Does Decriminalization of All Drugs Improve Our Collective Well-Being? Oregon Is Betting on Yes

Graphic: Well+Good Creative
Amid the chaos of the presidential election, it was easy to miss some of the other ballot box results. Among those that would, in normal circumstances, have made headlines were several extremely significant wins for drug reform that portend better health and well-being for millions of people within several states.

The most groundbreaking news comes out of Oregon: The state's residents became the first in the nation to vote to decriminalize possession of all drugs, including substances like heroin and cocaine. They also opted to legalize the use of psilocybin ("magic mushroom") in therapeutic settings. And while cannabis legalization seems a little 2018, it's actually a pretty big deal that New Jersey, South Dakota, and Montana passed full legalization of the plant's use, cultivation, and sale; that typically conservative Mississippians authorized it for medical use; and that Arizona finally gave up the sad title of being the last state to consider cannabis possession a felony.

These victories were won by substantial margins, too, says Matt Sutton, the director of media relations for Drug Policy Alliance, a nonprofit organization dedicated to drug policy reform that was the chief architect of Oregon's decriminalization measure. "Many of the [states' various drug reforms] passed overwhelmingly," he says, noting that this is evidence of a demonstrable shift in attitude in recent years. "That's not the kind of support that we saw for early marijuana reform."

And while it may seem like a stretch to posit that decriminalizing, say, heroin is actually good for the health of a population, evidence shows that this approach is almost absolutely beneficial to the well-being of a community. Below, a closer look at the drug reform measures passed last week and how they mark an overall trend towards wellness when it comes to how the United States handles substance use and abuse.

Experts In This Article
  • Charles Grob, MD, Charles Grob, MD is a professor of psychiatry and biobehavioral sciences and pediatrics at UCLA and a psychedelics researcher.
  • Matt Sutton, Matt Sutton is the Director of Media Relations for Drug Policy Alliance, a nonprofit organization dedicated to drug policy reform.

Decriminalization of all drugs: Measure 110 in Oregon

First and foremost, it's important to understand what the passing of Oregon's new measure actually means. Decriminalization is not legalization, and Oregonians won't be seeing cocaine boutiques popping up next to Starbucks. In the state, it will still be illegal to possess drugs like cocaine, heroin, LSD, and methamphetamine. (Cannabis, meanwhile, is fully legal in Oregon.) The difference is that citizens will no longer be arrested or given jail time for possessing small amounts of these drugs; instead, they will be cited or ticketed a maximum fine of $100. Possessing large amounts of these drugs and/or trafficking them will remain a criminal offense.

Critically, the measure also mandates the establishment of an addiction treatment program funded, in part, by cannabis sales tax and savings to the criminal justice system resulting from the measure. This is a radical approach to addressing a serious problem. According to Sutton, about one in 10 people in Oregon are dealing with a substance-use disorder, but the state ranks dead last in access to treatment. "We haven't invested in those services the same way that we've invested in criminalization, in jails, and prisons," he says. "This is going to provide so much more access to care than people who use drugs in Oregon have ever seen before."

The reform, Sutton explains, was modeled in part after Portugal's decriminalization efforts. Those began in 2001 after criminalization proved to be an ineffective and costly response to a heroin epidemic contributing to epidemics in HIV/AIDS and hepatitis. The country replaced criminal consequences with access to treatment. "What they saw was, within just a few years, those HIV/AIDS and hepatitis rates plummeted, as did overdose, and the people voluntarily accessing treatment went way up," says Sutton. And drug use patterns actually didn't change, he adds—meaning that decriminalization didn't make people any more likely to use drugs than they were before the changes.

The measure's authors didn't just copy and paste what they saw work overseas. They met with Oregonians working within the treatment and recovery, public health, criminal justice, and social justice communities to tailor the program to the state's population and needs.

As a result, the treatment program created under the measure will not be a one-size-fits-all solution. "It's really a full range of services to meet people's needs. It's evidence-informed, culturally sensitive treatment, but it's also harm-reduction services, it's other health services, and even things like housing and job assistance, because we do realize that if people are struggling with housing insecurities, or if they can't get a job, it's hard to ask people to stay sober," explains Sutton. Notably, people don't have to interact with the police in order to access these services. "Anybody can walk right into the addiction recovery center, do the health assessment, and be referred to services."

