Without Vision The People Perish

The story was simple: Measure 110, the Oregon ballot measure which passed in 2020 decriminalizing drug possession, was a failure. It was the reason you couldn't go to the park without having to scan the playground for used needles while junkies shot up on a bench and others were already passed out. It was the reason there were so many more tents, often with some skinny guy hovering around a mountain of bicycle parts (almost certainly stolen). It was the reason there were so many more people dying of fentanyl overdoses and straining emergency response services. It was the reason so many more people were getting shot and sometimes killed, even in swanky areas like the NW Alphabet District. It was the reason downtown Portland was such a shit hole. The defunct Greyhound bus terminal next to the still busy Amtrak station even stank of literal shit (and still does). 

Right-wing media jumped on the chance to flog its favorite whipping boys of Portland and decriminalization. Soon columnists at the New York Times were jumping in. Portlanders—always exquisitely sensitive to what talking heads in the national media say about our fair city—found this scorn to sting most of all. Plus, all the criticism validated our suffering, made it special and gave us permission to wallow a bit. Hell, even leftists have jumped on the bandwagon, recently calling out our crazy experiment with decriminalization—mistakenly calling it “legalization”—as libertine MANGO wokeness run amok. 

Except the story was wrong. It wasn't Measure 110 causing these problems even if everyone looked around at all this and saw the glaring correlation between it and this recently passed ballot measure. But of course, correlation is not causation. 

Arrests for drug possession in Portland were already going down even before Measure 110. This was for material, not ideological, reasons. We have limited jail space. We have very little in-patient drug treatment for those on Medicaid (and our State Hospital for the profoundly mentally ill has been in perpetual crisis for years). We have had a colossal shortage of public defenders. All of this meant that when a cop arrests somebody for shooting up, tax payers pay for him to take the user to jail. Pay to have the user booked and sit in the jail for a few hours before being released because we need the space for more dangerous people. Pay to have the user wind their way through the legal system, through the courts, through probation, through the system of non-profit or for-profit contractors hired to “help” the user possibly get clean, find a job, and get housing—which is now all the more difficult with a criminal record. And, of course, this makes the already miserable existence of the user even more miserable. In addition to spending all day trying to stay out of withdrawal, they now have to navigate these legal and paralegal systems. If they are also homeless, this navigation is impossible. You are too overwhelmed with just trying to figure out where to sleep, how to keep your stuff from being stolen, where to piss and shit safely, and how to eat and clean yourself up and keep your feet dry. Especially keeping your feet dry in a city where it rains from October through June (and trench foot is very much a thing). 

Overdose deaths did indeed go up after Measure 110. In 2020, we had 14 deaths per 100,000. By 2022 it was 31. Except look at the rest of the country. Oregon was actually pretty average. Slightly less than neighbor Washington and slightly more than California (and yes, considerably more than Idaho) but far lower than tough on crime states Florida and Louisiana (and West Virginia is downright apocalyptic). 

Oregon was among the last states to make the switch from heroin to fentanyl, which arrived on its westward trek across the country like some sort of zombie pioneer on the Oregon Trail just as Measure 110 passed. 

Drug use became even more visible because homelessness became even more visible. And here Oregon is special. We are among the top states with the fewest number of housing units for the very poor: 24 units for every 100 who need housing. West Virginia may have more than double the rates of overdose deaths than we do, but they have far less public drug use because their impoverished addicts have homes in which to shoot up. Our impoverished addicts often have no private place in which to do so. 

Oregon is also special in our woefully inadequate behavioral health system—for decades now. When the 2002 Dot Com Bubble burst, it clear-cut a huge swath out of the Silicon Forest, and the resulting lost tax revenue cut a huge swath out of our state Medicaid program—especially in mental health. Medicaid expansion under the Affordable Care Act resulted in increased spending but money is only so effective if our state health care foundation is a decentralized, byzantine patchwork of coordinated care organizations, county and federal health centers, and other non-profit contractors. Oregon currently ranks 46th in the nation for adults with substance use disorder able to get treatment when they seek it. To this day, if someone on Medicaid here in Portland wants to get clean and needs an in-patient treatment program, the procedure is the same as it was twenty years ago: show up at the local detox center at 7:45 in the morning, where you are almost certain to not be admitted because they do not have enough beds. You will be encouraged to show up at the same time the next day when maybe they will have a bed or maybe the next day after that. Usually if you show up five days in a row you will finally be admitted. Needless to say, many a therapeutic window is missed because good fucking luck getting an addict anywhere at a specific time, much less doing so four or five days in a row. 

