Overdose Epidemic
‘It’s Like a War Zone’: What Happened When Portland Decriminalized Fentanyl
After a failed experiment with legal leniency, Oregon’s liberal stronghold tries to chart a path out of the fentanyl crisis. Can the city find a balance between care and coercion?
T
he man at the West Burnside Street bus stop looks stone dead, sprawled out on the sidewalk with his eyes rolled back. Lucky for him, he overdosed on a weekday, just five blocks from the downtown Portland, Oregon, fire station, where the quick-response unit is on duty, and they’re on the scene in minutes. With the sangfroid of someone who has performed this ritual too many times to count, paramedic Justin de Jesus jabs the man’s shoulder with a shot of naloxone to reverse the effects of fentanyl, the hyper-potent synthetic opioid that is driving the U.S. overdose epidemic. His partner applies an oxygen mask and, slowly, the man’s breathing picks up. After a quick knuckle rub to the sternum, he stirs back to life.
But this brush with death is no wake-up call.
Hostage to his addiction, the man shows no gratitude. He won’t give his name and bristles when asked if he’d like more help. Before the first responders have packed up their kit, he disappears around a corner, presumably to score again. If someone overdoses to the point where they have to be revived, de Jesus later explains, “they tend to seek out that dealer because, in their words, ‘That’s the good stuff.’ They’ll just do a little less, so they won’t die. But since there’s no standardization, you could be getting a fentanyl pill that has nothing in it — or 10,000 times the standard therapeutic dose, so you just drop dead.”
Drug overdoses killed some 87,000 Americans over a 12-month period ending in September 2024 — more lives lost than the wars in Vietnam, Afghanistan, and Iraq combined. Although the death toll is down significantly from a peak of almost 114,000 the year before, Oregon and other Western states have lagged behind the downward national trend, making them ground zero of the decade-long fentanyl crisis. Nowhere has the social and economic impact been more acutely felt than in Portland, a proudly progressive, midsize city of more than 600,000 that not long ago was one the most desirable places to live in the country, despite stubbornly high rates of unsheltered homelessness and substance abuse.
In late 2020, Oregon voters overwhelmingly passed the most liberal drug law in the country, decriminalizing possession of small amounts of hard drugs like fentanyl and methamphetamine. Instead of jail time, Ballot Measure 110 aimed to expand addiction treatment services in a state that ranked last in such offerings nationwide, through hundreds of millions of dollars in revenue redirected from a cannabis tax and savings resulting from decreases in arrests and incarceration. Additional funding went to harm reduction services — naloxone distribution, needle exchanges, testing kits — that make drugs “safer” to use. Advocates hoped to follow in the footsteps of trailblazing countries like Portugal and France, where nuanced approaches that prioritize health care over punishment have curtailed overdoses and public drug use. In some respects, it was the closest any place in the U.S. had yet come to The Wire’s “Hamsterdam”: a drug zone where police permit dealers to operate as long as they don’t fight over territory and confine sales to a limited number of blocks, enabling addiction service providers to focus their efforts.
Editor’s picks
The timing could not have been worse. Months into decriminalization, Mexican drug cartels ratcheted up the flow of fentanyl across the border and up the Interstate 5 corridor, where it flooded onto city streets, plunging prices to less than a dollar a pill. As lockdown despair from the Covid-19 pandemic deepened, the killing of George Floyd sparked monthslong racial justice protests that turned violent and engulfed parts of downtown. With police turning a blind eye, Portland became a honeypot for local and out-of-state addicts to score cheap dope and use it freely. “It was like a perfect storm that brought us from this really vibrant, amazing downtown to a tourist destination [for drug users],” says Rick Graves, a spokesman for Portland Fire and Rescue. Overdose deaths, retail theft, and homicides surged to record levels, running law enforcement and first responders ragged. “We’d revive the same people, and revive them again and again,” says Dave Friedericks, a veteran paramedic and firefighter whose downtown station responded to 36 overdose calls in a 48-hour period in the summer of 2023.
