Oregon Measure 110 and Its Impact on Addiction Treatment: What You Need to Know

What Measure 110 Changed in Oregon

Ballot Measure 110, approved by Oregon voters with 58% support in November 2020 and implemented in February 2021, made Oregon the first U.S. state to decriminalize personal possession of all drugs. Under the new framework, possession of small quantities of controlled substances, including heroin, methamphetamine, cocaine, and fentanyl, was reclassified from a criminal misdemeanor to a Class E violation, equivalent to a traffic ticket carrying a maximum $100 fine. The fine could be waived if the individual called a treatment hotline for a health assessment.

The second major component of Measure 110 was financial. The law redirected a significant portion of Oregon's cannabis tax revenue, approximately $300 million over the first biennium, to the Drug Treatment and Recovery Services Fund. This fund was distributed to behavioral health resource networks (BHRNs) in every Oregon county to expand treatment, harm reduction, peer support, and housing services.

Proponents argued that criminalization had failed to reduce drug use, disproportionately harmed communities of color, and created barriers to seeking treatment. The measure's architects envisioned a health-centered approach that would redirect individuals away from the criminal justice system and toward voluntary treatment and recovery support services.

The Treatment Funding Expansion

The influx of Measure 110 funding represented the largest single investment in addiction treatment infrastructure in Oregon's history. Behavioral health resource networks received grants to hire peer support specialists, open sobering centers and drop-in facilities, expand medication-assisted treatment, and provide housing support for individuals in recovery. The goal was to create a continuum of low-barrier services that met people wherever they were in their relationship with substance use.

In Portland, Measure 110 funding supported new drop-in centers in Old Town and East Portland, expanded mobile outreach teams, and funded additional beds at existing residential facilities. In the Willamette Valley, rural communities received resources for telehealth-based treatment and transportation assistance to get individuals to appointments. Statewide, hundreds of new peer support positions were created.

The rollout of funding was not without challenges. Delays in distributing grants meant that some programs did not begin operating until late 2022, nearly two years after the measure passed. Administrative requirements for the new BHRNs were complex, and some smaller organizations lacked the capacity to apply for or manage the funding effectively.

The Citation and Hotline System

Under Measure 110, individuals found in possession of small amounts of drugs received a citation rather than an arrest. The citation included a phone number for the Lines for Life treatment hotline, and calling the number to complete a health screening would result in dismissal of the $100 fine. The system was designed to be the bridge between decriminalization and treatment entry.

In practice, the citation-to-hotline pathway was used far less frequently than proponents had anticipated. Data from the first two years showed that fewer than 1% of individuals who received citations called the hotline. Many individuals simply discarded the citation, and enforcement of the $100 fine was inconsistent across jurisdictions. The low engagement rate became one of the most cited criticisms of the measure.

Defenders of the system argued that measuring success solely by hotline call volume missed the broader picture. They pointed to increases in voluntary treatment admissions, expanded harm reduction contacts, and the reduction in criminal records for drug possession as meaningful outcomes independent of the citation system.

Overdose Deaths and Public Health Data

The most troubling data point in the Measure 110 debate is the trajectory of overdose deaths. Oregon's drug overdose fatalities rose from 472 in 2019 to over 1,000 in 2023, with fentanyl accounting for the majority of the increase. Portland and Multnomah County experienced the sharpest increases, but the trend was statewide. These numbers placed Oregon among the states with the fastest-growing overdose death rates in the nation.

Attributing the overdose surge directly to Measure 110 is contested. The same period saw sharp increases in fentanyl deaths across nearly every U.S. state, regardless of drug policy. The national fentanyl supply expanded dramatically between 2020 and 2024, and the COVID-19 pandemic disrupted treatment access and social support networks everywhere. Researchers caution against isolating one policy variable in a multi-factorial crisis.

Nonetheless, the perception that decriminalization contributed to worsening outcomes was politically powerful. By 2024, public sentiment had shifted significantly, and the Oregon legislature took action to modify the measure's approach.

Legislative Amendments and the Path Forward

In March 2024, Oregon Governor Tina Kotek signed House Bill 4002, which effectively reversed key elements of Measure 110. The new law recriminalized public drug use, restored misdemeanor penalties for personal drug possession, and established deflection programs that route individuals toward treatment rather than incarceration when possible. The treatment funding mechanisms from Measure 110 were largely preserved.

The 2024 amendments reflected a bipartisan consensus that decriminalization without robust and rapid treatment access had not produced the intended results. The new framework attempts to combine accountability with treatment access, a hybrid approach that other states and cities are watching closely.

For individuals currently seeking treatment in Oregon, the policy shifts mean that the state's investment in treatment infrastructure remains intact even as the legal framework around drug possession has been tightened. The beds, clinics, peer support workers, and harm reduction services funded by Measure 110 continue to operate.

What Measure 110 Means for Treatment Seekers Today

The practical impact of Measure 110 and its subsequent amendments on someone seeking treatment in Oregon today is nuanced. The expanded treatment infrastructure, including more peer support, more outpatient slots, and more harm reduction services, is a direct and lasting benefit. Access to naloxone is more widespread, drug checking services can identify fentanyl contamination, and individuals can seek help without the same level of criminal justice fear that existed before 2021.

At the same time, the challenges that predated Measure 110 have not disappeared. Wait times for residential treatment remain significant, particularly for publicly funded programs. The workforce shortage in behavioral health continues to limit expansion. And for many individuals, the most effective treatment may involve leaving Oregon entirely for a residential program that provides geographic distance, specialized care, and a change of environment.

Trust SoCal has worked with numerous Oregon residents who decided that out-of-state treatment was the right choice for them. Our team helps with insurance verification, travel coordination, and aftercare planning that accounts for the return to Oregon communities. The policy environment in Oregon may shift, but the clinical principles of effective addiction treatment remain constant.

Evidence-Based Treatment Remains the Gold Standard

Policy debates about decriminalization, criminal penalties, and harm reduction are important, but they should not obscure a fundamental reality: evidence-based clinical treatment is the most effective intervention for substance use disorders. Medically supervised detoxification, behavioral therapies such as cognitive-behavioral therapy and motivational interviewing, medication-assisted treatment for opioid and alcohol use disorders, and sustained aftercare support have robust research backing spanning decades.

Whether an individual enters treatment voluntarily, through a deflection program, or through a court order, the clinical process is the same. Assessment, stabilization, therapeutic engagement, skills building, and transition planning form the core of effective treatment regardless of the policy context that brings someone through the door.