Improved access to effective addiction treatment can only be a boon to a population's well-being, especially when the new system is replacing a relative void in care. And decriminalization also encourages more people to seek that treatment, Sutton says, because they no longer fear criminal repercussions. Stigma is also reduced when criminalization is eradicated, he explains. And that encourages more people to seek help.

But these aren't the only ways in which community and individual well-being will be improved under these policy changes. The criminalization of drugs in the U.S. has a racist history, and it continues to negatively affect Black, Indigenous, and people of color (BIPOC) populations disproportionately to this day. Sutton explains that we now know that President Richard Nixon's "war on drugs," accelerated under President Ronald Reagan, was less about getting drugs off the streets and more about penalizing the Black community and anti-war liberals. "What ended up happening is mass incarceration skyrocketed, and the penalties for drug possession and other drug-related crime became more severe," says Sutton. This, he explains, essentially "gutted" communities of color, especially since the penalties for drugs typically found within them, such as crack cocaine, were more severe than those for drugs typically found within white communities, like powder cocaine.

Not much has changed in the decades since. Communities of color continue to experience a greater number of interactions with police due to current drug policies. "Drug possession arrests have been used to harass, target, and even harm people of color," says Sutton. He points to Breonna Taylor, who was killed by police during a drug-related raid, and to George Floyd, whose drug use was leveraged to justify his murder by police. "Association with drugs or anything like that served as kind of an excuse by law enforcement for their actions," he says.

Drug possession is, astoundingly, the most arrested offense in the United States. "Every 23 minutes, somebody's life is potentially turned upside down [due to arrest for drug possession]," says Sutton. "Disproportionately, these are people of color." If such interactions with the police don't kill you—as they did in the case of Breonna Taylor and so many others—they certainly don't improve your circumstances or in any way better your life. "Sending somebody to jail or prison or putting them on probation is not going to help them get care," Sutton says. "We wouldn't treat any other health condition like that. Drug use never should have been looked at as something that was criminal."

Ultimately, Oregon's measure, which Drug Policy Alliance will be implementing on the ground, could get more people into treatment for drug use, lower overdose deaths and needle-related infection rates, reduce the number of lives derailed by incarceration or threatened by interactions with the police, and free up funds earmarked for criminal justice so they can be invested in social programs. It's truly a groundbreaking approach in a country that historically has not advocated for, or exercised a compassionate response to, drug use and the disease of addiction.

Psilocybin legalization in therapeutic settings and decriminalization advances: Oregon and Washington, D.C.

Oregon also made history last week as the first state to legalize psilocybin use in therapeutic settings. To be clear, this is different than decriminalizing the substance. What this vote means is that psilocybin can be legally sold and administered to individuals in certain settings for the treatment of mental-health disorders.

If you're not familiar with psilocybin, the drug popularized in the 1960s has enjoyed a resurgence as of late, thanks in part to Michael Pollen's popular book How To Change Your Mind, which argues for the benefits of psychedelic-aided therapy. According to psychedelics researcher Charles Grob, MD, a professor of psychiatry and biobehavioral sciences and pediatrics at UCLA, data on the botanical's therapeutic benefits is preliminary, though promising. Researchers are currently looking at its potential to treat major depression that is unresponsive to standard antidepressant medications. Dr. Grob has studied the therapeutic effects of psilocybin treatment in people with advanced-stage cancer who were experiencing anxiety, depression, and demoralization due to their diagnosis. He says their mental health improved after treatment, and that subsequent studies showed similar results.

"There's also some good data looking at psilocybin's efficacy in treating alcohol abuse," Dr. Grob says. Individuals who go through a course of psilocybin treatment seem to be far less likely to continue drinking, and this research is consistent with findings from the 1960s." Research has also shown it to be effective in helping individuals, within the context of psychotherapy, quit smoking.

That said, with such limited data, Dr. Grob feels this legalization may be a bit premature. "It almost seems a little early to be formally approving of [this approach] when comprehensive research evaluations in this field are just getting off the ground," he says. "On the other hand, you could make the case, perhaps, that psychedelic research was put on ice for several decades after the turmoil of the '60s, so it's high time to be doing this."

The safety and efficacy of these efforts will depend in large part on who is authorized to administer the treatments—something that remains to be seen at this point. Dr. Grob believes it's important that those undergoing treatment are screened for certain mental-health conditions such as schizophrenia and bipolar disorder, which may make the treatment risky. And as anyone who's ever had a bad trip on 'shrooms can attest, it's wise to make sure providers are trained to guide people through unpredictable experiences. Oregon has some time to figure out these logistics, however, as the measure allows the state two years to sort regulations before its implementation. "There'll be more data out there in two years," says Dr. Grob. "I believe that, under optimal conditions, you can establish good safety parameters and see people having successful therapeutic outcomes."

