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.

Figure 1. Measure 110 implementation timeline.
Removal of criminal penalties
In 2017, the Oregon legislature reduced penalties for PCS in an amount below set quantities from a felony to a misdemeanor offense while retaining felony penalties for possession of greater quantities (House Bill 2355 2017 (Or.)). As of February 1, 2021, Measure 110 redesignated PCS under the smaller quantities as a violation rather than a crime (quantities are listed in Table 1). Measure 110 simply maintains the threshold amounts that were established in 2017 but changes the offense classifications: PCS in an amount below the threshold is now a ‘class E violation’, and possession of an amount equal to or greater than the threshold amount is a misdemeanor, unless the person possesses ‘a substantial quantity’ of a drug (five times the minimum quantity triggering a misdemeanor offense) or the offense qualifies as a ‘commercial drug offense’ (requiring the presence of three or more factors ostensibly indicating possession for commercial purposes). The thresholds were carried over from prior law; thus, they were not based upon expert research or stakeholder analysis.
Table 1. Offense level for possession of differing quantities of drugs in Oregon post-measure 110
Drug	Class E Violation	Misdemeanor	Felony*
Heroin	<1g	≥1 g but <5g	≥5g
Cocaine	<2g	≥2 g but <10g	≥10g
MDMA (ecstasy)	<1 g or 5 pills	≥1 g or 5 pills but <5 g or 25 pills	≥5 g or 25 pills
Methamphetamine	<2g	≥2 g but <10g	≥10g
LSD	<40 units	≥40 units but <200 units	≥200 units
Psilocybin	<12g	≥12 g but <60g	≥60g
Oxycodone	<40 pills	≥40 pills	n/a
* Possession may also be a felony if it is considered a ‘commercial drug offense’, requiring the presence of three or more factors ostensibly indicating possession for commercial purposes.
Source: Senate Bill 755 2021 (Or.).
Since Measure 110 took effect, people who possess drugs below the specified quantities are no longer subject to arrest, conviction, incarceration, or a criminal record. Instead, law enforcement may now issue a citation for a class E violation, punishable by a presumptive fine of $100. The courts must dismiss the citation upon receiving verification that the person completed a health needs screening through a Behavioral Health Resource Network (BHRN) or the designated statewide telephone hotline (explained in the following section), or accessed an equivalent or more intensive treatment contact, within 45 days. This provides the individual with an opportunity to connect with services voluntarily. Failure to pay a fine will not result in additional penalties or incarceration, which commonly occurs when fines are unpaid in most parts of the country (Hager, 2015).
Police can no longer search an individual based only on suspicion of PCS, since PCS within the specified quantities is no longer a crime. However, they may still confiscate any drugs they discover through lawful searches (Or. Rev. Stat. s. 131A.020(1)).
Impact on drug possession arrests
To explore preliminary impacts of Measure 110 on entry into the criminal legal system, data on monthly total arrests for PCS were obtained from the Oregon Criminal Justice Commission (2022). Arrests included those occurring from January 2017 to July 2022, which resulted in the individual being fingerprinted and generating a data point in the Law Enforcement Data System. We conducted an interrupted time-series analysis to estimate whether observed levels of PCS arrests differed significantly after implementation of Measure 110 (the policy ‘interruption’), relative to levels expected based on pre-implementation trends (Hartmann et al., 1980). Given the profound changes to street activity, policing, and court proceedings after the COVID-19 pandemic began, we added an additional ‘interruption’ to the model to account for trends associated with COVID-19 prior to decriminalization. Data were therefore divided into three distinct time periods for analysis: pre-policy and pre-pandemic (all observations prior to March 2020), pre-policy during the pandemic (March 2020-January 2021, inclusive) and post-policy implementation (February 2021 onwards). The interrupted time series model produced estimates of the change in monthly PCS arrest rates within and between each time period and tested whether there was evidence to reject the null hypothesis that PCS arrests were unchanged upon implementation of Measure 110. P-values <0.05 were considered statistically significant and all analyses were conducted in STATA S/E v. 16.
The total number of PCS arrests per month resulting in a fingerprint was analyzed from January 2017 to July 2022: 38 monthly observations pre-policy and pre-pandemic; 11 monthly observations pre-policy during the pandemic; and 18 observations post-policy implementation. Table 2 displays the mean and slope of (change in) monthly PCS arrests within each time period. During the pre-policy and pre-pandemic period, there were an average of 1244 arrests recorded per month. This decreased significantly after the onset of the pandemic to 632 arrests per month (P < 0.001), and again after policy implementation to 209 arrests per month (P < 0.001) (see Figure 2). While the trend lines within each time window appeared to be decreasing, this was only significant in the post-policy implementation period: after February 2021, mean monthly arrests have continued to decrease by approximately 10 per month (β=-10.1; P < 0.001).