A highly addictive painkiller, fentanyl is 50 times stronger than heroin (two milligrams — or the equivalent of five to seven grains of table salt — is considered a lethal dose), with black-market analogues that are thousands of times stronger. Dealers mix fentanyl with other drugs to increase profits, and fentanyl’s effects on users are exacerbated by an evolving array of cuts, notably xylazine (a.k.a. “tranq”), an animal tranquilizer that, when injected, can rot flesh and lead to amputation. Complicating matters, many addicts in Oregon use fentanyl and psychosis-inducing forms of methamphetamine in tandem, raising the likelihood of a fatal overdose and making it even harder to get them to seek treatment.
In January 2024, Portland made national headlines when Gov. Tina Kotek declared a 90-day state of emergency to tackle the fentanyl crisis. Within months, state lawmakers voted to repeal Measure 110, ending a nearly four-year experiment with decriminalization. Then the reform-minded district attorney of Multnomah County, where Portland is located, was ousted by one of his own prosecutors, in a ballot seen as a referendum for greater accountability. Now, anyone caught with illicit drugs who doesn’t have outstanding warrants is given a choice: Be charged with possession and go to jail; or be “deflected” to community-based addiction treatment. Anti-drug laws, in other words, are back in force, albeit with a brand of “tough love” that reflects the Rose City’s liberal ethos.
I made two trips to Portland last year to see how the transition is working out. In a live-and-let-live city that likes to signal its virtues, can empathy and stricter law enforcement go hand in hand? When does hands-off harm reduction become enablement? And with a drug as deadly addictive as fentanyl, is compulsory detox and treatment a viable option? How Portland manages this next chapter could be a bellwether for larger American cities grappling with the tangle of addiction, rampant homelessness, and deteriorating public safety.
“The challenge here in the U.S. is massive,” says Dr. Andy Mendenhall, CEO of Central City Concern, a nonprofit that provides housing and addiction services to nearly 16,000 people each year. The unrelenting flow of fentanyl combined with a dearth of shelter beds, affordable housing, and behavioral health resources has resulted in an addicted population that’s chronically homeless and harder to get into treatment, he explains. “On a more esoteric level, people feel stressed out and isolated from each other. There’s a lack of connection, and we’ve become this soundbite culture where feelings are to be avoided or turned off. And there are so many different distractions that folks are going to turn to something to help them feel different.”
ON A WIND-BLOWN CORNER near the old Greyhound bus station in Chinatown, homeless addicts muster in front of a white van serving free cups of coffee. The van is operated by the Mental Health and Addiction Association of Oregon, a Measure 110-boosted nonprofit that employs former drug users who apply their lived experience to guide peers into recovery. They offer tickets to a nearby resource center where people can get free showers, do laundry, and eat hot food, no strings attached. Should anyone request detox or a housing referral, staff assess their mental health and other criteria to determine the best fit. “It’s why I call Portland ‘Supportland,’” says Ricco Mejia, a charismatic ex-heroin addict raised by “whores and bank robbers” who serves as outreach manager. “I was struggling and asked for help, I received help, and I became the help.”
Word is that 35-year-old Bruce Ferguson is ready to come in for detox, and Mejia is waiting with a smile and handshake when he turns up. A husky skater with a shock of terracotta hair and a soulful aspect, Ferguson says he started taking Adderall and later pot to deal with teenage anxiety. He fell in with a troubled crowd. A Percocet prescription after a dental operation segued to heroin addiction that got him kicked out of the family home. Then came fentanyl. “It’s not how it used to be,” he says. “It controls every decision you make.” With a powerful high that wears off in less than an hour, some addicts are compelled to use upward of 20 to 30 times a day, leaving fleeting windows of self-possession. “People that you would never even guess become users and now, within a couple of days, months, they’re homeless out here,” Ferguson says. “They’ve lost everything: families, cars, houses, careers.”
Ferguson lost a steady job landscaping, his apartment, and the girlfriend he shared it with. He’s had almost no contact with his parents over the past few years. “I just want to be a decent human being and be accountable, be trustworthy, and I want to be a good son to my mom and my dad and make them proud,” he says, “because I’ve done the complete opposite of that.” He steals constantly to slake his addiction, which compounds the gnawing sense of shame and the urge to numb out — aware he’s one false move from another long stint in jail, or an early grave. “If I don’t get my shit together, I’m going to lose everything for good.”
