Drug Decriminalization, the Introduction of Fentanyl to Drug Markets, and Fatal Overdose in Oregon

• In Event: Assessing Decriminalization, Harm Reduction, and Public Health Approaches to Policing the Opioid Crisis

Abstract

Background
In 2021, Oregon became the first state to decriminalize drug possession. No analysis of the effect of this law on overdose mortality has fully accounted for the introduction of fentanyl to Oregon’s unregulated drug market, a substance known to drive fatal overdose rates.

Methods
The association between fatal drug overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington DC that did not decriminalize drugs. The rapid escalation of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogs. A changepoint analysis was used to determine when each state experienced a rapid escalation of fentanyl in its unregulated drug market, which was included as a covariate.

Results
A rapid escalation of fentanyl in Oregon’s drug supply occurred in the first half of 2021, contemporaneous with decriminalization. Adjusting for this escalation as a confounder, the effect of drug decriminalization on overdose mortality in Oregon was null (Tau = -0.51; SE = 0.36).

Conclusions
This analysis found no association between M110 and fatal drug overdose rates.

Authors

• Michael Zoorob, Rhode Island Hospital

• Ju Nyeong Park, Brown University

• Alex Kral, RTI International

• Barrot Lambdin, RTI International

• Brandon del Pozo, Brown University