Figure 2. Interrupted time series analysis of drug possession arrests in Oregon, 2017–2022. Figure depicts monthly PCS arrests in Oregon prior to and following the implementation of Measure 110. Pre-policy observations are partitioned by whether they occurred before or after the onset of the COVID-19 pandemic. Graph exhibits significant reductions in monthly arrests following the onset of the pandemic, and a further significant reduction after implementation of Measure 110. Following policy implementation, mean monthly arrests continued to decline significantly. Source: Oregon Criminal Justice Commission, 2022.
Table 2. Possession of a controlled substance (PCS) arrests in Oregon, 2017 to 2022.
 	Pre-policy, pre-pandemic (Jan 2017 – February 2020)	Pre-policy, pandemic (March 2020 – January 2021)	Post-policy implementation (February 2021 – June 2022)
Mean (SD)	Β (p-value)	Mean (SD)	Β (p-value)	Mean (SD)	Β (p-value)
PCS Arrests (N/month)	1243.8 (139.0)	−4.6 (0.076)	632.3 (107.3)	−8.8 (0.344)	208.9 (63.9)	−10.1 (<0.001)
Mean and standard deviation of monthly data are shown within each time period. Β-coefficients and corresponding p-values denote changes to monthly data within each time period. Estimates generated using interrupted time-series analysis with Newey-West standard errors. Significant values are shown in bold.
Source: Oregon Criminal Justice Commission, 2022.
Impact on class E violations
Citation data were made publicly available by the Oregon Judicial Department. In the first 13 months that Measure 110 was in effect (February 1, 2021 to February 28, 2022), 2008 cases involving a class E violation for PCS were filed (see Table 3) (Oregon Judicial Department, 2022). The majority of those cases, 1536 (76%), resulted in the imposition of a fine, largely due to failure to appear in court or submit verification of a health needs screening. Most citation recipients were males and 85% of citation recipients were between the ages of 21 and 49. While over 16% of race and ethnicity data on citations is unavailable or missing, the available data suggests that at least 77% of citations were issued to white people in the first year of implementation (whites comprise 86% of the total population in Oregon) (Oregon Judicial Department, 2022; United States Census Bureau, 2021a).
Table 3. Class E drug possession violation citations, February 1, 2021 to February 28, 2022
 	Count (Percentage)
Total	2008 (100)
Status	 
Imposition of a fine	1536 (76.49)
Dismissed	149 (7.42)
Pending resolution	323 (16.09)
Sex	 
Male	1458 (72.61)
Female	477 (23.75)
Missing	73 (3.64)
Race	 
Asian, Native Hawaiian, or Other Pacific Islander	13 (0.65)
Black	48 (2.39)
Indigenous	26 (1.29)
Other	34 (1.69)
White	1556 (77.49)
Unavailable or Missing	331 (16.48)
Ethnicity	 
Latinx	83 (4.1)
Age	 
<18	16 (0.80)
18–20	57 (2.84)
21–29	514 (25.60)
30–39	802 (39.94)
40–49	399 (19.87)
50–59	160 (7.97)
60+	50 (2.49)
Missing	10 (0.50)
Source: Oregon Judicial Department, 2022.
Health services provisions
Measure 110 established the Oversight and Accountability Council (OAC) to administer the health service provisions of the measure. The OAC is assisted by the Oregon Health Authority (OHA), the state agency tasked with implementation and oversight of Oregon's Medicaid plan and various health programs. Measure 110 requires that the OAC contains significant representation from people with lived experience, including three individuals from communities that have been disproportionately impacted by drug law enforcement, two individuals with a current or past SUD, and two recovery peers. The remaining 14 individual members are SUD experts, service providers and a representative from an SUD nonprofit advocacy group. The OAC was formed on February 1, 2021.
Measure 110 expands services for people who use drugs through two mechanisms, both administered by the OAC in coordination with OHA: 1) by establishing BHRNs where people receive health needs triage, screening, assessments, and referrals to services; and 2) by funding Access to Care (ATC) grants to increase treatment, recovery, harm reduction, peer support, and housing services. Measure 110 also establishes a 24-h statewide telephone hotline to provide health needs screenings and referrals to services.
State tax revenues from cannabis sales are the primary source of funding for the health service provisions of Measure 110. All quarterly revenues in excess of $11,250,000 will be allocated to the Drug Treatment and Recovery Services Fund, which pay for BHRN services and the ATC grants program to increase community-based services for people with substance use needs. Cannabis sales tax revenues for fiscal year 2020 were over $178 million, and they are expected to increase in subsequent fiscal years (Associated Press, 2021; Oregon Department of Revenue, 2021). For the fiscal 2021–23 biennium, the Oregon legislature allocated a total of nearly $305 million to fund Measure 110 services (plus an additional $11 million for tribal organizations), averaging to over $150 million per year (Gemei, 2022b). Other funding sources for the Drug Treatment and Recovery Services Fund include 1) savings from reduced criminal legal system costs associated with Measure 110, 2) any additional allocations from the legislature, and 3) all other funds dedicated to Measure 110 from any source.
