Increase in fatal drug overdoses is associated with introduction of potent opioid, not drug decriminalization, study finds.
When overdose rates spiked in Oregon in 2021 after the state decriminalized low-level drug possession, blame quickly turned to the new state law. But a new study by researchers at Brown implicates another factor: the introduction of fentanyl into Oregon’s unregulated drug market.
“What’s compelling about this analysis is that it follows the path of fentanyl across the country and offers testament to the destruction wreaked by this highly potent drug,” says study author Brandon del Pozo, PhD, an assistant professor of medicine and of health services, policy, and practice (research). “When fentanyl arrives in Oregon in early 2021, we can see from the data that it wreaks destruction there, too. That was also when decriminalization was taking effect in Oregon.”
With the implementation of Measure 110 in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. In April 2024, in reaction to the state’s skyrocketing overdose rate and other concerns, Oregon’s governor signed into law a bill that rolled back Measure 110 by making “personal use possession” a misdemeanor punishable by up to six months in jail.
Del Pozo says that there hasn’t been an analysis of the association of Measure 110 with overdose mortality that has fully accounted for the introduction of fentanyl to Oregon’s unregulated drug market, despite the fact that fentanyl is known to be the prime driver of fatal overdose in the US.
In the paper, published in JAMA Network Open, del Pozo and his team evaluated the association between changes in state fatal drug overdose rates and the escalation of fentanyl availability across the country from 2008 to 2022.
Comparing Oregon to 48 US states as well as Washington, DC, that did not decriminalize drug use, they analyzed national data from state drug laboratories showing what kinds of illicit drugs were being recovered and tested. They focused on the percentage of the drug supply accounted for by fentanyl and its analogs, which increased state by state over time. The researchers then plotted this data against publicly available information from the US Centers for Disease Control of each state’s fatal drug overdoses.
They found that across all states, an increase of fentanyl in the illicit drug supply was strongly correlated with an increase in drug overdose fatalities.
“It was a very tight relationship: the more fentanyl that was recovered and tested by the state, the higher the fatal overdose rate in that state,” del Pozo says.
