Topic: Legalization of all drugs (i.e., legalizing drugs currently
deemed illegal)
Research Question:
How would the legalization of all currently illegal drugs impact crime
and homelessness rates across the U.S.?


Evaluate your identified website based on neighborhood, author’s background, and bias. Assign each factor a grade according to the grading scale suggested in Chapter 6. Given the three grades you assigned this website, do you believe it provides relevant, accurate, and credible information?

As more people view substance use as a health issue rather than a criminal legal issue, drug policies based on criminalization and punishment have drawn increased criticism around the world. Support for decriminalization – where drug possession for personal use remains prohibited but is not subject to criminal penalties – is gaining significant ground. Drug possession has been decriminalized in Portugal for over two decades, and they are often held up as an example of how decriminalizing drug possession and investing in health services can produce significant societal benefits, including reduced rates of communicable disease transmission and overdose and increased harm reduction and treatment utilization (Slade, 2021). The United Nations committed to promoting alternatives to criminal responses to drugs, including decriminalization, in 2018 (United Nations System Chief Executives Board for Coordination, 2019). Major public health organizations support decriminalizing drug possession, including the American Public Health Association and the Global Commission on Drug Policy (American Public Health Association, 2013; Drug Policy Alliance, 2017; Global Commission on Drug Policy, 2018).
The United States is globally recognized as the primary proponent of the war on drugs, arresting more people annually for drug offenses than any other country (Sunrise House, 2019). Yet, individual states have already departed from a strict prohibitionist approach. Twenty-one states and the District of Columbia, the nation's capital, have legalized cannabis possession for recreational purposes by adults aged 21 or older, and many more have expanded medical access and/or decriminalized personal possession of the drug (Berke et al., 2022).
The voters of the state of Oregon expanded drug policy reform beyond cannabis and decriminalized the personal possession of all drugs when they approved Measure 110, the Drug Addiction Treatment and Recovery Act, in November of 2020 (Measure 110 Drug Treatment and Recovery Act 2019 (Or.)). This first-of-its-kind reform in the U.S. eliminates criminal penalties for possession of all drugs within certain limits and invests hundreds of millions of dollars in health services for people who use drugs. Recent polling shows that two-thirds of the American public support decriminalization, indicating reforms like Measure 110 in Oregon are likely to be introduced in other U.S. jurisdictions (American Civil Liberties Union, 2021; Dandekar, 2022). While implementation of Measure 110 is ongoing, tracking this monumental shift will help inform drug policy both inside the U.S. and globally.
This paper will summarize the criminalization of drug possession in the U.S., analyze the major provisions of Measure 110, and explore early implementation impacts, successes and challenges. This paper will conclude with lessons drawn from Oregon's experience so far and how they may inform future drug policy.
Drug-related arrests and collateral consequences in the U.S.
Drug-related offenses comprised 15% of all arrests (nearly 1.5 million arrests) in the U.S. in 2019, and almost 90% of these arrests were for the personal possession of drugs (Federal Bureau of Investigation, 2020a, 2020b). American law enforcement disproportionately targets low-income communities and people of color when enforcing drug laws, despite the fact that people of all races use drugs at similar rates (Camplain et al., 2020; Centers for Disease Control and Prevention, 2019). As a result, Black people comprise 26% of all drug-related arrests nationally even though they comprise 13% of the U.S. population (Federal Bureau of Investigation, 2020c; United States Census Bureau, 2021b).
A drug-related arrest can have lifelong impacts on an individual, even if that arrest does not ultimately result in a conviction or incarceration. An arrest record can negatively impact one's ability to pass a background check for housing or employment, impact child custody, disqualify one from securing public benefits such as food or cash assistance, lead to deportation, and much more (Drug Policy Alliance, 2021). When a drug arrest results in incarceration, it separates people from their families and communities and can disrupt access to lifesaving harm reduction services or medications for opioid use disorder, placing many at heightened overdose risk upon release from incarceration since the vast majority of jails and prisons in the nation do not provide these services (Waddell et al., 2020). These collateral consequences disproportionately fall upon communities of color and low-income people, depriving them of opportunities to advance and further entrenching them in poverty with lasting generational effects.
The criminalization of drug possession contributes to high-risk substance use practices, such as using alone or in risky situations and reusing drug equipment. It also deters many people from calling emergency services for assistance due to fear of arrest (Bowles et al., 2020). Stigma and mistreatment from healthcare providers further deter people with substance use needs from seeking healthcare and medical assistance, even in emergencies (Bergstein et al., 2021). Avoiding or delaying medical assistance can have particularly deleterious effects among this population because people with substance use disorders (SUDs) often have a higher prevalence of comorbidities and chronic diseases requiring medical treatment (e.g., hypertension, diabetes, cancer) than the general population (Wu et al., 2018). This discriminatory treatment is associated with marginalized people who use drugs having worse health outcomes than the general population (Cruz et al., 2018).