Washington, D.C., also made moves with respect to psilocybin, albeit less sensational ones. There, psilocybin was de-prioritized criminally, meaning that the new measure instructs law enforcement to treat investigations and arrests around psilocybin as their lowest priority. Psilocybin has already been de-prioritized or even fully decriminalized in several cities across America, including Denver; Oakland and Santa Cruz, California; and Ann Arbor, Michigan. Other cities and states have open bills circulating on the matter. These measures make sense for all the same reasons decriminalization of all drugs make sense: Compassionate, rather than punitive, responses see better results in terms of the overall health of a population.

Legalization and other progressive cannabis measures: New Jersey, Montana, South Dakota, Mississippi, and Arizona

With this election, New Jersey, Montana, South Dakota, and Arizona joined 11 other states in legalizing adult recreational cannabis use. Mississippi, meanwhile, joined a growing majority of states in legalizing cannabis for medical purposes. None of these moves are necessarily groundbreaking, but they do further signify a growing shift in attitudes around drug legalization. Sutton notes that some of these states were "new terrain" for this movement given that several of them are typically quite conservative. "Mississippi is the heart of the South, and the South has been a region that's been hard hit by the drug war. But, unfortunately, it's also an area where it's been an uphill battle to get any significant reform," he says. "Same thing with South Dakota—it has the highest arrest rate for marijuana possession in the country, and it's now the first state to legalize medicinal and recreational use at the same time."

He also points out that this election has illuminated how out of touch state governments can be. For example, his team has been trying to get marijuana reform passed legislatively in New Jersey for two decades without success. "When it finally went to the ballot box to citizens, it passed by a two-to-one margin," he says. "That starts to make legislators look a little tone-deaf because obviously their citizens support legalization."

The wins for the legalization of cannabis are a boon to wellness even if, like psilocybin, research remains early stage due to years of legal constraints. According to a report released by the American Civil Liberties Union, Black and white people use cannabis at roughly equal rates, but Black people are 3.7 times more likely to be arrested for possession than white people. So, legalization is critical in reducing arrests, harmful interactions with law enforcement, and incarceration rates. And early data (along with decades of anecdotal use) shows that cannabis is helpful in treating chemotherapy-induced nausea and vomiting and may be helpful in treating pain (particularly nerve pain), muscle spasms like Parkinson's tremors, sleep disorders, anxiety, and more. And legalization also reduces stigma, says Sutton, allowing for, say, a cancer patient to access relief they might have felt was "wrong" in the past.

This isn't to say that legalization isn't without risks. Although Sutton says use typically remains stable in populations where cannabis is legalized, a new study suggests that legalization results in higher levels of addiction. Its authors advocate for using the data to inform the development of legalization efforts rather than to stop them, and it's definitely a space to watch. But while legalization may make it easier to obtain cannabis, it's never exactly been difficult, Sutton points out.

The future of legalized drugs, and how to take up the cause

If the war on drugs was aimed at reducing drug supply and consumption, it did not succeed. "What we've seen over the last 30 years is that the drug market hasn't reduced; it's only increased," says Sutton. "The only thing we have to show for it is skyrocketing mass incarceration and 70,000 people dying of accidental overdoses per year."

Fortunately, he says, we're entering a "new world" for drug-policy reform, one where there's increasing support for making substance use disorders a public-health issue, rather than a criminal one. "We're really excited for what's to come next," he says.

And speaking of further developments, Sutton says his team is currently at work on legislative efforts to decriminalize all drugs in California. There are efforts underway in Washington and Vermont, too. "And the Drug Policy Alliance also released an all-drug decriminalization framework at the federal level that already has a lot of legislative interest. We've already secured a House sponsor," he says. That will be introduced either at the end of this year or early next, at which point Sutton's organization will work on building broader support.

If you're interested in helping to advance a compassionate-care approach to drug use, Sutton says to sign up for action alerts from the Drug Policy Alliance. "We're constantly reaching out to people to contact their legislators and express support for these different initiatives," he says. "That can go a long way, legislators hearing from their own constituents that this is an issue they care about." And if the 2020 election results are any indication, this most certainly is an issue many, many Americans care about—one that requires sweeping reforms like those pioneered in Oregon.

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