As Mejia and Ferguson set a time to meet at the downtown center, Ferguson’s ex-girlfriend appears. She’s recently relapsed, and looks worse for wear. Ferguson later confides that he introduced her to fentanyl, a fact that still haunts him. After they catch up, he tells Mejia that his ex’s presence is “stirring the pot a little.”
“That’s that friendly fire we talk about,” replies Mejia, launching into pep-talk mode. “The lifestyle firing back at us. Most people get taken out on the battlefield by people on our own side. Could be friends and family. They want what’s best for us. But we need a timeout from them to work on ourselves first. So just maybe setting a boundary with her, right?”
Much to Mejia’s relief, Ferguson shows up at the resource center a few hours later. He showers, cuts his hair, and organizes his art supplies for a weeklong stay at Recovery Works Northwest, a 16-bed inpatient detox facility that opened with Measure 110 funding. Nervous but upbeat, Ferguson says he wants to sober up and reconnect with his father, a schoolteacher now living in Italy. Past experience has also taught him that feeling normal again can be the hardest part of all. “I have energy and get complacent, like, ‘I can handle that [drug] and it’s not going to hurt me,’ and it does. Every time.”
When it’s time to head over, Ferguson tells Mejia that he needs to run a few more errands and will come back in the afternoon. But he never does.
Mejia is unfazed. Having been in and out of detox 15 times himself, he knows better than anyone that the path to recovery is seldom a straight line. “It’s the lifestyle and the disease of addiction, making choices for them.” After so many relapses, he credits getting into supportive housing with outpatient treatment for helping him finally turn the corner from being “a community hazard to an asset. People were here to help me when I was ready, and we’ll be here to help him.”
According to the Multnomah County Health Department, individuals who are homeless and addicted like Ferguson are at 51 times greater risk for overdose death. Of an estimated 7,000 homeless people in Portland, at least 456 died on the street in 2023, the deadliest year on record. And despite the infusion of more than $1.7 billion since 2015, homelessness in the Portland area continues to climb faster than authorities can house people. Decades of underbuilding have led to a dire housing shortage that has spiked rents and home prices, while some addicts find it easier to service their addictions on the street. In a bid to ease the deficit and draw more people into care, Multnomah County is opening temporary housing sites with low barriers to entry. In Portland’s Clinton Triangle area, a fenced-off “village” between train tracks hosts 140 housing pods and another 20 tent platforms that are free of charge, part of a network of some 750 pods across the city. No one is turned away for substance abuse; the site is staffed primarily by people in recovery, with on-site mental health counselors to connect residents with drug treatment should they seek it.
I find 39-year-old Sean Smeeden holed up in one of the tiny homes in a cold sweat, raw out of detox. “Fentanyl and opioids ruined my life even before I started doing them,” he says, explaining that the drugs killed his mother, uncle, and grandmother within a year-and-a-half period. Although the premises are rife with active fentanyl smokers, Smeeden, a self-described “nomad” from Alaska, is grateful for a space to call his own. After four sleepless nights, his withdrawal pangs are fading enough to look for work as a dishwasher. If he can stay sober, he’d like to get certified as a computer programmer and secure more permanent housing. “I’m going through it right now,” he says, “but that’s OK, because I feel alive. Suffering or not, it feels good to feel.”
IN DOWNTOWN PORTLAND, the proliferation of low-barrier housing, treatment centers, and harm reduction services are in tension with struggling business owners who invested back when the local economy was booming. More than 2,600 downtown businesses, already hobbled by the pandemic and street riots, have shut down, citing customer loss due to homelessness and crime. The city’s office vacancy rate stands at 30 percent, the highest in the nation, and job loss is the largest of any major metropolitan area. From San Francisco to Seattle, a similar decline has stoked fears of an “urban doom loop”: an ever-downward spiral where lower occupancy and property valuation leads to a withering tax base from which to fund policing, first responders, and other critical services.
“I’ve learned that the disease of addiction has a hit on my life.… The hit man is me.”
