State-Level Drug Decriminalization Did Not Increase Overdose Deaths, Study Published By American Medical Association Finds

Removing criminal penalties for simple drug possession appears to have no significant impact on fatal overdoses, according to a new study published by the American Medical Association that analyzed the effects of decriminalization policies in Oregon and Washington State.

“Our analysis suggests that state decriminalization policies do not lead to increases in overdose deaths,” said Corey Davis, an adjunct professor at the Department of Population Health at the New York University (NYU) Grossman School of Medicine and a senior investigator for the new report.

The findings, published Wednesday in the journal JAMA Psychiatry, come on the heels of another recent study co-authored by Davis that found that decriminalization in the two states resulted in reduced arrests for drug possession and did not lead to an uptick in arrests for violent crimes.

“These two studies show that drug decriminalization measures in Oregon and Washington reduced arrests and did not increase overdose deaths,” Davis said. “Taken together, these findings signal reduced harm to people who use drugs and possibly their communities as well.”

“Legal changes to remove or decrease criminal penalties for drug possession are not associated with the fatal drug overdose rate 1-year post implementation.”

Researchers examined a year’s worth of post-decriminalization data on overdose deaths from the two states, comparing them to control groups consisting of states with similar overdose rates. “After the investigators found no statistical significance in overdose death rates between Oregon, Washington, and the control group,” says an NYU medical school release, “the investigators conducted a sensitivity analysis incorporating an additional seven months of provisional data. The findings did not change.”

In short, fatal overdose rates in Oregon and Washington were roughly the same as what would have been expected in absence of the policy change.

Authors of the new report acknowledged the need for further study on medium- and long-term effects of decriminalization as well as how reduced penalties impact different racial and ethnic groups.

“This study is an important first look at the impact of drug decriminalization on overdose, but continued monitoring is needed,” said Spruha Joshi, an epidemiology professor at the University of Michigan School of Public Health and a co-lead author of the study.

Joshi noted that in Oregon, for example, the state’s decriminalization law also drastically increased funding for treatment and recovery services—money that didn’t go out until after the researchers’ study concluded.

“Laws decriminalizing drug possession in Oregon and Washington were not associated with changes in fatal drug overdose rates.”

“In addition to reducing penalties for drug possession, Measure 110 in Oregon directed hundreds of millions of dollars of cannabis revenue to increasing access to programming aimed at reducing overdose risk. However, these funds were not distributed until after our study period,” Joshi said. “It will be important to continue to monitor overdose rates as more data become available to assess the impact of the distribution of these funds.”

The report notes that Oregon’s rollout of approximately $287.3 million for behavioral health services “was slow and most was distributed between April and September 2022, after our study period.”

“Funded programming has the potential to decrease risky drug-related behaviors and support pathways to addiction recovery, which can reduce nonfatal and fatal drug overdose,” researchers wrote.

While the study evaluates Oregon and Washington together, the nature of decriminalization in the two states was markedly different.

In Oregon, voters passed Measure 110 in 2020 to remove criminal penalties for drug possession and expand access to drug treatment and recovery services.

In Washington, meanwhile, criminal penalties for simple possession disappeared in late February 2021 as the result of an unexpected state Supreme Court decision that overturned the state’s felony drug possession law. Less than three months later, lawmakers again criminalized possession as a misdemeanor.

In May of this year, Washington further adjusted its laws to increase criminal penalties and further fund treatment programs. Last week the Seattle City Council passed a local measure authorizing prosecution of simple drug possession as well as public consumption.

Authors of the new study contend that despite the less-than-three-month period of formal decriminalization, Washington’s new drug possession law is “markedly different” than the previous statute because it “reclassifies most drug possession crimes from felonies to misdemeanors and substantially reduces the types of objects that qualify as drug paraphernalia.” It also encourages law enforcement to divert cases for assessment, treatment or other services besides criminal prosecution.

Washington and Oregon had the 33rd and 34th highest fatal overdose rates in the country, respectively, according to U.S. Centers for Disease Control and Prevention data from 2021, the most recent available.

Amid the ongoing overdose crisis and visible homelessness, public support for decriminalization in Oregon is flagging. While 58 percent of voters cast ballots in favor of Measure 110, polling recently released by opponents found that 61 percent of respondents now feel the measure has been a failure.

Earlier this month, a coalition of liberal and conservative business and political leaders unveiled a ballot proposal that would undo core parts of Measure 110 by recriminalizing possession of certain drugs and creating a new offense for public consumption of illegal substances.

Legislators already made some adjustments to Oregon’s decriminalization law this year, passing a package of reforms in June to provide an oversight council with more staff and administrative aid from the Oregon Health Authority (OHA).

A January audit of the decriminalization measure by the secretary of state found that OHA needed to provide more support and better coordination. It concluded at the time that it was too soon to tell whether Measure 110 programs could curb the state’s drug problems.

Photo courtesy of Jernej Furman.