Alex Kral is a Distinguished Fellow at the nonprofit health research institute RTI International and is based in San Francisco, USA. He has been conducting evaluations of harm reduction services and drug policies for three decades.

In February 2021, Oregon became the first US State to decriminalize non-commercial drug possession and significantly increase funding for substance use disorder treatment and harm reduction services as a result of Ballot Measure 110 (BM110). To understand perceived impacts of drug decriminalization, we started by conducting qualitative interviews (N=34) in four geographically distinct Oregon counties in the summer of 2022 with representatives from law enforcement (officers and leadership), emergency medical services/fire, district attorney offices, community corrections, juvenile justice, and the treatment and harm reduction communities. Next, we conducted secondary analysis of calls for emergency service data comparing numbers in the largest city in Oregon (Portland) to three similarly sized cities in neighboring states (Seattle, Washington; Sacramento, California; and Boise, Idaho). Calls for service data (N=4,162,620) were analyzed across the four cities between January 2018 and June 2022. The qualitative data yielded concerns by law enforcement that BM110 had led to increases in crimes, particularly property-related crimes and disorderly offenses. Law enforcement also indicated that public opinion in Oregon had soured on BM110 because people feel like they are witnessing and being victimized more by crimes. Quantitative analyses showed that there were no increases in calls for service in Portland after implementation of BM110 and that trends were similar to the comparison cities. Furthermore, there were no discernable increases in public calls for service for disorder crimes, property crimes, or vice crimes following BM110’s enactment in Portland, when taking seasonality into account. The calls for service data do not support the negative perceptions of BM110 that were expressed by criminal legal system representatives we interviewed in Oregon. Our 4-year project will also evaluate evidence-based health interventions, drug use and drug-related health outcomes, treatment and harm reduction services uptake, experiences of people who use drugs, and assess the budget impact of BM110.