The city’s reputation for drugs, crime, and homelessness “has really crushed us,” says Jessie Burke, a community organizer and co-owner of The Society Hotel in Old Town Chinatown, a neighborhood that’s a perennial hub for the homeless and drug addicted. Burke, of mixed Chinese American descent, bought the rundown 19th-century building for $700,000 in 2013 and invested more than $4 million in renovations, hoping to be a part of the historic neighborhood’s renaissance. Business was “going gangbusters” in the early years, she says — but since 2019 has plunged by about 40 percent, at a loss of $30,000 a month. “I remember thinking this is hard, but I don’t think I ever thought I would witness the things that I’ve witnessed now.”
During decriminalization, overdoses became so common that the city asked Burke to install a naloxone dispenser in the lobby (she refused), and drive-by shootings between rival drug gangs punctured the night. Although the violence has tapered off, the hotel’s front doors remain locked. Sidewalks outside are lined with tents and addicts nodding off next to pipes and burnt tinfoil. Some are missing limbs. When I visited last May, a half-naked man streaked by in a fit of psychosis. The week before, another man high on meth armed with a machete threatened to chop the head off an employee’s three-year-old daughter. “You have to be tough as nails to work here,” says Burke. “Most days it’s like you’re entering a war zone, and you don’t realize it until you leave.”
A former competitive fencer with a no-nonsense attitude reflecting her East Coast roots, Burke insists that people high on hard drugs should not be allowed free rein. “It doesn’t need to be jail, but we used to have something called the Cheers van where the drug of choice was alcohol, and if you were passed out or drunk, they would pick you up and you would go to the drunk tank and sober up,” she says. “It has to be built a little differently, because the drugs are different. But the fact that people get to walk the streets and be aggressive on meth and have a machete is unacceptable. People deserve predictability — it’s the baseline safety that people expect.”
Burke also decries the lack of oversight on public funds earmarked for homelessness and treatment services, claiming that there are no hard deliverables for any contract that goes out the door for Multnomah County’s $4 billion annual budget. (Her concerns were echoed in a December 2023 state audit of $264 million in Measure 110 funds allocated to treatment service groups, which cited “insufficient data” to assess their effectiveness.) One low-hanging measure she calls long overdue is a centralized server, much like the kind hotels rely on, that tracks the availability of beds in public-funded shelters. On any given night, hundreds of beds lie empty. Comparing the poor performance to standards in the private sector, she says, “Small businesses don’t have the luxury of failing year after year, not delivering the thing that they promised.”
In May, Burke lost her bid for a seat on the Multnomah County board of commissioners. But on the side, she served as campaign manager for her friend Nathan Vasquez, the insurgent county prosecutor who defeated his boss for the district attorney job on a campaign pledge to more aggressively prosecute criminals. At his victory party at a swank hotel on the edge of Chinatown, Vasquez affirmed that he would end open-air drug markets and get more users into treatment, “restoring the idea that it is OK to hold people accountable, and do it in a compassionate manner.”
I RETURNED TO PORTLAND in early November, after Donald Trump won reelection. Scores of downtown storefronts were boarded up in anticipation of clashes between cops and anarchists that, for a change, never materialized. Just as the U.S. electorate shifted right, Portland reasserted its progressive bona fides by using a ranked-vote system to elect the most diverse city council in its history. The law-and-order mayoral candidate was rejected for Keith Wilson, a moderate businessman with no political experience who promised to end homelessness within a year. Contrary to what some might have heard, “Portland remains a very liberal city,” says Richard Clucas, a politics professor at Portland State University.
Two months into recriminalization, it was hard to discern any visible change in the downtown drug market. People smoked fentanyl in plain sight and clustered at the usual spots: around the public library, the Burnside Street McDonald’s, along Alder Strett, in the parking lot beneath the closed Montessori school. And after dark, the dealers were impossible to miss: short young men in hoodies and women in pajama pants, slinking around corners with side packs.
Overdoses were down slightly across the city, in large part thanks to weaker drugs. Since last May, the fentanyl supply experienced a dramatic shift in potency, locally dubbed “the drought.” Nearly half the samples tested by the harm reduction group Outside In contained BTMPS, an industrial chemical nicknamed “bug spray dope” for its acrid taste when smoked. Though toxic, it’s not known to cause overdose or immediate death, fueling a theory that it may be part of a deliberate effort by Mexican cartels to kill less of their customer base while ensuring profits by requiring users to smoke more to get high.
