclassified the possession of small amounts of drugs as a misdemeanor under growing local pressure.
Once a hallmark of progressive legislators’ platforms, decriminalization is now fading from discussions around drug rehabilitation. In the shadow of Measure 110, Oregon continues to grapple with the delicate balance between criminal punishment and treatment. Policymakers tackling the drug epidemic can glean important insights from Measure 110’s shortcomings and areas for improvement, particularly regarding the timing of implementing a proposal of such magnitude.
The Inception and Rationale Behind Measure 110
Measure 110 was originally proposed and drafted by the Drug Policy Alliance, a community group that advocates for drug decriminalization across the U.S. In an interview with the HPR, DPA Director of Public Health Kellen Russoniello characterized the policy as a “move from a criminal legal approach to drug possession to a public health approach.” Prior to Measure 110, drug possessions were categorized as a Class A misdemeanor in Oregon, meaning that offenders could face up to one year of jail time or a fine of up to $6,250. DPA activists believed that they could lower a major barrier to treatment by removing criminal punishments for drug possession. Doing so would diminish the overall stigma associated with substance addiction.
Under Measure 110, Oregon law enforcement issued $100 citations for drug possession offenses. Individuals could avoid paying the fine by contacting a state-operated hotline to undergo a substance use disorder screening. The initiative aimed to on-ramp individuals onto a comprehensive network of resources, including harm reduction services, peer support, and housing assistance.
To develop a new localized network of drug treatment resources, Russoniello shared that Measure 110 allocated “over $300 million in the first two years…towards services that didn’t traditionally enjoy a sustainable source of funding from [the] state or federal government.”
Racial justice was another key motivation behind the policy. Across the nation, Black Americans are incarcerated at disproportionately higher rates than their White counterparts; that racial gap is particularly stark with drug offenses. Although drug use rates were consistent across racial groups, Black Americans comprise 12% of the U.S. adult population but accounted for over twice that proportion in drug-related arrests in 2019. Similarly, the arrest rate for Black Oregonians was 490% higher than the average statewide rate.
While in prison, incarcerated individuals often do not get the care they need. As Tera Hurst, executive director of the Health Justice Recovery Alliance, a statewide organization in Oregon advocating for addiction recovery providers, shared, “Oregon’s system of criminalization has been a proven failure at getting people into services that they need.” Measure 110 strived to reduce the racial disparity in drug-related arrests by removing a charge disproportionately given to Black individuals, thereby reducing arrests of Black Oregonians by 94%.
Measure 110’s Results and Analysis: A Deep Dive
Less than two years in, many Oregonians began to realize the program was falling short of its promised goals. Between 2020 and 2022, overdose deaths in Oregon increased by 68%, four times greater than the national average increase of 19%. While overdoses were rapidly increasing, compliance with Measure 110 remained stubbornly low: 95% of individuals who received a ticket ignored it without any consequence. Most local stakeholders attribute such shortcomings to a mix of vague policies, implementation misalignments, and regionwide challenges that complicated the rollout of Measure 110.
In the face of public health and racial justice shortcomings, critics of Measure 110 tie part of the policy’s failure to the DPA’s geographical detachment from the implementation itself. DPA is based in New York — thousands of miles from Oregon — leaving some local community leaders, such as Kevin Barton, District Attorney for Washington County, Oregon, feeling they were merely “guinea pigs” for the organization.
Other critics argue the measure failed because it assumed a fine alone would motivate people to seek treatment. In 2021, Oregon state lawmakers passed a bill that removed any penalty for recipients who failed to either obtain treatment or pay the fine. From his conversations with police officers, Barton found that most recipients of those citations “just crumple them up and never end up appearing in court” because there was little accountability for paying the fine or following up on the hotline’s recommendations. Such gaps led to a vicious cycle where fewer officers handed out these ineffective citations, which meant that fewer drug users received citations in the first place.
As a supporter of Measure 110’s original intentions, Hurst pinpointed the lack of follow-up on the citations as a critical point of failure in treatment onboarding: Low uptake resulted in such a low volume of calls that the cost of running the hotline reached $7,000 per completed phone call. Police officers also lacked proper training in referring individuals for treatment or counseling. As Hurst stated, “They need someone to say, ‘Here’s the number to call. We’re going to send somebody who has the expertise out. You can leave. We’ve got them.’” Insufficient law enforcement training resulted in key provisions like the specialized tickets with treatment hotline information being inconsistently distributed. Even among informed officers who issued the tickets, there were inconsistencies and poor communication with treatment providers, which further undermined the system’s effectiveness.
