One-Year Association of Drug Possession Law Change With Fatal Drug Overdose in Oregon and Washington

Abstract

ImportanceTwo states modified laws to remove or substantially reduce criminal penalties for any drug possession. The hypothesis was that removing criminal penalties for drug possession may reduce fatal drug overdoses due to reduced incarceration and increased calls for help at the scene of an overdose.ObjectiveTo evaluate whether decriminalization of drug possession in Oregon and Washington was associated with changes in either direction in fatal drug overdose rates.Design, Setting, and ParticipantsThis cohort study used a synthetic control method approach to examine whether there were changes in drug possession laws and fatal drug overdose rates in Oregon and Washington in the postpolicy period (February 1, 2021, to March 31, 2022, in Oregon and March 1, 2021, to March 31, 2022, in Washington). A counterfactual comparison group (synthetic controls) was created for Oregon and Washington, using 48 states and the District of Columbia, that did not implement similar policies during the study period (January 1, 2018, to March 31, 2022). For 2018-2021, final multiple cause-of-death data from the National Vital Statistics System (NVSS) were used. For 2022, provisional NVSS data were used. Drug overdose deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14.ExposuresIn Oregon, Measure 110 went into effect on February 1, 2021. In Washington, the Washington Supreme Court decision in State v Blake occurred on February 25, 2021.Main OutcomeMonthly fatal drug overdose rates.ResultsFollowing the implementation of Measure 110, absolute monthly rate differences between Oregon and its synthetic control were not statistically significant (probability = 0.26). The average rate difference post Measure 110 was 0.268 fatal drug overdoses per 100 000 state population. Following the implementation of the policy change in Washington, the absolute monthly rate differences between Washington and synthetic Washington were not statistically significant (probability = 0.06). The average rate difference post Blake was 0.112 fatal drug overdoses per 100 000 state population.Conclusions and RelevanceThis study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates. Additional research could examine potential other outcomes as well as longer-term associations with fatal drug overdose overall and across racial and ethnic groups.

Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon

“…This represents 2 years of post-intervention data, one additional year beyond the analysis period of Spencer 2023 10 and 9 months beyond that of Joshi 2023. 11 Our primary dependent variable consisted of all fatal drug poisonings (i.e., accidents, suicides, homicides, and unknown intent); the corresponding cause of death classifications are listed in the Supplement. Direct replications of Spencer 2023 used monthly-level Underlying Cause of Death mortality data restricted to unintentional drug poisonings from January 2018 to December 2021.…”

“…As M110 took effect on February 1, 2021, we conceptualized the treatment period as commencing in the first half of 2021 or, in monthly analyses, as commencing in February 2021. Following previous studies, 10,11 we do not include Washington State in the comparison group because its supreme court effectively decriminalized drug possession for four months between February 25 (when it struck down the state’s drug possession law) and July 25, 2021, when misdemeanor recriminalization took effect.…”

“…Spencer concluded M110 “caused 182 additional unintentional drug overdose deaths to occur in Oregon in 2021,” representing a 23% increase, 10 while Joshi et al used a similar analytical approach and did not detect a change in mortality. 11 However, neither study fully accounted for the “third-wave” of the overdose mortality crisis reaching Oregon: the supply-side shock of illicitly manufactured fentanyl, the highly potent synthetic opioid. 12 The former study did not mention fentanyl at all, and the latter used total fentanyl seizure counts from 2018-2019 only to test the fit of its model.…”

Safe space for injecting drugs is approved in Scotland

“…Meanwhile, a study in the United States has found no evidence that legal changes to decriminalise possession of drugs have had any effect in reducing drug overdose deaths 4. Early in 2021 the states of Oregon and Washington removed or substantially reduced criminal penalties for possession of drugs and increased their spending on support services in an attempt to treat the problem as a public health issue rather than a criminal one.…”

JAMA Psychiatry—The Year in Review, 2023

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