For years, fentanyl production in northwestern Mexico was close to a free-for-all: If you had the recipe, you could cook the drug, which yielded wildly varying degrees of potency. In October 2023, the Chapitos faction of the Sinaloa cartel imposed a ban on fentanyl production and killed dozens of violators, purportedly in response to intensified pressure from U.S. law enforcement. According to Victoria Dittmar of Insight Crime, a think tank that studies organized crime in the Americas, production continues by other Sinaloa cartel factions, and has since moved into neighboring states like Sonora and Baja California, where cooks operate under the oversight of the cartel. Weaker fentanyl cuts could be a calculated decision, “as by doing this, they reduce law enforcement pressure on them while still maintaining profits,” Dittmar says. “But at this stage, this is just a hypothesis.” Additionally, when certain precursor chemicals are in short supply, fentanyl may be cut with xylazine and other ingredients to increase the volume of the final product at any stage of the chain, from cook to U.S. distributor, “so even if production in Sinaloa appears to be more centralized, the end product can still vary.”
One factor behind the decline in deaths that’s not in question is more widespread availability of naloxone. While some residents contend that harm reduction measures like the free handouts of drug paraphernalia and tarps have exacerbated a sense of decay around Portland and left addicts more vulnerable to abuse, the impact of the opioid reversal drug on streets where it was once scarce to nonexistent is “a major success story,” says Dr. Todd Korthuis, the head of Oregon Health & Science University’s addiction medicine section. He singled out the work of Save Lives Oregon, a network of organizations that has distributed more than 675,000 naloxone doses, resulting in almost 20,000 overdose reversals.
Reid Elder, an UberEats driver who obsessively tracks Portland’s drug scene and collects free naloxone, says he’s administered “hundreds” of life-saving doses over the past two years. Seven nights a week, he and his partner, Elena Perez, work the graveyard shift downtown in their Toyota Prius while monitoring emergency dispatch on a smartphone app. Anytime an overdose call comes through that’s in range, they detour to the scene equipped with naloxone, often arriving ahead of first responders. When things are slow, the couple distribute snacks and hand warmers, along with nudges to seek help. In general, social service workers in Portland are “too passive,” Elder laments. “Getting people off the street is gonna take a lot more assertive helping.”
On a drizzly Friday night, we check in with “Squints,” a 34-year-old Black man who Elder says has been on the same corner in Chinatown for four nights. It’s 42 degrees out, and Squints is shivering under a thin blanket and a soaked sheet of cardboard. Elder offers a ride to a nearby shelter, but he politely declines and asks for a lighter instead. When Squints finally agreed to be taken into the hospital five days later, Elder found fentanyl foil under his blanket. Following surgery to remove a blood clot in his leg, he returned to the street. “It’s mind-boggling,” says Elder. “People get into this state, and they’re not even trying to meet their survival needs.”
Just after 10 p.m., we pull up to the corner of 13th and Taylor Street as a busted dealer is loaded into an ambulance. He’d tried to make a run for it and was tackled by a member of the Central Bike Squad, a 10-person police unit tasked with disrupting the downtown drug trade (and whose run-and-gun exploits are featured on a COPS-style Instagram account). In his side pack, officers found 50 grams of compressed fentanyl, $1,126 in cash, and a revolver.
Though police don’t make a point of asking, officer Cristina Serrano, a native Spanish speaker, tells me “more than 90 percent” of the street-level dealers they arrest are undocumented Hondurans who belong to networks on Mexican cartels’ payrolls — a fact that squares with Drug Enforcement Administration investigations from Oakland to Salt Lake City. “Some of them don’t even know it’s a misdemeanor now,” she says, “so they just keep doing it in the street.” (Indeed, a month earlier, when Serrano arrested a woman who’d been weighing out fentanyl powder with a scale at this exact same spot, she says the woman was less concerned about going to jail than feeding her infant child.) Typically, dealers give an alias when arrested and skip their court date; if the heat becomes too great, they move on to another Western state where their warrant won’t be extraditable, in a distribution merry-go-round.