I know this because after 18 years of sobriety, my adopted dad relapsed in 2004. It began with meth before he drifted to his lifetime drug of choice, alcohol. I had only known him sober, known him as that guy who was a frequent AA sponsor and routinely quoted from the Big Book. Thus it took awhile for me to grasp the gravity of what was happening. He had lost his housing for reasons unrelated to addiction, so I let him crash on the floor of my graduate school studio. Within a month I had to kick him out when he kept stealing my Vicodin. It says a lot about his character that his response when I told him through tight lips and misty eyes that he had to leave and I needed his key was “you’re right, Baby; I can’t help myself right now.” That was the beginning of twelve years spent cycling in and out of recovery, much of it living out on the streets in the pervasive dampness or summer heat of Portland.  

Of course, over the next year he would randomly show up at my call box, begging to stay “just tonight.” Long-Distance Lover suggested we dedicate one day out of the week for him to spend the night but no other night would be allowed unless a prior arrangement had been made. So every Tuesday he spent the night with me, now no longer in grad school but living on disability in a tiny Section 8 studio for seniors and the disabled. For him it was a guaranteed dry, quiet night to sleep, get a bath and a decent meal. For me it meant knowing he was still alive. I got to smell homelessness on these nights—something fungal mixed with cheap cigarettes, beer, and sweat. Got to see how it and addiction grasp one by the psyche and slowly asphyxiates the self. “It’s like being a ghost,” he once told me. “People just look right past you.” Including a public health system that never could provide the residential treatment that he most needed despite years of calling every helpline, of interminable wait lists, of a forced-labor boot camp that left him broken, of programs that were more performative than useful, of nights sleeping on the pavement outside the detox center to be sure he was there at 7:45 am when they might give him a bed. 

He did survive. And he did eventually get sober again through an out-patient program that was successful because by then he had a supportive relationship and housing through her. But all those years without proper treatment left him with multiple traumatic brain injuries (including three weeks in a coma in an ICU after being brutally beaten), Hepatitis C (thanks to limited harm reduction resources like clean needles), no teeth, and a felony arson conviction for a fire he did not set but will make it nearly impossible to ever obtain housing in the future should he no longer have it through his partner. He will celebrate ten years clean in a few months but will be too sick to make merry much. 

After all the hand-wringing, the Oregon Legislature tweaked Measure 110 in 2024 to re-criminalize certain types of drug use. But the same material conditions remain. As does the biology of addiction, which cannot be fixed with jail. People in my neighborhood complain that public drug use is still rampant despite re-criminalization. Yep and it’s probably going to get even worse in the coming years. A Medicaid apocalypse is nigh thanks to H.B.1 (the so-called “Big Beautiful Bill”). Substance use treatment is likely to be even harder to get. 

But what my neighbors are seeing has been decades in the making. My adopted dad was living all of these problems twenty years ago. It’s just that the problems were in other people’s neighborhoods. My neighbors could ignore it then. Could look right past people like my dad. But the problems—who are people and every bit as much my neighbors as those living in the million-dollar homes up the street from me—are impossible to ignore after nearly half a century of decisions made by politicians in Washington and Salem to defund our public health and housing infrastructures. Most of those politicians are now dead or retired, not only to never suffer any consequences for their bad policy making, but who usually made a great deal of money off of them. 

Yet instead of focusing on who has power, people choose to blame people like my dad. We need to get tough on these addicts who choose to live a “libertine” lifestyle, refuse treatment, and force us to asshole-proof bathrooms. Of course, there are assholes in every sector of society. The asshole addicts ruining public restrooms may be doing more visible, tactile societal damage, but it’s of a far lesser magnitude than the private equity asshole CEOs buying up all our housing and medical practices before stripping them for parts. And a libertine lifestyle requires a trust fund that the guy shooting up in the park does not have. He doesn’t even have a private place in which to pass out after being up all night trying to keep himself safe, dry, and his stuff from being stolen. And may well want to get clean but can’t get the treatment he needs. 

It’s not only that the story about Measure 110 was wrong, but our politicians cannot seem to give us a coherent story of what is happening with all its context and complexity. Instead we get only press releases and public comment periods before continuing to push an “emergency” through the fine sieve of “process.” But without that story grounded in context and complexity, there is no vision for a future in which that guy in the park has treatment and a home. Just a lot of mistaken stories that can never fix the problem but do cause terrible harm.