All services funded by Measure 110 (those provided by BHRNs and recipients of ATC grant funding) are to be made available at no cost to any individual regardless of ability to pay, immigration status, or involvement in the criminal legal system. Further, all services must be ‘evidence-informed, trauma-informed, culturally specific, person-centered, and non-judgmental’. Providers can seek reimbursement through any insurance provider, including Medicaid, but cannot directly charge the service recipient. Combined, these provisions represent a dramatic departure from how services were otherwise funded and delivered in Oregon and how they continue to operate elsewhere in the U.S.
Behavioral Health Resource Networks
BHRNs will provide crisis care, service referrals, and health screenings, including a SUD screening by a qualified health professional. After completing the screening, interested individuals can work with a case manager to develop an individualized intervention plan to address various health needs, which can include goals and steps to secure SUD treatment, treatment for coexisting health problems, housing, employment and training, childcare and other services. The case manager will connect the individual with services and maintain contact to facilitate access to care as needed. BHRNs will also proactively engage people in services through mobile or virtual outreach. In alignment with research on the efficacy of peer-delivered services (Bassuk et al., 2016), all of the services will utilize peers with lived experience of substance use to engage people and enhance service delivery.
The Legislature allocated $265 million for the fiscal 2021–23 biennium to establish at least one BHRN in every county across the state, with an additional $11 million set aside for tribal governments (Oregon Health Authority, 2022a). BHRNs were to begin providing services available 24 h a day, every day of the year by January 1, 2022, but bureaucratic challenges in the grant decision process resulted in delays (Gemei, 2022b). The OAC approved final funding allocations for a total of 234 organizations in 44 BHRNs covering the 36 counties on August 31, 2022, nearly nine months after all decisions were slated to be complete (Oregon Health Authority, 2022c). OHA developed and maintains an online dashboard detailing the allocations of BHRN funding, participating organizations and services to be provided in each county (Oregon Health Authority, 2022a, 2022b).
Access to Care grants
ATC grants were developed to create and expand services for people who use drugs. These grants fund low-barrier SUD treatment, recovery support, harm reduction, peer support, and housing services, including permanent supportive housing, for people with substance use needs. Both community-based organizations and local governments may receive funding, though government entities must ensure grants are not used to replace funding already in use for services.
In the spring of 2021, the Oregon Legislature approved an initial $31.4 million ahead of schedule to fund ATC grants, and they were granted to 67 community-based and 11 tribal organizations in June of 2021 (Hawa, 2022). As of July 2022, this amount increased to approximately $41.6 million to fund more services (Oregon Health Authority, 2022d). These funds totalled roughly 13% of the total funds allocated for Measure 110 implementation to date, meaning that 87% of monies intended for implementation had not been approved or released within the first year of the measure being in effect (see Figure 3).

Figure 3. Measure 110 funding allocations, 2021–23 (in millions) and services accessed as of January 2022. Source: Hawa, 2022; Oregon Health Authority, 2022a, 2022d.
OHA published preliminary information about organizations funded through ATC grants, tribal set-aside funds, and direct amended contracts. They also provided preliminary information about the types of services provided to individuals through this funding.
OHA reported that over 16,000 people accessed services funded by the initial $31.4 million already allocated to community-based and tribal organizations across Oregon (Hawa, 2022). Participants primarily engaged in harm reduction services (59.7%), followed by assistance with housing needs (15.5%), peer support (11.7%), screening or clinical assessment (11.3%), SUD treatment (<1%), supported employment (<1%), and peer doula support (<1%). More recently, OHA announced that, as of September 30, 2022, the number of people who had accessed services funded by Measure 110 (both through ATC grants and BHRNs) had increased to over 60,000 (Oregon Health Authority, 2023). Legislative budget negotiations to determine funding allocations for the 2023-25 biennium are in process.
Statewide telephone hotline
A statewide telephone hotline was established on February 1, 2021 (the same date that criminal penalties for possession of small amounts of drugs were removed) to provide 24/7 screening and referral services for people with citations while the state establishes the regional BHRNs. According to media reports (the only publicly available data on hotline calls), 111 people had completed the health needs screening by May of 2022 (Myerly and Gemei, 2022).
State-Driven evaluation
Measure 110 requires regular audits to evaluate its finances, funding recipient performance and criminal legal impacts. The Oregon Secretary of State will audit the Drug Treatment and Recovery Services Fund to determine where monies were allocated, the effectiveness of BHRNs and services provided by grant recipients, and access to treatment and other services made available by Measure 110. The Secretary of State must also analyze data on the citations for drug possession, including the number and race of recipients.