In early 2021, Oregon and Washington implemented short-lived experiments effectively decriminalizing drug possession. During these periods, both states experienced sharp rises in overdose deaths, mirroring a national upward trend influenced by factors such as the fentanyl epidemic and COVID-19's social impacts.

A 2023 survey of nearly 500 drug users across eight Oregon counties found that only 1.5 percent began using drugs after Oregon's Measure 110 passed. Meanwhile, Washington saw a 91 percent reduction in drug possession arrests—from 9.2 to 0.8 per 100,000 residents per month—averting approximately 20,000 arrests and prompting the vacating of hundreds of thousands of prior convictions after the state Supreme Court voided the possession statute in State v.

Policy analysts have sought to isolate the effects of decriminalization from broader national trends. While proponents had hoped for a decline in overdose deaths, the evidence remains mixed on whether decriminalization itself contributed to increased fatalities once controlling for external factors.

Critics, including Manhattan Institute’s Charles Fain Lehman, have argued that the study supports claims that decriminalization caused overdose deaths and a surge in crime. However, the mortality study referenced does not address crime, and the arrest data shows no statistically significant increase in violent or property offenses attributable to Measure 110.

The study's central estimate uses a synthetic control method, blending data from other states to model what Oregon and Washington might have experienced without decriminalization. The authors emphasize caution in interpreting results, contrasting with Lehman’s analysis, which has been described as containing errors and misconceptions.

This ongoing debate underscores the complexity of assessing drug policy impacts amid overlapping public health crises and varying regional dynamics.

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