Do No Harm

E. Tammy Kim / The New Yorker

An ambitious law set forth a more humane way to address addiction. Then came the backlash.

In the early months of the pandemic, joggers on the Bear Creek Greenway, in southern Oregon, began to notice tents cropping up by the path. The Greenway, which connects towns and parks along a tributary of the Rogue River, was beloved for its wetlands and for stands of oaks that attracted migrating birds. Now, as jobs disappeared and services for the poor shut down, it was increasingly a last-ditch place to live. Tents accumulated in messy clusters, where people sometimes smoked fentanyl, and “the Greenway” became a byword for homelessness and drug use. On a popular local Facebook page, one typical comment read, “Though I feel sorry for some of the people in that situation, most of them are just pigs.” In Medford, the largest city along the trail, police demolished encampments and ticketed people for sleeping rough.

One September evening in Medford, a white cargo van belonging to a nonprofit called Stabbin Wagon parked near the Greenway, between an auto-repair shop and a Wendy’s. For unhoused people across Oregon, cargo vans have become a symbol of help. Some contain primary-care clinics and food pantries. Others, like Stabbin Wagon’s, distribute a more controversial kind of aid: safe supplies for drug users.

Stabbin Wagon’s director, Melissa Jones, pulsed with nervous energy, and wore flip-flops and a T-shirt that read “Nothing ends homelessness like housing.” With her was Samantha Strong, a young activist with a green buzz cut and piercings. The two women—Stabbin Wagon’s only employees—opened the van’s doors to reveal plastic bins and hanging compartments of inventory, neatly arranged and all free. There were boxes of naloxone, needles of various gauges, cookers, pipes, fentanyl test strips, soap, and hand sanitizer.

People arrived on foot, by bike, and by car. Jones and Strong greeted them fondly, mostly by name. A young woman with a distant expression brought her little dog; they’d been living on the Greenway for years. A middle-aged guy who looked dressed for a hike called out his desired items like a food order. