Drug Decriminalization Policies Work — With Properly Funded Treatment Services
Critics of decriminalizing drugs have pointed to rising overdose rates to argue that decriminalization doesn’t work. In fact, such policies are effective — when combined with robust state support for addiction treatment.
A patient is handed his daily dose of methadone by a nurse on October 4, 2017, in Lisbon, Portugal. (Horacio Villalobos / Corbis via Getty Images)
One of the biggest winners of the 2020 elections, across red and blue states alike, was drug decriminalization. With even many conservatives getting on board with decriminalization, it seemed as though the “war on drugs” might soon be relegated to the dustbin of history. The most sweeping of the 2020 initiatives was Oregon’s Measure 110, which decriminalized personal possession of all drugs. The leading precedent for the ambitious law was Portugal’s similar policy passed twenty years earlier.
These drug decriminalization experiments are coinciding with a fentanyl-driven third wave of the opioid epidemic, and conservatives are citing these rising overdose deaths to call for a return to the war on drugs. But a closer look at the experiences in Oregon and Portugal shows that decriminalization is not to blame: the real problem is lack of state support for addiction recovery.
Recent articles from the New York Times and the Washington Post have depicted serious problems with overdoses and public drug use in both Oregon and Portugal. This has led conservatives like Bret Stephens to decry “The Hard-Drug Decriminalization Disaster.” Stephens draws anecdotes from another Times piece, describing an Oregonian woman who “sidesteps needles, shattered glass and human feces” to get to work and who once witnessed another woman performing “oral sex on a man at 11:30 in the morning on a block between Target and Nordstrom.”
Anecdotes about public blowjobs (which are, indeed, still illegal in Oregon) don’t amount to proof of anything, but Stephens also cites data showing a rise in opioid overdose deaths in Oregon over the last few years.
The data does not back up his narrative either, however. It is true that overdose deaths have risen significantly in Oregon since the 2020 measure, but the state’s overdose data from 2019 to 2021 shows a rise identical to that of its neighbor, Washington State, where drugs are still criminalized — and 2022 shows a much steeper rise in Washington than in Oregon. Oregon’s decriminalization happened to come amid a horrific rise in overdose deaths across the nation, driven by the spread of fentanyl and the COVID-19 pandemic. Since 2016, fentanyl overdose deaths have surged 279 percent nationwide, and 2022 was a record-breaking year with 109,680 people dying from drugs, the vast majority from fentanyl.
Behind the Statistics
There is an overdose disaster in Oregon and across the country, and it is an unacceptable humanitarian crisis. Not only is it an atrocity in itself, but the political response to the overdose epidemic could end up rolling back decriminalization. It’s easy to ridicule Stephens, but he is not alone in taking aim at decriminalization policies. Not even three years after Oregon’s decriminalization measure passed with 58 percent of the vote, an even greater percentage of Oregonians — 63 percent — support recriminalizing drug possession.
Oregon’s Measure 110 has in fact been a failure, but not because it decriminalized drugs. Its failure lies in an underfunded and inadequate addiction treatment and recovery system. Even before Measure 110, the state had the second-highest addiction rate in the nation and ranked very last in access to addiction treatment services. While Measure 110 promised to fund recovery and improve the situation, that funding has been woefully inadequate.
After bureaucratic hurdles and delays, some funding has finally gone to support harm reduction services like clean needles and test strips as well as peer support and shelter. However, residential addiction treatment lags far behind. Medicaid patients wait months for a treatment bed, so those leaving hospital detox are thrown back into the world without access to inpatient services and only limited access to outpatient ones — a clear recipe for relapse. Last year, the state had fewer than thirty youth residential treatment beds that accepted Medicaid. But if addicts cannot get help at the moment they are ready, they may be dead or no longer ready for treatment by the time it arrives.
“I talked to a woman the other day who’s living in her car, and she was sobbing and crying and so desperate for treatment,” Solara Salazar, a director of Cielo Treatment Center, told the New York Times.
I’m trying to give her some hope and I say, “Just keep trying and you’re going to make it,” but I know that’s a lie. She’s not pregnant, so she doesn’t meet the benchmark for an immediate bed. And I’m going to tell her she has to call every single day for four months and then maybe she’ll get a bed?
Stephens dismisses those who blame poor treatment funding for the “disaster.” On the contrary, he says, addiction is a “lifestyle” whose adherents refuse help. But those like Salazar who actually work in addiction treatment reject the idea that addicts don’t want help. The lack of available treatment and months-long wait times that addicts face fly in the face of the claim that treatment funding doesn’t matter because addicts don’t want it. While he cites data showing most addicts in Oregon don’t seek treatment, it is likely that many aren’t trying to get treatment precisely because they already know that the treatment system is inadequate and unlikely to help them.