Under Measure 110, the man caught with fentanyl weight and a gun might have walked away with a ticket — or nothing at all. Today, it’s hardly any worse; Serrano says he could normally expect to be released “within hours.” Only because it was a weekend and there was no judge on duty, the man would have to spend a couple of nights in jail. The remainder of Serrano’s shift would be spent doing paperwork at the precinct, leaving no bike patrol on duty downtown until Monday morning.
Like water probing for gaps, the Hondurans were back on the same block before midnight.
“You can push people further away by forcing them [into treatment], and those people will just recede into the shadows.”
THE NEXT MORNING, I ask the central precinct commander, Brian Hughes, if there’s any disincentive to dealing fentanyl in his city. “There’s none — and they know that; it’s part of the business model,” he says. “There needs to be more risk [for dealers].” While recriminalization under the new law, HB 4002, has enabled police to make arrests and carry out investigations that have led to up-the-chain arrests and larger drug seizures, he says authorities are still hamstrung by capacity shortages in the jails and on the street. (Following the George Floyd protests, police hiring was put on a freeze that was later lifted.) He says a city the size of Portland should have at least 1,100 officers. Today, there are just 785 on staff, with some entering retirement; another 150 officers are in training but it will take months before they are in service. “We are way too low now,” says Hughes.
Hughes was more upbeat about the deflection option available to drug users to avoid the criminal justice system. Provided they have no outstanding warrants and are not a threat, they could choose to be dropped off at a new center across the Willamette River, where they are screened by health workers and referred to additional treatment services. Operated by Baltimore nonprofit Tuerk House, the center offers 13 sobering stations that are open 24-hours, with plans to open a permanent sobering center in 2027 that can accommodate 50 people for longer stays and involuntary holds, including withdrawal management services and medication-assisted treatment.
It’s still too early to assess the efficacy of the program. As of late February, only 267 have entered deflection (the majority of people arrested with drugs are brought to jail on other charges or an outstanding warrant). Moreover, once they are delivered and officers remove the handcuffs, nothing can stop them from walking away — as most appear to be doing, much to the ire of neighbors and business owners. “They haven’t even finished the booking process and they’re out,” says Serrano, noting that after 30 days, offenders become eligible for deflection again if arrested. Deflection is a “good idea,” she adds, “but when is enough, enough?”
Incoming district attorney Nathan Vasquez says he’s aware of these loopholes and has a plan to fix them. “Being progressive is wonderful, but there’s still a social contract,” he says. “When it comes to [small possession] drug crimes, the goal should never be to lock people up. At the same time, you have to have a motivational piece to push people toward treatment, and sometimes it’s OK to put someone in jail for a few days.”
To make his point, he shares the story of a key witness in a triple homicide case who was addicted to fentanyl and had overdosed multiple times. As the trial neared and it was obvious she would not show up, he arranged a warrant to have her held for 10 days with an ankle monitor — enforcing a de facto detox stint. Since the trial ended, Vasquez says the woman texts him every three months to thank him for helping her get sober, something she told him she “never would have done” without him. There are “many paths to recovery,” Vasquez says, “and it’s never wise to take any threat of being held accountable off the table.”
One component of Vasquez’s plan will be involuntary detox in treatment dorms built on county jail grounds. Along with traditional guards, they will be staffed by medical nurses working to use the detox period to get them “in the right zone” before they are released to an inpatient or outpatient treatment program, with a supervised plan that could include Suboxone, a medication used to alleviate opioid cravings, and a dedicated case manager. He wants to start with 100 to 120 beds and, if enough funding can be raised from the county, federal grants, and private investors, be staffed up and running by the end of 2026. Because he has no plans to seek higher office, Vasquez says he can put “results ahead of politics” and, hopefully, create a model that other mid-sized American cities can replicate.
