They're blaming deaths on Oregon's drug decriminalization. I'm not sure that's fair.

Data requires context.

The New York Times headline: “Oregon Is Recriminalizing Drugs, Dealing Setback to Reform Movement.

The New York Times sub-headline: “Oregon removed criminal penalties for possessing street drugs in 2020. But amid soaring overdose deaths, state lawmakers have voted to bring back some restrictions.” (Bold added for emphasis.)

Look, I do not know for sure whether the increase in overdose deaths in Oregon has nothing, something, or a lot to do with the state’s decision to decriminalize drugs starting in 2021. But it took me mere minutes of data analysis to be less convinced than most. Indeed, the few people who actually study this topic carefully (note: the author of the second link is an Inside Medicine reader) are not convinced that the legal change in Oregon is behind an overdose mortality increase there.

I tend to be sympathetic to these experts’ views on two grounds. First, as you’ll see in the Data Snapshot below, most of the trend was already underway when the law went online in Oregon—and similar increases happened in some other states simultaneously. Second, the increase in deaths seems to match other known drivers, such as fentanyl’s hold on the market.

Data snapshot.

Below are monthly overdose deaths in Oregon and Oklahoma from 1999 through mid-2023. Oklahoma has some of the strictest drug laws in the US. Oregon’s decriminalization laws went live in early 2021.

The faint dashed blue line represents the moving average (yearly); the red dotted line is the approximate predicted trend for 2021-2023, based on the 2020 trend. Raw data: CDC. Analysis and image: Jeremy Faust for Inside Medicine.

The faint dashed blue line is the moving average (yearly); the red dotted line is the approximate predicted trend for 2021-2023, based on the 2020 trend. Raw data: CDC. Analysis and image: Jeremy Faust for Inside Medicine.

Can you really look at that and tell me that a policy Oregon implemented in 2021 can be squarely blamed for its increased overdose mortality? If so, why did nearly the same increase occur in Oklahoma, a state with strict drug laws?

Oregon is hardly alone, nor is it the worst state on drug deaths.

I also looked at the other US states’ data over the last few years. Some had decreases in 2021. Some had big increases. I also made some simple graphs looking at 2021 and 2022 compared to 2020 (the last year before Oregon decriminalized drugs) and to 2018-2019 (the last pre-pandemic years before Oregon’s new law went into effect).

The upshot? Oregon is among the worst states when it comes to increases in drug deaths over the last 5-10 years. But it is hardly alone, and not an extreme outlier by any means. In some year-over-year comparisons, Oregon indeed had the largest increase. It others, it was among the worst. In others, it was more in the middle. I’ve seen stories saying Oregon is the worst state in terms of any drug death increases. That’s cherry-picked data.

Increases aside, in 2022, Oregon was the state with the 25th highest rate of overdose deaths per capita in the US. In other words: average. In 2019, it was 40th. In 2020, it was 38th.

So, no, things are not going well with respect to overdose deaths in Oregon. They’ve worsened over time. But it’s not correct to make the case on reversing decriminalization based on out-of-context mortality data alone.

The way forward.

I’m open to whatever turns out to save lives. There are compelling reasons to decriminalize drug use (at least in part) and there are compelling reasons not to. As a physician, I’ve seen what bad drug use can do to people. But if I stop to think about it, it is very difficult for me to tease out how much of the destruction I’ve see has been related to the drugs themselves and how much has been related to our screwed-up system of incarcerating people whose pathologic use of substances is a physical disease. As an ER doctor, I don’t just see “addicts”; I see people with substance use disorders who have been wrecked by a system that mostly leaves them worse off, not better.

Substance use disorders are terrible. They can destroy people—and others around them. Driving while intoxicated remains a scourge for all of us, whether related to alcohol or other drugs. And, yes, I am glad that I don’t live in an area where I have to hide my kids’ eyes from people injecting themselves with substances of any manner on the open streets. But I think we can do much better than the old way—tossing people with substance use disorders into cells where we can’t see them.

We know that better treatment is the answer. We need humane ways to deal with this longstanding problem. Throwing the issue back to law enforcement doesn’t strike me as the right approach.