Oregon decriminalized drugs 2 years ago. What can B.C. learn from its rocky start?

Oregon has struggled to reduce the number of users and overdose deaths on Portland's streets despite decriminalizing personal possession of all hard drugs in 2021. Delays in funding treatment services and the challenge of piecing together a system that a drug user can easily access have also been significant barriers, according to an audit.  (Andrew Lee/CBC - image credit)
Oregon has struggled to reduce the number of users and overdose deaths on Portland's streets despite decriminalizing personal possession of all hard drugs in 2021. Delays in funding treatment services and the challenge of piecing together a system that a drug user can easily access have also been significant barriers, according to an audit. (Andrew Lee/CBC - image credit)

Police have spotted Charles Laprain with powdered fentanyl in a parking lot in Portland, Ore. Two years ago that would have been a crime.

Instead, Portland police officer David Baer writes him a $100 US ticket, which could be waived if Laprain calls the recovery hotline on the back of the citation.

Which, he admits, he's 50/50 on doing.

"It gives a person more of a chance to at least get clean," he said on the late January afternoon. "It don't do any good when people are locked up."

Interactions like this happen everyday for Baer since Oregon brought in Measure 110, which decriminalized possession of small amounts of all hard drugs in the state in February 2021.

He was surprised to find out British Columbia also recently moved to eliminate criminal penalties for personal possession, and says there could be unforeseen challenges.

"You're going to see an increase in public drug use," Baer said.

Oregon, for instance, saw a 52 percent rise in opioid deaths in the first year of its new measure, and has struggled to get enough access to treatment in place — a challenge B.C. already faces.

Georgie Smyth/CBC
Georgie Smyth/CBC

Leading the way

According to an audit of the initiative by Oregon's Secretary of State's office published last month, it's "too early to tell" how this health-based approach to drug use is working in Oregon.

Measure 110, which was voted for by 58 per cent of Oregonians in 2020, means drug use is still illegal in public but possession is not.

Instead of being treated as criminals, users are directed by information on the back of citations into treatment options, which are funded using over $135 million of redirected tax revenue from the state's legalized cannabis sales.

But as the state's found out, not many people are calling to get help. By June last year, the hotline, which is supposed to connect drug users to services, received just 119 calls at a cost of over $9,200 per call, according to the audit.

Delays in funding treatment services, confusion around program governance and trying to piece together a system that a drug user can easily access have also been significant barriers, according to the report.

Andrew Lee/CBC
Andrew Lee/CBC

They're the kinds of challenges British Columbia, which became the first jurisdiction in Canada to decriminalize 2.5 grams or less of opioids, cocaine, meth and ecstasy in January, could learn from, says Tera Hurst from Oregon's Health Justice Recovery Initiative, an advocacy coalition which campaigned for Measure 110.

WATCH | CBC's About That looks at why B.C. decriminalized hard drugs:

While there are a number of differences that set Oregon and B.C. decriminalization measures apart, like the Canadian program being just a three-year trial, both vanguard jurisdictions share the grim reality of having among the highest national concentrations of drug use and overdose deaths in each respective country.

That's made stakeholders impatient for fast working solutions.

But as Hurst, who is also a recovering addict, told CBC News, solving addiction and substance use in society is complex and doesn't happen quickly, despite the high stakes for Oregon to succeed as an example in North America.

"We can be used as either a model for why you should do it, or a model of why we can never do that," she said.

Deaths rise

The numbers, however, show Oregan had more opioid overdose deaths in 2021, the year decriminalization went into effect, than the two years prior, according to Oregon Public Health Surveillance.

Statistics for 2022 are still being compiled, but some critics are already calling for the measures to be scrapped and for the money to be invested elsewhere.

Advocates for decriminalization there say the program needs more time to succeed and the increase in deaths coincided with a national uptick in overdose deaths and drug toxicity across the states.

Andrew Lee/CBC
Andrew Lee/CBC

In its path to considering decriminalization, Health Canada has made no secret of investigating, through various task forces, how other jurisdictions executed alternatives to criminal penalties.