Patchwork of funding for treatment and harm reduction
To complicate matters, the U.S. does not provide universal healthcare, resulting in a disorganized, patchwork system for accessing and paying for health services (Haeder, 2017). Health insurance in the U.S. is largely tied to employment so that many full-time and some part-time employees are covered by employer-chosen private insurance plans (Pollitz et al., 2019). Medicaid and Medicare are the two large publicly funded insurance options predominantly reserved for people who are low-income, have disabilities, or are over the age of 65. Meanwhile, underemployed or self-employed people may have to independently pay for their own private insurance or go uninsured. Even among the insured, there is a wide range in the types of services that may not be fully covered, so that insured patients may still need to cover co-pays, meet deductibles out of pocket, or seek prior authorization from their insurance company to pay for services.
Medicaid is technically the largest public payer of SUD treatment in the United States; however, federal and state substance abuse block grants pay for a significant portion of these treatment costs across the nation. This is because policies for both state-run Medicaid programs and private insurance payers vary greatly from state to state, meaning many people still experience a funding gap for services. Insurance payers often differ in the types of services covered, prior authorization requirements, eligibility criteria, co-pays, and the number and types of local participating providers (Dickson-Gomez et al., 2022). As a result, treatment-related costs and barriers remain for far too many people who seek care, even when they are insured. Within this patchwork of insurance coverage, public block grant funds remain an essential funding stream in most states because they cover or supplement the costs of SUD services for both publicly and privately insured patients, as well as the uninsured (Woodward, 2016). Abstinence-only SUD treatment, where the explicit goal of treatment is to discontinue all drug and alcohol use indefinitely, is the dominant modality available in the U.S. (Lee and O’Malley, 2018).
Referrals from the criminal legal system have historically made up a quarter or more of all admissions to SUD treatment in the U.S. (Substance Abuse and Mental Health Services Administration, 2021). The criminal legal system has assumed a growing role in SUD treatment by requiring treatment completion as part of a sentence, due to drug court participation, or as a condition of release from incarceration or community supervision. In these cases, courts also determine which treatment programs qualify to satisfy those requirements. Although insurance may cover some or all of the costs for those who are insured, the un- or underinsured often incur large expenses for court-mandated SUD treatment.
Historically, health insurance does not cover harm reduction, employment support, long-term recovery, housing, and/or peer support services. These programs primarily rely upon grants from the private sector, local or state government funds, and/or donations (National Academies of Sciences, Engineering, and Medicine, 2020). The federal government has generally eschewed funding harm reduction services, including a decades-long prohibition on using federal funds to purchase needles and other drug supplies (Oliva et al., 2021). Recently, the federal government allocated a modest, though historical, one-time infusion of $30 million for a national harm reduction grant program to fund 25 programs across the country. Those funds can be used to purchase needles and other equipment, although the general ban remains, and safer smoking equipment like pipes cannot be purchased (Department of Health and Human Services, 2021). Consistent and adequate funding remains a challenge for the majority of harm reduction programs operating across the nation.
Description of Oregon's Measure 110 & early impacts
Oregon voters’ approval of Measure 110 on November 3, 2020 was the first time decriminalization for possession of controlled substances (PCS) other than cannabis advanced anywhere in the U.S. Titled the ‘Drug Addiction Treatment and Recovery Act’, Measure 110 represents a drastic departure from a punishment-based approach to one that is more humane and health-centered. Measure 110 redesignates possession of small amounts of drugs from a misdemeanor criminal offense to a violation punishable by a citation and fine of up to $100. The fine is waived if the individual completes a health needs screening and submits verification to the court. The measure also redirects substantial funding into health services for people who use drugs, including harm reduction services, low-barrier SUD treatment, housing, recovery, and peer support services. Measure 110 presents an alternative to the costly practice of arresting and incarcerating people for drug use and the negative consequences associated with such an approach. Instead, it offers funding to improve and expand care in the state of Oregon, which ranks near the bottom of states in the U.S. for access to services for people with substance use needs (Mental Health America, 2022).
A broad coalition of individuals and organizations organized to support Measure 110. Organizational support came from SUD treatment providers, harm reduction service providers, housing providers, and organizations that focus on civil rights, racial justice, and labor rights, among others (Oregon Secretary of State, 2020). Notably, people with lived experience with substance use needs and drug-related criminal legal system involvement helped to craft the policy, worked on the campaign, and were involved in implementation. Over 58% of voters supported Measure 110 and ensured its passage in November of 2020.
The measure can be divided into two primary categories: provisions removing criminal penalties for PCS and provisions to expand and improve health services. Measure 110 also requires regular financial and performance evaluations. The following sections analyze the measure as amended by the Oregon Legislature during codification of the measure into statute (Senate Bill 755 2021 (Or.)). A timeline of the key implementation milestones is presented in Figure 1.