Does the Treatment Promised by Measure 110 Need More Teeth?

We consulted Dr. Todd Korthuis, who runs the addiction medicine section at Oregon Health & Science University.

Oregon is experiencing a soaring number of fatal overdoses—nearly 1,400 last year—and many blame Measure 110, the drug decriminalization law voters passed in 2020. (It also funds drug treatment services like Laura Hall’s nonprofit Project Patchwork.)

Critics say the law robbed Oregon of a crucial tool: the criminal justice system. Business leaders are now bankrolling efforts to recriminalize possession of hard drugs, including heroin and meth, and replace voluntary treatment services with diversion programs.

In other words: coercing people into treatment with the threat of jail.

Defenders of Measure 110 say that’s what America tried for the better part of a century and it never worked in the first place. Groups like the Drug Policy Alliance point to racial disparities in criminal enforcement and a 2016 study that found coerced treatment was less effective. Just look at Portugal, they say, which made progress against its drug scourge after decriminalizing drugs in 2001.

To find out who’s right, WW consulted Dr. Todd Korthuis, who runs the addiction medicine section at Oregon Health & Science University. He and his team of researchers and practitioners have been on the front lines of the state’s fentanyl crisis since hearing early reports of the “blue pills” replacing heroin on the street four years ago.

Korthuis’ answer: It’s complicated, and both sides are papering over a nuanced issue in order to score political points.

On one hand, Korthuis says to blame Measure 110 for the staggering number of overdose deaths in the past few years is to overlook a much larger factor: the introduction of the super-powerful synthetic opioid fentanyl, which hit Portland’s streets right around the same time as the new law went into effect.

He says a lot of the political discussion misses the point. “Fentanyl is just a more compelling secular trend,” he says.

On the other hand, Korthuis is skeptical of Measure 110 supporters’ claims that coercive treatment doesn’t work. He says the widely cited 2016 study was “well intentioned” but limited in scope. Less than half the studies it reviewed were conducted in the United States, he says, and it excluded others that found drug courts to be effective.

And Korthuis is wary of international comparisons: “There’s not a lot of equivalence between Portugal and Oregon.”

For one thing, Portugal has nationalized health insurance and implemented intervention programs for people publicly using drugs that “are not dissimilar to our drug courts,” he says.

In other words, Portugal puts more pressure on people to seek treatment. “I’ve heard lately, ‘You need carrots and sticks,’” he says. “I think that is oversimplified but actually closer to the truth.”

So what should Oregon do?

First of all, Korthuis says, we need to work on prevention, particularly in schools, something in which state policymakers have invested little until this year (“Generation OD,” WW, March 15).

Secondly, Oregon should increase access to medicines like methadone and Suboxone, which are both effective at treating fentanyl dependence (see main story for how those drugs work).

Ultimately, Korthuis says he’s optimistic Oregon can address its drug crisis. He cites the Oregon Health Plan as an example of how the state has successfully made big bets—and, despite early criticism, pulled them off.

“If we’re serious about it, we’re going to have to take some hard steps,” Korthuis says. “Not everybody’s going to be happy. We’re going to have to compromise.”

Read this week’s cover story on eight moms seeking a way out of addiction.

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