Another source of friction was the state legislature’s inability to approve a full budget for the measure. Although police officers began issuing tickets in early 2021, the key treatment components did not receive the promised $300 million in funding until summer 2022. This delay left ticket recipients during that period navigating an underdeveloped drug treatment system.
However, amidst the turmoil of implementing the measure, Oregon also faced two extenuating circumstances that made it difficult to directly link Measure 110 to Oregon’s worsening drug-related trends.
First, as the COVID-19 pandemic up-ended people’s everyday lives, Oregon’s government, law enforcement, and treatment providers found themselves inundated with a new host of emergencies that relegated Measure 110 to the back burner. Many clinics that typically offered drug treatment services had their funding rerouted to COVID-19 treatment centers, which forced them to cut to 50% capacity. As at-risk individuals found themselves socially isolated, without employment, and cut off from a reliable drug source, they became more likely to use drugs — and use them without the proper supervision or safeguards.
As both Hurst and Russoniello pointed out in their interviews, the COVID-19 pandemic quickly became the most complex crisis that the U.S. had ever faced. The pandemic increased opioid usage across the country and exposed weaknesses in existing systems, let alone the brand-new drug treatment approach introduced by Measure 110.
Second, the new spread of fentanyl from the East to the West Coast created an increasingly dangerous drug supply in Oregon. Hurst argued that the rise in overdose deaths “had nothing to do with 110,” noting that if Measure 110 were responsible, “then Washington and California wouldn’t have seen a spike.” Empirical evidence supports Hurst’s claim: A study comparing Oregon to surrounding states in the region found similar drug overdose trends across the board.
As Barton aptly puts it, “I don’t want to say perfect storm. We had the horrible storm of all these things happening at once that just created the worst scenario possible.”
Charting a Path Forward: Drug Decriminalization Post-Measure 110
The DPA still attributes the rollback of Measure 110 to “drug war defenders” and “Oregon leaders who scapegoated Measure 110,” arguing that the measure was not given sufficient time to prove its benefits. However, most Oregonians still associate the rise in drug use with Measure 110, making complete decriminalization a politically unattainable policy to continue. A poll in late summer 2023 found that nearly two-thirds of Oregonians –– including 79% of Hispanic Oregonians and 74% of Black Oregonians –– wanted to repeal parts of Measure 110 and bring back penalties for illegal substance possession. Among all voters, 54% supported fully repealing Measure 110.
That being said, the recovery-centered paradigm shift that Measure 110 intended to introduce still rings true for both treatment providers and law enforcement officials in the region.
In the midst of growing sentiments against Measure 110 in late 2023, Hurst organized a delegation of Oregon legislators, service providers, researchers, and law enforcement to Portugal to study their decriminalization model. Inspired by the “collaboration between providers and law enforcement” she witnessed, Hurst started a pilot program to connect the outreach work of the Portland Police Bureau’s bike squad and Oregon State Police with expert treatment providers in the region.
Under the new pilot program, police officers could refer individuals traditionally charged with drug possession directly to an outreach worker who would arrive within 10 minutes, bypassing Measure 110’s hotline system. When explaining the rationale behind the program, Hurst emphasized that ending the cycle of addiction cannot be achieved through current strategies centered on shame and punishment.
Hurst argued that Measure 110 could have been more effective if it had been properly implemented from the start with adequate funding and staffing in the state’s Health Authority. As she shared, “I would like to see an actual agency own it.”
However, others argue that the presence of social workers alone is insufficient to encourage people to seek treatment. Barton perceives the situation as the carrot and stick metaphor: Law enforcement needs to complement its provision of treatment services with a “real possibility of a threat of incarceration” to combat the allure of highly addictive drugs.
In May 2024, Washington County joined a state program that made drug possession an “unclassified” misdemeanor, requiring court appearances unless offenders complete six months of treatment. Barton highlighted its early success, noting the positive impact on marginalized communities hit hardest by homelessness and crime since Measure 110.
The push for new treatment measures reflects a growing acknowledgment of the challenges Measure 110’s decriminalization experiment faced. While it aimed to prioritize treatment over punishment, its implementation revealed the consequences of insufficient infrastructure and resources. Many individuals fell through the cracks of inadequate support and accountability resources, leading to escalating rates of homelessness, addiction, and untreated mental health issues across the state. As Oregon reintroduces limited criminal consequences and community-led pilot programs, it is clear that a sustainable solution to the drug crisis requires a well-funded, holistic approach that combines treatment access with community accountability.
