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What “The Daily” Gets Right and Wrong about Oregon’s Move to Recriminalize Drugs

A doctor at an overdose-prevention center responds to The Daily, a podcast produced by the New York Times, on the recriminalization of drugs in Oregon. What are the true causes of the addiction crisis, and how can we solve it?

Mike Pappas

March 22, 2024
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Photo: Patrick T. Fallon/Getty Images

It’s been over three years since Oregon passed its Drug Addiction Treatment and Recovery Act, also known as Proposition 110. The act decriminalized so-called hard drugs, such as heroin and crack cocaine, and attempted to fund treatment services using tax money from cannabis sales in the state. But now, as Oregon is seeing a rise in overdose deaths, critics have claimed that the decriminalization of drugs helped create a rise in open-air drug markets and led to this increase in deaths. On March 1st, the state legislature voted to effectively repeal Proposition 110, recriminalizing narcotics. The bill has now passed in the state house and senate, and Democratic governor Tina Kotek has indicated she intends to sign it.

Many are now asking, what went wrong in Oregon? As a recent episode of The Daily from the New York Times correctly indicated, there were a lot of problems with Prop 110 from the start. The act was to include two main components: decriminalization and an increase in substance-use services and supports. While decriminalization occurred, there were significant delays in launching treatment programs, since the infrastructure for them was lacking. Meanwhile, there were also delays in funding for other necessary services, like housing. The Daily also correctly notes that when Prop 110 was passed, the COVID-19 pandemic took place amid an influx of fentanyl. Even after a cursory evaluation, it becomes clear that, contrary to what the proposition’s opponents would like to claim, many factors have contributed to the increasing number of overdose deaths in Oregon besides Proposition 110’s passing. This led one lawmaker in Oregon to note that, given the lack of treatment options in the state, Oregon was the worst place to experiment with decriminalization.

But what is missing in The Daily’s critique? Is there anything it leaves out from its analysis? The elephant in the room is this: that the overdose crisis is a crisis of capitalism. While many commentators focus on substances that are supposedly inherently addicting, or on addiction as “a disease” triggered by substances, the origins of drug addiction don’t lie in this or that “evil” substance. As we have discussed, research shows there is a confluence of factors at play — and the substance itself is often the least important one. Often at the center of addiction is self-medication; people are medicating some sort of ailment that is rarely addressed under capitalism. Today, we see more and more people living in precarity, struggling to make ends meet. Folks are seeing increasing housing insecurity as landlords raise rents. These circumstances were only further exacerbated by a pandemic that took a terrible toll on vast numbers of poor and working-class people because, both nationally and internationally, large corporations’ bottom lines were put above maintaining public health. These are issues that capitalist states, politicians, and the capitalist system itself have no way of resolving. Capitalism cannot resolve these issues because it creates them.

To analyze Proposition 110 in more detail, its goal of expanding harm reduction and treatment services was positive, but its approach was limited from the start. As a provider working at two of the nation’s only overdose-prevention centers, I find it stunning that the act did not establish safe-consumption sites or overdose-prevention centers, which are proven to save lives. These centers are locations where people can bring their drugs to use under medical supervision, so that staff can intervene in case of an overdose. At these locations, people can often obtain a variety of other services, including general health care, case management, laundry services, and so on. But, even though various cities across the U.S. have seen a rise in overdose deaths, there are still only two — possibly three in the future with Providence, Rhode Island’s recent approval — overdose-prevention centers in the country. Politicians continually cry about how distraught they are about overdose deaths in their city or state, but they always fail to have the courage to propose solutions that have been shown to save lives both nationally and internationally.

And these measures are ones that even other capitalist states have successfully implemented. When designing their bill, Oregon looked to Portugal, which decriminalized drugs, opened safe-consumption sites, and made clear investments in public health. But what Oregon did not take into account is that these successful measures in Portugal — which are still nowhere near perfect — were adopted in country that has a functioning public healthcare system. Moreover, Portugal’s measures were instituted on a national level, not on a small state level. There’s no universal healthcare in Oregon or anywhere in the U.S. — because in the U.S. healthcare is always an avenue for profit extraction, not actually maintaining health. And while Portugal’s measures took years to show positive outcomes on paper, Oregon allowed for only a short period to measure outcomes before scrapping the effort.

Instead of pouring resources and personnel into providing care and expanding services — as would be necessary to even begin addressing the overdose crisis anywhere — officials were busy trying to redirect funds into the same old methods of policing before things even got off the ground. As noted in Decriminalization of Drug Possession in Oregon: Analysis and Early Lessons:

Even before all the funding for the first cycle of Measure 110 was allocated, let alone dispersed and utilized by service providers, there were three separate attempts to pass legislation to redirect some of these funds to law enforcement efforts to stop unsanctioned cannabis grows (House Bill 4016 2022 (Or.); Senate Bill 1541 2022 (Or.); Senate Bill 1587 2022 (Or.)).

So, to be clear, some officials were attempting to direct funds away from an already chronically underfunded system of social services while claiming they wanted to address the state’s addiction crisis. A program can attempt to increase referrals to treatment as much as it wants, but if those services are vastly underfunded, if there aren’t workers to do the job of assisting folks, and if those there are aren’t paid living wages and given workplace protections like having a union, then those services will be infective and inadequate. Plus, the social service workers will likely be more exploited. Addressing the overdose crisis requires a massive expansion of social service infrastructure and funding, an expansion that capitalist politicians don’t want to make.