The example of Portugal is even clearer. Since Portugal’s decriminalization policy began way back in 2001, we have many more years of data to understand its effects.
In order to declare the policy a disaster, Stephens cites a rise in the percentage of adults using drugs: from 7.8 percent in 2001, when the policy began, to 12.8 percent in 2022. Yet the article the statistic came from also notes that Portuguese drug use in 2022 was still below European averages. Furthermore, overall drug use is not a very meaningful statistic given that the overwhelming majority of drug users partake without becoming addicted.
More significantly, Stephens cites a rise in overdoses in Lisbon over the last four years and a decline in people obtaining treatment since 2015. Given that the policy began in 2001, why does Stephens only cite overdoses since 2019 and treatment rates since 2015? You could probably guess: statistics covering 2001 to 2015 refute his entire narrative.
When the policy was passed, there were widespread warnings of a total catastrophe. On the contrary, “new HIV infections, drug deaths and the prison population all fell sharply within the first decade.” A 2007 report stated that “while drug addiction, usage, and associated pathologies continue to skyrocket in many EU states, those problems — in virtually every relevant category — have been either contained or measurably improved within Portugal since 2001.”
The report concluded: “The data show that, judged by virtually every metric, the Portuguese decriminalization framework has been a resounding success.” Even decriminalization’s opponents had to admit that it worked, and no one — not even right-wing parties — openly proposed reversing the policy.
The Effects of Austerity
While current data shows Portugal still much better off than the rest of Europe and the United States, Stephens is right that the situation has gotten worse in recent years. The last decade has seen an uptick in drug deaths, in sharp contrast to the “resounding success” of the 2000s. The formerly untouchable policy is being reexamined. One culprit for the deterioration since 2020 is the COVID pandemic, which has seen a sharp rise in drug deaths across the world. But the regression in Portugal began years earlier. So what changed? Did decriminalization suddenly stop working after a decade?
Unsurprisingly, the situation went from improving to deteriorating right after neoliberal austerity programs cut treatment funding and contracted out formerly state-run services to private nongovernmental organizations (NGOs).
Portugal’s 2001 decriminalization law that saw such success crucially did more than decriminalize drug possession. It also set up robust harm reduction as well as treatment and recovery programs. Those in active addiction could get clean paraphernalia and medical supervision as well as methadone, which eases opioid withdrawals.
Those caught with drugs are sent to dissuasion commissions, which determine if the user is addicted, and if so, recommend treatment programs. If the addict voluntarily chooses to attend treatment, the commission books it for them, and they can attend for free. After residential treatment programs, recovering addicts get job support from the government, including loans to start worker cooperatives. Portugal treated addiction as a health issue rather than a criminal one, and unlike the United States, it treated health care as a right.
Amid an economic crisis, budget cuts and outsourcing destroyed Portugal’s world-renowned drug treatment system. In 2012, “Portugal decentralized its drug oversight operation” as “a funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups.” At the same time, the country’s Institute for Drugs and Drug Addiction was disbanded and absorbed into the National Health Service, which simultaneously had its own budget cut by 10 percent.
The result: year-long waits for state-funded rehabilitation treatment, and a sharply decreasing number of people treated. Blaming government disinvestment, João Goulão — Portugal’s drug czar since 2005 and the architect of the decriminalization policy — said, “What we have today no longer serves as an example to anyone.”
Speaking almost a decade ago, a dissuasion commission member said, “If the person shows up at ten o’clock in the morning, we can schedule them for one o’clock in the afternoon at the treatment facility in order for them to start the analysis.” With wait times for treatment in Portugal going from four hours before the effects of austerity kicked in to an entire year, is it any mystery that Portugal’s drug statistics have been getting worse?
A Left Approach to Decriminalization
Jacob Sullum, writing in the free-market libertarian Reason magazine, has defended Oregon and Portugal’s decriminalization efforts against Stephens’s attacks while calling for full legalization. But Reason ignores the real culprit behind the drug problems in Oregon, Portugal, and everywhere else: an underfunded and privatized treatment and recovery system.
While drug-warrior conservatives like Stephens want to solve addiction by locking addicts in cages, libertarians would let addicts die on the street without access to treatment. Both of these approaches are an affront to human dignity. We need a left alternative to drug policy that works alongside decriminalization: robust state-provided treatment at every step of the way, along with a social safety net that would give people the stability that can help stop them from relapsing or from becoming addicted in the first place. If the decriminalization movement does not demand this, it is more likely to fail, and we may well see the fruitless, destructive war on drugs return as a result.
The goal of stopping our country’s grotesque and increasing number of overdose deaths demands that we provide free, immediately available treatment and a social safety net for all. Anything less is a barbarous violation of human rights.