Enforced treatment is not a new concept in the U.S. state and local governments have used drug courts and other systems since the 1970s to compel people to get sober, and the approach is gaining bipartisan momentum owing to the lethality of fentanyl. California lawmakers, for instance, have passed legislation that makes it easier to detain people and force them into medical treatment for addiction. A half-dozen recovering heroin and fentanyl addicts told me, unequivocally, that they never would have broken free without a “nudge from the judge.” “I got rescued, not arrested,” says one, who now works for a recovery nonprofit.
Other former addicts counter that involuntary treatment is unethical and dehumanizing, and it does more harm than good. “Most people already couldn’t quit using drugs when they were facing a bunch of consequences, so when you come in and say there’s gonna be one more consequence it’s not like, ‘Oh, the fucking light switch flipped,’” says Morgan Godvin, a drug policy researcher and former heroin user who spent four years behind bars as a result of her addiction. “You can push people further away by forcing them, and those people will just recede into the shadows.” Most empirical data affirms that involuntary treatment is less effective, particularly the “cold turkey” approaches used in some prisons. A 2024 study in Massachusetts dealing with fentanyl addiction found that civic commitment, whereby family members seek court-mandated treatment for a loved one, increased the risk of overdose after forced abstinence.
“The goal is to have as many people as possible make the choice between prosecution and treatment consciously, and have a sense of accountability for that,” says Central City Concern’s Mendenhall, noting that recovery outcomes are better when self-directed. However, when individuals have lost the ability to help themselves due to acute mental illness and addiction, and pose a danger to themselves and others, “involuntary treatment is absolutely necessary.” Oregon still faces a severe shortage of psychiatric care facilities, and people with dual diagnoses are generally excluded from civil commitment. These people are “falling through the cracks,” he adds, resulting “in the greatest inequities and preventable death” from overdose and exposure.
Once again, Portland will be a test case as authorities try to strike a balance between care and coercion. “Measure 110 was, ‘We’re going to let you exist out in the street, and good luck — we hope somehow you’re gonna decide to make the leap to treatment,’ not taking into account the nature of the beast [fentanyl and meth],” says Vasquez. “What if we tried this other path, where there is a medical component, and a criminal justice component, and not shy away from that but embrace it in a way that says, ‘How can we help get these individuals connected to treatment in a long-term way?’”
LATE ONE NIGHT, making the rounds with Elder and Perez, we speed to an overdose call in Chinatown, right across the street from The Society Hotel. An unconscious man named Gilbert is receiving emergency breathing from a woman, and three discarded shots of naloxone litter the ground. “His heart’s working, but he’s not breathing,” the woman shouts. The man’s lips are turning blue, and Perez, unsure of how long he’s been out, jumps in to give him another shot of naloxone. The woman pushes her against the wall: “Goddamit, you’re gonna kill him if you give him another shot!” Perez pleads. “We’re on the same team, mama!” The scene is harrowing and poignant, two strangers trying their damndest to save a dying man on a cold, wet sidewalk. And they succeed: Gilbert wakes up just as an ambulance and fire truck arrive.
While I was in Portland, the Centers for Disease Control released preliminary figures indicating that U.S. overdose deaths had experienced their first significant decline in years. There are many theories as to why — and no definitive consensus. Some drug policy analysts touted greater international pressure on Chinese companies that make fentanyl precursor chemicals and larger seizures on the U.S. southern border for the drop in fentanyl supply and strength, with some asserting that intensified law enforcement has changed cartels’ behavior. Just days ago in Portland, a multiagency operation combining the efforts of the DEA, FBI, and local law enforcement led to the arrest of 46 traffickers — including Honduran nationals allegedly working with the Sinaloa cartel — and the seizure of 44 pounds of fentanyl powder as well as more than 2,500 pills. Since taking office, President Trump has escalated the War on Drugs, designating the cartels as global terrorist organizations and threatening to target them inside Mexico with air strikes and Special Forces. But like other heavy-handed campaigns of the past, such tactics are unlikely to be effective given the cartels’ diffuse operations, fentanyl’s low cost and ease of transport, and the insatiable U.S. market for cheap opioids. “Even if all fentanyl producers in Mexico are taken out, production would still take place,” says Insight Crime’s Dittmar, noting that it costs about $60,000 to set up a lab and buy materials. “We already see it happening in Canada, and there is some indication that it could be happening in the United States.”
