Drugs: decriminalizing does not increase deaths – 10/21/2023 – Marcelo Leite

As if by definition, evidence weighs little in shaking common sense, but here’s one: in the American states of Oregon and Washington, the decriminalization of drug possession did not cause an increase in overdose deaths.

This isn’t about the ladies promoting the right to be intoxicated, but about the journal of the American Medical Association. On September 27, Jama featured an article with data on what happened to overdoses in Oregon and Washington in the 12 months after the legal changes.

In Oregon, a grassroots initiative passed Measure 110 in a referendum in the 2020 election. (Another measure, 109, authorized services for psilocybin, the psychedelic substance in “magic” mushrooms.)

With it, possession of small amounts of any drug ceased to be a crime and became a type of misdemeanor, punishable by a US$100 fine that could be suspended in exchange for health care.

In Washington, further north on the West Coast, the change came from the state Supreme Court, which declared the previous drug law unconstitutional. The state Legislature then passed a new law recriminalizing drugs but mandating that police provide treatment rather than making arrests.

Both states moved towards the model adopted in Portugal: transferring this psychosocial issue from the police sphere to the health jurisdiction. Despite current questions about this European experience, the results obtained there were good.

In Oregon there is also a problem with the influx of drug addicts into the city of Portland and the open consumption of drugs on the streets (which has not been legalized, by the way). However, the explosion in consumption and fatal cases predicted by the most conservative did not occur.

In that state, overdose deaths were rising at a galloping pace: 76% in a decade, from 2011 to 2021 (in neighboring Washington, the increase had been 66% from 2019 to 2021). With the arrival of synthetic opioids, such as fentanyl, the situation was getting out of control: an 84% increase in fatal overdoses from 2020 to 2021 alone.

The Jama study concluded that there was neither an increase nor a decrease in overdose deaths in Oregon. The variation was just 0.268 cases per 100 thousand inhabitants from 2021 to 2022, with the new legislation in force. In Washington, it was 0.112 per 100,000, also without statistical significance.

The authors used a trick to arrive at these numbers. They used data from 48 other US states and the District of Columbia (Washington, DC, not to be confused with the northwestern state) to construct a synthetic, that is, artificial, control group.

Counterintuitively, his hypothesis was that deadly overdoses might actually have decreased, not increased. After all, there is a clear association between incarceration and an increased risk of death from excessive drug use.

That didn’t happen either. But the researchers themselves point out, for both possibilities (increase or decrease), that the 12-month period after the change in the law may be too early to assess its effects.

Oregon legislation determines that part of the taxes from legal cannabis businesses in the state must be transferred to harm reduction. Such disbursements only began in April 2022, after the research deadline, so it would not be possible to capture their possible impacts.

In Brazil, the problem is not opioids, like heroin, but crack. A drug that degrades the addict in a very different way, so the European and American models do not have immediate application here. But it would be a good start of public debate to support it on evidence, not beliefs or preconceived ideas.

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