Every life lost to overdose is a tragedy. Policies can impact overdose rates. However, no single policy, intervention, or approach can change overdose rates on its own — overdoses rise and fall because of a combination of factors.
This is especially important when looking at Measure 110, the first state law in the U.S. to decriminalize possession of small amounts of drugs in Oregon.
In November 2020, Oregon voters passed Ballot Measure 110, decriminalizing possession of small amounts of drugs while expanding addiction services and social supports because voters supported a public health approach to drugs and addiction. Communities wanted more investments in their treatment and recovery infrastructure instead of putting people behind bars.
Rather than someone getting arrested for personal drug possession, Measure 110 meant that they were given a citation and fine of up to $100. The fine could be waived if a person completed a health assessment in person or through a hotline. This led to a decline in drug-related arrests and incarceration. But after valid frustration with street conditions, Measure 110 faced misguided backlash. As a result, low-level possession was recriminalized in September 2024.
Measure 110 wasn’t just about decriminalization. While in effect, Measure 110 also invested hundreds of millions of dollars into health and overdose prevention services and addiction recovery infrastructure which are still funded to this day. This included overdose prevention services such as the opioid reversal medication naloxone, fentanyl test trips, and medications for opioid use disorder which cut overdose risk in half.
Before Measure 110, Oregon ranked nearly last in access to treatment and lacked services to address addiction and overdose at a critical time when overdose deaths were rising. For the first time, Measure 110 helped fill the gaps in care and paid for programs, staff, services, and tools that were unavailable or inaccessible to most Oregonians before.
Measure 110 did not legalize drug sales, production, or distribution. This distinction is important. Measure 110 just changed penalties for possessing small amounts of drugs that a person may have for their own use. It did not legalize producing, trafficking, or selling them to other people.
Drug sales, production, and distribution remained illegal. Police could still legally enforce those laws and make arrests. During Measure 110, people who sold, produced, or distributed drugs were still subject to arrest and criminal penalties because they broke the law. Despite this fact, critics continue to falsely claim that Measure 110 legalized drugs and blame it for overdose increases. But the real reason deaths went up is because the drug supply was illegal, unregulated, and unpredictable. This allowed potent drugs like fentanyl to overtake the supply so many people did not know what they were using or its potency, dramatically increasing the risk of overdose.
Oregon’s overdose crisis did not happen in isolation and started long before Measure 110 was implemented. It unfolded during a nationwide fentanyl crisis and, eventually, the global COVID-19 pandemic as well. Deaths rose in Oregon and in all states where possession remained criminalized. By the time the initial Measure 110 funding made it to community organizations to expand access to lifesaving services, fentanyl had already rapidly permeated the drug supply and led to more overdose deaths. The COVID-19 pandemic also delayed some of the funding rollouts to organizations on the ground because the Oregon government was prioritizing responding to the COVID-19 public health emergency.
Background on the Overdose Crisis.
Beginning around 2013, fentanyl drove a sharp rise in overdose deaths, hitting the eastern U.S. hardest before moving West. National overdose deaths peaked at their highest in 2022, before declining in 2023. However, not all states and regions were impacted at the same time in the same manner. In Oregon and neighboring states, like Washington and California, the overdose crisis followed a similar trajectory to the rest of the country but started later. Fentanyl entered Oregon’s drug supply in 2019, and overdose deaths soon rose sharply over the next few years.
Across the U.S. in the past decade, overdose deaths have risen in cities and small towns, across urban and rural areas, under different laws, political leadership, and approaches to drug use. These deaths rose because fentanyl entered the drug supply. Then the crisis intensified nationally when the COVID-19 pandemic started in 2020, because people were isolated, disconnected from treatment and services, and many self-medicated with drugs.
The unpredictable spread of fentanyl exacerbated the overdose crisis in the western U.S. just as Measure 110 officially took effect Oregon in February 2021. Oregon was the only state that had decriminalized low-level drug possession. Yet deaths followed a similar trend as Nevada, California, and Idaho; neighboring states where drug possession remained illegal.
A range of reputable studies in 2023, 2024, and 2026 show that Oregon’s increased deaths were due to the spread of fentanyl to the West Coast rather than decriminalization. Overdose was a national crisis before Measure 110.
Overdose deaths began to decline in 2024, while Oregon’s drug decriminalization law was still in effect. CDC data show that Oregon’s overdose deaths began a steep decline starting in March 2024. They went down 22% from 1,900 deaths in 2023 to 1,480 deaths in 2024, coinciding with the last six months that Measure 110 was in effect. The Oregon Health Authority credited some of this drop to the fact that Measure 110 helped fund increased access to overdose prevention, treatment, harm reduction, housing, employment and peer support. Although low-level possession was recriminalized in late 2024, the health services continue to be funded and are still saving lives to this day.
Broader national and regional trends in overdose deaths matter. The presence of Measure 110 alone cannot explain why overdose deaths were rising across much of the country at the same time. And it runs counter to the overlooked fact that overdose deaths actually started to fall in Oregon and nationally while Measure 110 was law.
Some countries like Portugal have decriminalized drugs with positive results including reduced overdose deaths, drug use, and HIV infections all while increasing participation in treatment and other health services.
But Oregon’s law took place under very different conditions that Portugal and other countries didn’t have to deal with, like fentanyl. Oregon also does not have universal healthcare like Portugal. And the state was implementing a new system during the COVID-19 pandemic at the same time fentanyl was rapidly transforming the West Coast drug supply.
Overdose deaths are a national issue — Oregon wasn’t spared. When national overdose deaths began declining across the U.S. in 2023, they eventually fell in Oregon and other West Coast states in 2024. The decline was due to many factors. This includes expanded access to medications for opioid use disorder and the opioid reversal medication naloxone — lifesaving interventions expanded through years of progressive drug policy advocacy and bipartisan support.
We know that Oregon’s overdose deaths began declining when decriminalization was in effect and before the state recriminalized possession. Oregonians have legitimate concerns about public drug use, overdose, and addiction. Measure 110 suffered from implementation challenges stemming from COVID-19 pandemic disruptions, delayed distribution of funding for addiction services, and the missteps of local leaders and law enforcement. Those concerns deserve serious attention, and we can learn from them. But they should not lead us to confuse correlation with causation or ignore the role fentanyl played in Oregon’s overdose crisis.
Good drug policy starts with an accurate, truthful diagnosis of the problem. It’s important to look at all the variables to truly understand the relationship between overdose and decriminalization. Oregon’s overdose crisis was part of a national fentanyl crisis, not the doing of a local policy.
