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As a Social Worker, I Know Oregon’s Recriminalization of Drugs Impedes Treatment

Oregon’s move to recriminalize drugs sets people up to fail. We need evidence-based help beyond treatment alone.

A member of the Portland Fire and Rescue Community Health Assess & Treat team pushes a patient into an ambulance after they were administered Narcan for a suspected fentanyl drug overdose in Portland, Oregon, on January 25, 2024.

Oregon is moving backward. Gov. Tina Kotek will soon sign a bill passed in the state legislature, House Bill 4002, that will recriminalize drugs without offering any real solutions to the public suffering the war on drugs continues to perpetuate. The reversal upholds the same lie that’s been sold to United States public for decades — that the threat of jail deters consumption and helps get people into treatment. In fact, Oregon’s State Senate Majority Leader Kate Lieber reiterated this sentiment in January when she said “there needs to be both carrots and sticks” to build in some “accountability” via the criminal legal system.

Both Democrats and Republicans introduced proposals to revert drug possession into a misdemeanor and impose jail time if treatment was not completed within a set timeframe. Ultimately, HB 4002 achieved bipartisan consensus and quickly moved through the House and Senate. Although advocates claim it was a victory, in reality, this policy is designed to disappear the poor and people experiencing homelessness into jails instead of giving them the help they need — a move that can be understood when you realize that much of the rollback effort was bankrolled by wealthy business owners and led by the former chief of Oregon’s prisons who all want to protect their bottom line.

Criminalization does not address why people are struggling — housing is unavailable, treatment is expensive and inaccessible, and many need medical and social services. Under Oregon’s new measure, attending a Christian-influenced Narcotics Anonymous meeting qualifies as “treatment” if no other options are available (which is true in much of the state), while other self-help groups are not considered to be qualifying treatment. If someone refuses to participate, they will go to jail and, when released, return in worse shape to the same circumstances and likely get arrested again.

I speak from experience when I say this is counterproductive. I am a social worker and former addiction treatment provider who has worked with people under criminal legal treatment mandate. I have seen how threats of punishment disrupt the therapeutic process and make it nearly impossible to help clients. I have begged parole and probation officers to let my clients stay in treatment after they tried to send my clients back to jail over a single positive drug screening. I’ve seen far too many clients cut off from services before they could fully benefit, fueling a cycle of punishment. Research confirms that the criminal legal system’s forced approach hurts more than it helps — people mandated to treatment do no better than those who are there voluntarily, and they face a higher risk of overdose.

Under Oregon’s new law, if someone continues to use drugs after being arrested for possession, they can be thrown in jail for up to six months. While in jail, the probation officer may permit release to attend community treatment, even though treatment is already scarce in Oregon since it is a state that ranked 49 out of 50 in access to substance use treatment before the state’s decriminalization statute, Measure 110, was implemented.

The measure increased access to treatment and harm reduction services after over $300 million in cannabis tax revenue was invested into the infrastructure via Behavioral Health Resource Networks and Tribal Grants across the state, but the system is not yet equipped to deal with a rapid influx of mandated clients facing the threat of jail. The new approach will make it harder to find a spot in treatment, as new criminal legal referrals threaten to overtake the few spots that exist. Moreover, people’s lives will be disrupted — they will be torn from treatment programs over a positive drug screen only to be jailed and put in line for treatment once again.

Arresting people will not facilitate greater engagement in an overburdened treatment system. Many people have few options in their communities, cannot afford fees and remain stuck on wait-lists. Like my former clients, people often have to travel long distances to get to the nearest facility or get on a wait-list until a slot becomes available. Further, cost remains a barrier, even for the insured. High co-pays and costly deductibles are common, and prior authorization policies dictate how much treatment one may receive. Under the state’s new measure, people will face incarceration when they cannot overcome these barriers.

Moreover, the criminal legal system has a terrible track record of providing access to more effective, evidence-based substance-use disorder treatments. Methadone and buprenorphine are effective treatments that cut the risk of fatal fentanyl overdose in half while also reducing cravings and withdrawal symptoms. Yet federal and state policies restrict access to these lifesaving medications, resulting in thousands struggling to find a provider. Few jails and prisons provide them at all.

The norm in many treatment settings is to use a one-size-fits-all approach called “Twelve-Step Facilitation,” an abstinence-only therapy rooted Christian theology and the principles of Alcoholics and Narcotics Anonymous. Meanwhile, Contingency Management, one of the most effective treatments for methamphetamine and cocaine addictions, is not covered by the majority of insurance plans, and few facilities offer this approach. We shouldn’t force people into rigid, ineffective treatment that sets them up to fail and then punishes them for that inevitable failure.

Lastly, we must recognize that many of the people suffering on the street need housing first, an approach to addressing homelessness with decades of evidence from major cities across the globe. They may also need case management, mental health and medical treatment, and harm reduction support before they are stable enough to reap the potential benefits of treatment. We also need overdose prevention centers to help bring public drug use indoors, keep people safe and connect them with care. More than 100 of these sites are in operation in countries around the world, and research shows they reduce public drug use, reduce overdose deaths and improve public safety. Throwing the same vulnerable people into jail every few weeks perpetuates a costly cycle of punishment and disruption when we could be investing in programs that provide immediate and longer-term safety for everyone in our communities.

Saving lives at this moment requires us to ensure that our systems can serve our most vulnerable community members with quality, effective, on-demand services to meet their complex needs. Evidence-based, voluntary treatment is one piece of the puzzle; criminalization is not.

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