Geographically, Portland might be the closest example Canada has to drug decriminalization but it's certainly not the most prominent. Portugal, which was once Europe's worst country for drug use and deaths, began decriminalizing all drugs in 2001. Overdose deaths and rates of drug use fell. They've since stayed consistently below the EU average.

But solving substance-use disorder and drug use elsewhere in the world isn't just a matter of copying and pasting the Portugal model — as Oregon now knows.

More treatment access still needed

A big difference between the European country and the U.S. state is health care access. Portugal has universal health care, like Canada, while the U.S. does not. So implementing the model in Oregon required the construction of a scaled-up detox and treatment system that hadn't existed before, which created friction and delays in the rollout, says Hurst.

"We are running into all the walls and finding all the different barriers that are out there and trying to figure out how to work around them," she said.

An oversight council which included people with lived experience of recovery has helped direct grants to community groups throughout the state, which are mandated to provide services like screening and referral for substance use disorder, housing and case management. At least one of these groups must exist in every county or tribal area, under the measure.

Andrew Lee/CBC
Andrew Lee/CBC

Despite the investment, Oregon still rates 50th in the U.S. for access to treatment with a 2022 analysis of gaps in services showing Oregon would need to double its current offerings to meet demand.

In British Columbia it can take up to four weeks for a person to get into detox, "an eternity for someone who is using drugs", said Dr. Paxton Bach, a co-medical director at the B.C. Centre on Substance Use (BCCSU).

Transitioning from that program to bed-based treatment could take months, says Bach, potentially leaving users in a vulnerable limbo.

But Canada's Minister of Mental Health and Addictions, Carolyn Bennett, who toured Oregon in August 2022, says there are lessons to be learned for B.C. in Oregon's approach — in particular, funding a variety of community-based treatment organizations "to develop the kind of trusting relationships that allow people to think about about a different life."

Building trust

At a park in north Portland, O'Nesha Cochrane-Dumas is one person who represents that space between addiction and recovery.

She's an outreach counselor at The Miracles Club, a community centre that targets services toward Oregon's African American drug users. Black people and people of colour are disproportionately affected by drug policies, like the war on drugs, and, in Oregon, Black people are four times more likely to end up in prison, according to the U.S. Census and Department of Corrections.

Andrew Lee/CBC
Andrew Lee/CBC

Cochrane-Dumas has been there. She started using drugs at the age of 13, committed petty theft, had sex to survive and served three prison sentences before getting clean. She now does her outreach work at the park where she used to get high, handing out brand new shirts, socks and harm-reduction kits containing life-saving naloxone in this predominantly Black neighbourhood.

The work is subtle, and funded by Measure 110. Cochrane-Dumas says it's about building connections with drug users in the places they hang out. The hope is, when they're ready, users will be more likely to ask for help from someone who has been helping them already.

"They always know I got something for them. They're eager to see me," she said.

"One of these days they're gonna be struggling and they're gonna say, 'Ay-o, how can I get some help? I'm tired of doing this.'''

Frustrating reality

But as David Baer sees, sometimes that revelation doesn't happen. When he hands out the citations for drug possession people usually crumple them up and throw them away, he says.

During a ride along with CBC News he gets called to an overdose a block away. A young man is unconscious on a sidewalk and had just been given naloxone to reverse the effects of the opioids he's taken. As the man is coming to, paramedics tell Baer they did the same thing for him the day before, twice.

It's a frustrating reality of addiction that repeats several times a day on Baer's shift.

"I've known that guy for three years and I've obviously seen his decline," he said. "He used to use meth and now everyday he's out here using fentanyl."

A block away, Stephen Deloriea is also using fentanyl and meth to deal with his anxiety. He's soft-spoken and has been living on Portland's streets for a year.

Georgie Smyth/CBC
Georgie Smyth/CBC

In his hands is a tent cover he uses to carry his belongings, including cans he collects to trade for drugs. He used to be afraid of getting in trouble with the police, likening it to being "a bad kid" pulled into the principal's office at school. Now he says he has more time to deal with his "own problems."

Despite slow progress on other measures, his story does suggest change on one goal of decriminalization: breaking down the stigma around addictions.

"It's made it easier to function without having to worry about being a criminal."