In The Daily’s analysis, the journalists discuss the fentanyl crisis, but they frame it as if it popped up out of the blue. But as we have covered, drug war–era policies created a situation in which fentanyl comes into areas like Portland. And while the Biden administration pretends to care about the overdose crisis — most recently issuing its “Challenge to Save Lives from Overdose” — it continues to criminalize substances, helping create the exact market for illicit substances it claims to want to disrupt. This is because the criminalization of substances in a society of people seeking mind-altering substances — either to medicate for underlying pain and suffering or simply for recreational purposes — makes it a more profitable endeavor to traffic those substances illegally. And, because drugs are sold for a profit, it becomes desirable to use cost-saving measures like cutting more expensive drugs with other substances or using “stronger” synthetic opioids such fentanyl and its analogs, which helps drive the overdose crisis. It should be no surprise The Daily ignores this. A real analysis would require a critique of not only the Biden administration but also capitalist politicians more generally. The Daily would rather carry water for capitalist politicians and capitalist parties than point out their role in helping create and exacerbate the crisis.

In short, Proposition 110 told people to “get into (chronically underfunded and underdeveloped) treatment” and then go right back to the despair created by capitalism, all while doing little to nothing to alleviate that despair. Overall, it was a well-meaning but medically focused approach that did not and could not address the underlying causes of people’s substance use. This highlights the issue of trying to address substance use and addiction on either a city or a state level. These underlying factors are hard to address on city or state levels, so measures taken are often superficial and lacking. And this should not be surprising as we live under an economic system that separates and atomizes us in order to facilitate more efficient exploitation of our labor. It blames people for their apparent mistakes or faults, and it claims that those mistakes led to their position in life, instead of looking at how the system itself creates these conditions.

In this light, we can see how disingenuous Oregon’s recent decision to recriminalize drugs is, since it’s based on the idea to curtail drug use, it must be punished. A fundamental starting point in “helping” someone else is not to tell them where they should be, but to meet them where they are and go from there. But in Oregon, officials are somehow surprised when people don’t take Willy Wonka–style tickets (under Proposition 110, cops were directed to give fines for substance use and tickets to call a treatment hotline) to treatment, paternalistically handed to them by the same cops that harass them everyday to “get their lives in order” — all in a society that does little to help people get their lives back in order. Oregon isn’t an outlier here; throughout the U.S., states offer few supportive services for those suffering homelessness and addiction, and then they criticize those same people when they don’t enter those systems for care.

The case of Oregon’s Proposition 110 is especially unfortunate because it is now being used to argue that decriminalization doesn’t work. The results are also being used to further criminalize poor and marginalized people around the country with politicians calling for increased police budgets in the name of “public safety.” In San Francisco — a city that saw twice as many deaths from overdose than COVID in 2021 — the Democratic mayor has claimed that there needs to be “tough love” to address homelessness and the overdose epidemic, such as drug tests for welfare recipients. Whether it’s Democrats in Oregon — who control the legislature and the governor’s office — choosing to recriminalize drugs or Democrats in San Francisco drug testing welfare recipients, these examples only serve to underscore that the Democrats are no friends of the poor and working class, despite their progressive rhetoric.

Now Oregon has decided that it is easier to have cops go after users — a practice that has never had a positive effect in my own practice. If anything is to be gleaned from this example, it is that winning a rational drug policy in this country is an uphill battle. Establishing such a policy will require seeing humans as humans and loving them for who they are in light of all their flaws and complications — not only if they’re sober, or able to hold employment. Such a policy would require us to expand our concept of worth beyond what someone contributes to the economy. It would also require us to address the true issues that lead people to poverty and despair. Tackling the overdose crisis would require tackling a system that makes it so people can’t afford their homes and are becoming homeless. To even begin to address the issues of homelessness, mental health, and addiction, people have to be able to afford food and shelter and have access to adequate healthcare, circumstances every human deserves. This would require a war on the landlords and capitalists who create the dire circumstances that so many are living under. It would require challenging the market ideologies at the heart of capitalism.

But under capitalism, it is easier to blame the “addict” or “drug” as the problem, not the society itself. It’s easier to give some more money to cops to move people away from business districts — as some of Oregon’s richest business leaders welcome. Then people simply don’t have to see it or think about it. Seeing the end effects of the exploitation and devastation capitalism causes — dire poverty, homelessness, drug use — right in your face is often too much. In the eyes of capitalists, it makes consumers uncomfortable and hurts business. The irony is, at the same time, that sectors of the population living this way also serve an additional purpose for capitalists. As long as they don’t obstruct the everyday functioning of the system, desperate people can serve as a warning to help keep people in line: “Keep your head down, do your job, or you could end up like that.”

If we truly want to address the overdose epidemic, we must fight to win a society where those who are suffering from addiction are not condemned or vilified, but treated as humans who deserve love, kindness, and respect. A society where everyone has access to free housing and free healthcare, and can pursue their dreams and passions without the threat of poverty or homelessness and people are able to flourish and love for who they are, not where they are continually treated as expendable tools for capitalist exploitation. As the examples both in Oregon and nationally show, this won’t happen under capitalist parties and under a capitalist system. We need to fight for a party of the poor and working class that will put everyone’s most basic needs over the needs of capitalists and fight for a system that values life for more than its economic bottom line.

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Mike Pappas

Mike is an activist and medical doctor working in New York City.

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