Devastating as Oregon’s overdose crisis remains, health officials contend that vigilance on the home front is the best long-term strategy, however slow and messy. Korthuis emphasizes that fentanyl hit Oregon and other Western states later than Eastern states that are now seeing a sharp drop in overdose deaths due to changes in the drug supply, naloxone availability, and expanded treatment services. “There seems to be a natural evolution: The decline in overdose deaths maps out almost perfectly with when fentanyl appears in a state,” he says. “I’m confident that by doubling down on prevention and treatment we can demonstrate the success of innovative public health models in Oregon.”
Supporters of decriminalization maintain it was not given enough time to have an impact. Indeed, a new study published in the Journal of the American Medical Association concluded that “decriminalization of drug possession was not associated with an increase in fatal drug overdose rates” in Oregon, attributing the surge to the deluge of fentanyl instead. But in the wake of Measure 110, more people are getting access to naloxone and medically assisted treatment with proven drugs like methadone and buprenorphine. Community-based nonprofits offer a broadening spectrum of addiction services — from inpatient treatment and low-barrier housing to long-term counseling — that give fentanyl users a fighting chance of slipping its grip. And, critically, they are staffed by legions of emerging survivors who know the pain and isolation that lie at the root of addiction, and are ready to meet people where they are. “It’s all hands on deck here,” says Mejia, the outreach manager. “We’re keeping the momentum going.”
Back at the coffee van in Old Town, a gaunt addict named Travis walks up and asks for detox. “I’m just done,” says the 43-year-old, “I can’t live like this anymore.” Tommy Richmond, a volunteer who credits a jail term with helping him get clean, starts making calls. The first two places are booked, but Recovery Works Northwest has a single bed available, and Mejia comes to drive them over. On the way, Richmond stays on the phone trying to arrange housing for the day Travis exits detox, so he doesn’t slip through the cracks. If he commits to outpatient treatment, he could be eligible for county funds that would cover his rent while he gets back on his feet. “There’s going to be a bunch of guys living there, and they’re going to help you stay accountable,” Richmond says.
Travis worries aloud that he’ll be kicked back onto the street if he relapses. “Even at 13 years clean, I still wanna get high, but I share my thoughts and feelings like you’re doing, so I don’t put that into action,” says Mejia. He adds a parting shot: “I’ve learned that the disease of addiction has a hit on my life. What’s colder than that? The hit man is me. So, how I get militant and combat that is by doing what you’re doing today and asking for help.”
Set back in a residential area and flanked by towering pine trees, Recovery Works looks more like a cozy family home than a detox clinic. Sean Smeeden had spent a week here in the spring. (Five weeks after we met at the tiny home complex, I learned he was shot dead on a MAX train platform in north Portland.) It turns out Bruce Ferguson had also come through.
BY CHANCE I RUN into Ferguson on a downtown corner and invite him to lunch. Over a bowl of Thai curry, he tells me that he skipped his detox appointment that day in May to get high with his ex-girlfriend. But he made it to the clinic a week later and toughed it out, moving on to supportive housing with a group of men. He was building momentum, but having only a month to find a job and place of his own made him feel “discouraged and looking for ways to cope.” Before relapsing, he left the home to avoid putting anyone else at risk. Over the summer, he did another month-long stint at a sober house, and relapsed again. By his count, it was the 10th time.
Since then, he’d been sleeping rough and using, too ashamed to reach out to his family. “It hurts to even think about it; they care so much, and I don’t like to be the bearer of bad news.” He recedes into himself for a moment and lets out a groan, the ache of longing taking on a physical dimension. “It’s all so exhausting,” he goes on. “Sometimes I wanna curl up in a ball and cry, but out here you gotta keep a certain demeanor so people don’t walk all over you, target you.”
Ferguson was going on three days without sleep. As the heavy meal settles, he can barely finish sentences and then finally drifts off, head slumping on his chest. For the next hour I let him rest, until the cafe closes down and it’s time to head back out into the darkening street.
The headline of this story has been updated to reflect that Portland decriminalized fentanyl — meaning the drug remained illegal but the criminal justice system did not prosecute those who used it — but did not legalize it.