Lessons From Oregon’s Failed Drug Experiment
As a longtime drug policy reformer, I have spent the bulk of my career creating and implementing evidence-based programs to divert persons suffering from addiction or other behavioral health issues out of our justice system and into treatment and recovery.
This is important work when properly conceived.
Unfortunately, I have seen some of this work negatively impacted in recent years by the adoption of ill-advised “harm reduction” approaches like Oregon’s Ballot Measure 110 which decriminalized possession of small amounts of hard drugs like meth and fentanyl. The obvious failures of this approach in terms of community safety, public order, and personal well-being are impossible to ignore. Just look at big West Coast cities that have followed this approach and are now suffering from the loss of community spaces to open drug use.
However, I also worry that negative public reaction to the failure of those approaches—while entirely reasonable and understandable—might swing the pendulum too far in the opposite direction. What we need to do instead is to get rid of the worst elements of harm reduction practices while implementing evidence-based policies related to prevention, enforcement, treatment, recovery support, and supply reduction.
It was in 2008 that I first realized that drug policy based solely on harm reduction—a theory and policy practice aimed at reducing the negative consequences of drug use—could create a lot of harm itself.
I came to that realization during a flight home after speaking at a conference featuring experts from various disciplines in the drug policy world. I was invited to speak on a prevention topic, specifically getting rid of drug user’s own meth labs, which my colleagues and I had done in Oregon, Oklahoma, and Mississippi along with successfully lobbying Congress to pursue nationwide.
At the end of my conference presentation, harm reduction activists pressed to know which of the two primary methods for creating home meth labs was the least harmful for the meth cooks themselves. I had recently written an article that discussed those methods, but was stumped by the questioning. Both methods are incredibly dangerous, have a high risk of catching fire or blowing up, can produce gasses that kill quickly, and leave behind residue that is particularly damaging to children.
The purpose of those questions, they explained, was so that they could teach meth cooks how to use the least dangerous method, and thus reduce the harm to those users. It was baffling to me at the time. Preventing the creation of meth labs in the first place just seemed like a better strategy, which is what we successfully did through federal legislation.
When appropriately used, many harm reduction strategies are essential tools in humanitarian drug policy grounded in public health. Harm reduction can save lives and reduce human suffering. For example, expanding the availability and use of naloxone, a drug that can reverse a fentanyl overdose, saves countless lives each year. Another example is needle exchanges, which can significantly reduce the harm caused by communicable diseases.
When harm reduction is used to the exclusion of other evidence-based drug policies, however, it can create a lot of harm itself, for both individuals and communities—especially children.
For individuals, this is most directly seen by increased levels of suffering and death. Addiction, like schizophrenia, bipolar disorder, and Alzheimer’s disease, is in the family of illnesses that impair a person’s judgment and reason such that they often refuse or avoid treatment that could help them. Requiring treatment for addiction is often opposed by organizations such as the Drug Policy Alliance, who see a shift to harm reduction as a remedy to the damage done by the war on drugs. But both ideological extremes—sending drug addicted people to prison versus enabling addiction through pure harm reduction approaches—are themselves harmful.
As a drug policy colleague and I recently explained in our Atlantic essay, “Why Oregon’s Drug Decriminalization Failed,” the tools in the drug policy tool box are not on/off switches, but instead act more like dials that can be adjusted to provide the best outcome for individuals and communities.
Some harm reduction proponents have asserted that requiring treatment is ineffective. That is false. We have decades of evidence and studies that establish the efficacy of programs that require treatment, such as drug courts. More recently, some have asserted that requiring treatment is less effective than voluntary treatment. Not only do some studies show that to be incorrect, but it misses the point. The comparison is between requiring treatment and merely providing more harm reduction services, thus leaving people with severe addiction to suffer and die on our streets. That is not compassion—it’s enabling.
Pure harm reduction approaches also tend to focus only on harm to individuals suffering from addiction, ignoring harm to others and harm to the community. This is especially risky when the addicted person is a parent.
