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I had originally posted this in the Friday fun thread but it turns out that it was killing the vibe in there. Not sure what I was thinking. Anyway...
Note: I will completely qualify Portugal Europe and Portland Oregon in this article because they're easy to mix up.
Is liberalism peaking in Oregon?
In 2020, the state of Oregon passed a referendum, ballot Measure 110, which decriminalized all drugs(!) with a vote of 58% in favor.
Voters in Oregon (such as myself) believed this was the path to enlightened drug policy, being informed by the revered Portugal Europe model. Tacked onto the referendum was a bit of social justice theory as well: the police would be required to document in detail the race of anyone they stopped from now on for any reason. To ensure the police weren't disproportionately harassing the 2.3% of the population that's black.
As an occasional drug enjoyer, I do find it a relief to wander the streets of Portland Oregon squirting ketamine up my nostrils like I'm a visionary tech CEO without fear of police. But in broad strokes it appears to be a disaster.
Indeed, the ensuing data was an almost perfect A/B test, the kind you'd run with no shame over which kind of font improved e-commerce site checkout conversions.
By 2023, Oregon's drug overdose rate was well outpacing the rest of the country, so much so that the police officers regularly Narcan with them and revive people splayed out in public parks. Sometimes the same person from week to week. It's true this coincides with the fentanyl epidemic, which could confound the data and have bumped up overdoses everywhere but that wouldn't explain alone why deaths have especially increased in Oregon. The timing fits M110.
https://www.axios.com/local/portland/2024/02/21/fentanyl-overdose-rate-oregon-spikes
At some point someone decided to compare notes with Portugal Europe's system. Some stark differences!
https://gooddrugpolicy.org/wp-content/uploads/2024/02/PortugalvOregon1.pdf
Briefly, Portugal Europe uses a carrot and stick model with a lot of negative incentive, whereas Oregon just kinda writes a $100 ticket and suggests calling a hotline for your raging drug problem maybe.
In the first 15 months after Measure 110 took effect, state auditors found, only 119 people called the state’s 24-hour hotline. That meant the cost of operating the hotline amounted to roughly $7,000 per call. The total number of callers as of early December of last year had only amounted to 943.
The absence of stick appears to not be very effective in encouraging users to seek treatment.
Are the kids having fun at least? https://www.nytimes.com/2023/07/31/health/portland-oregon-drugs.html (paywall bypass: https://archive.ph/fHxWk)
That's the brightest part of the article. The rest is pretty depressing and sad and sickening and worrisome.
After a few years of this, the Oregon legislature yesterday finished voting to re-criminalize drugs.
The NYT again https://www.nytimes.com/2024/03/01/us/oregon-drug-decriminalization-rollback-measure-110.html (paywall bypass: https://archive.ph/3zksH)
The governor has indicated that she would sign.
Critics are out in force, arguing that the legislature overrode the will of voters (remember it was passed by referendum) and that the state sabotaged the program by not efficiently distributing treatment resources to addicts. This poster believes the low uptake and missing negative incentives prove that drug harm reduction is not primarily about access to treatment, but about incentive not to use. I do sympathize that better public services and addiction resources that people actually trusted would help, but fentanyl complicates the situation substantially. People need to hit bottom before they seek help (or so goes the popular saying) but fentanyl is so potent and unpredictable that they're dying of an unexpected OD before they find themselves at bottom, ready to seek change.
Frankly, I'm surprised Oregon repealed this so quickly. Has liberalism peaked in Oregon?
As someone who voted for the referendum back in 2020, I'm a little sad that some of the overdose deaths are on my hands. Kind of. Like 1 millionth of the overdose deaths perhaps. It's good to run experiments though, right? This was a pretty good experiment. We at least have an upper bound on how liberal a drug policy we should pursue.
I believe this shows Oregon is not quite as ideologically liberal as previously led to believe. Or, at least, not anymore.
This sort of reminds me of teh debate over statistical trends right after somewhere legalizes prostitution.
I'll say the same thing I have there: the long-term new status quo of a dramatic policy change is hard to deduce from the short-term reactions, and the trends in a world where something is legal everywhere are different from the trends where it's illegal everywhere except for one place.
Of course it would be better for the legalization argument if the day after everything was legalized, overdose deaths dropped 50% and never went up again. But that was probably never realistic...
The long-term vision is that we move to a model of treatment rather than criminalization, and lifting stigmas and fear of arrest makes it easier for people to find treatment or be targeted for it. But was a comprehensive and experienced treatment infrastructure deployed on the same day that the measure took effect? Did insurance start covering such treatment? Was the social stigma immediately lifted?
The long-term vision under legalization is that reputable, regulated corporations can start selling safe versions of drugs, complete with doctor-approved dosing instructions and Surgeon's general warnings and hotlines to call for help on the side of the package, instead of people getting unsafe street drug fro dealers that are incentivized to push them into more and more addictive shit. But did the measure even make it legal for corporations to operate in such a way, let alone have they actually started doing so?
The long-term vision is that people growing up under legalization can seek treatment and talk to people about the problems early in the process, and be less stigmatized and less pushed into a criminal part of society, and therefore make better decision and have better average outcomes. But what we're seeing today is mostly existing long-term heavy addicts suddenly having an easier time getting their fix, not anything about long-term trends for people growing up in the system.
And, of course, if a particular vice is legal one place and illegal everywhere surrounding it, lots of 'enthusiasts' will travel/move there to indulge, tainting the statistics.
Again, obviously this data is not good for the legalization argument, it is in fact evidence against it. But there's lots of reasons to expect short-term reactions to be bad in a way that the long-term equilibrium might not be. Especially in the case where you want to replace a bad solution to a problem with a good solution to a problem, but have so far only taken the step of removing the bad solution, which is mostly what I think is happening here.
I'm still optimistic about long-term trends, particularly if people actually devote the resources and effort into installing the new solution.
I think a difficulty is that providing treatment at the scale required is expensive and the people using the services that do exist are generally indigent and therefore cannot contribute to those programs. The ROÍ for treatment is also mostly to the individual getting treatment, not the public as the new rehabbed patient is likely to be replaced with someone else. So from the public tax point of view, rehabbing druggies is a cost sunk, and a relatively expensive one. Getting the public to approve of enough taxes to fully fund rehabs is running against the problem that there’s no large scale benefit to paying that tax. So there won’t really be enough money for enough treatment centers to make rehab a viable part of the program. What it leaves is “decriminalize drugs.” Which brings with it homelessness and street crime.
This, plus the fact that we have no idea how to do "treatment" that actually works. Scott posted loooooong ago that honest studies on rehab for alcoholism fail to beat a placebo. The end goal of most rehab studies for harder drugs like potent opioids isn't even "stops using potent opioids"; it's "maybe uses potent opioids slightly less and gets up to criminal mischief slightly less often". The true believers in the idea that we're just going to "apply 'treatment' directly to the forehead", if we just try hard enough politically and decide to spend enough money, and that it will magically convert addicts into non-addicts/non-users, are just banging their heads against reality.
Scott's post is worth re-reading.
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