Those who are severely addicted can cause a lot of harm to friends and family. Severe neglect of children is also prevalent among parents who are struggling with addiction to hard drugs such as meth or fentanyl. Substance abuse now drives roughly 80 percent of Oregon's child welfare cases. Addressing these issues is not about stigmatizing drug users or failing to use “trauma informed” practices. It’s about dealing with the harm being caused and stigmatizing the use of those hard drugs. In another Atlantic piece, “Destigmatizing Drug Use Has Been a Profound Mistake,” two of my drug policy colleagues recently explained how reducing social stigmas around hard drug use has led to disastrous consequences in terms of ruined lives, broken families, and unsafe neighborhoods.
A pure harm reduction approach can also fail to deal with community damage, including the loss of public spaces to drug use and drug dealing, and the crime that often accompanies and fuels those activities. Many communities have grown weary of pure harm reduction policies that have helped lead to the expansion of rampant drug use, homelessness, and criminal activities in their towns and cities.
We can and should encourage a public health approach to addiction. This will not require eliminating harm reduction, but rather shifting away from harm reduction as the prevailing ideology and returning to the full methods of drug policy science in which harm reduction is again one of many essential tools in the drug policy toolbox. Other important steps include implementing evidence-based prevention, enforcement, recovery support, and supply reduction policies.
Supreme Court Justice Louis Brandeis once famously stated in a case decided in 1932 that, “[A] single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.” Relatedly, the motto of the State of Oregon is Alis Volat Propriis, Latin for, “She Flies With Her Own Wings.”
I am proud to have been a small part of that legacy in Oregon in relation to drug policy reform over the past 30 years.
Sometimes experiments in the laboratory of democracy generate bad results. And the failed experiment known as Oregon Ballot Measure 110 is in the process of being corrected through the implementation of recently passed legislation signed by Oregon Governor Tina Kotek. This legislation seeks to undo parts of Measure 110 by adding accountability back into the system, together with measured approaches like conditional discharge and supervised probation to divert people out of the justice system and into treatment and recovery. But it took time to get into this mess, so it will likely take time to get out and we will need to alter our strategies based on what is working and what is not.
The new Oregon legislation is merely a first step to correcting the overreach of harm reduction. It will need adjustments in the coming years. Implementation will also be a struggle, as Oregon has consistently been at the bottom of the 50 states when it comes to access to evidence-based prevention and treatment.
Yet, I remain optimistic that with proper ongoing bipartisan oversight from the Oregon state legislature, we can make a lot of progress by shifting our focus and resources to providing a public health and evidence-based approach to drug policy, thus reducing harm to both individuals and their communities. We should see the results in healthier lives, cleaner and safer communities, and fewer drug related deaths and other health problems.
Rob Bovett is the vice chair of Oregon’s Criminal Justice Commission and an adjunct professor at Lewis & Clark Law School, in Portland, Oregon, where he teaches Drug Law and Policy. He was heavily involved in crafting and negotiating the recently enacted Oregon legislation reforming Measure 110. He is a member of the Stanford Network on Addiction Policy.
Excellent article, particularly the statement that much of today's acceptable approach to managing behavior is actually enabling. This is brilliant, as a description of a soft approach to both civil and violent forms of crime; they all enable more of both. Behavior that negatively impacts others simply has to be curtailed, as society has a right to control disorder.
We are on the verge of criminalizing speech, religious expression, redress of government harm and gatherings even as we decriminalize theft, drug activity, squatting, property destruction and antisemitism.
We do harm because we are busy enabling many harmful behaviors while shutting down disagreement. So much of our society is backwards.
Ruy, you are one of the few sane libs out there. "Harm reduction" is, however, merely a component of our larger societal issue of "harm prevention at all levels" that has completely demasculinized America (and the western world) and which makes us incredibly vulnerable as a society. The drug problem is as you point out multifaceted, and, correctly liken it to a dial. But I think punishment for abuse that harms others vs. just onesself is critical.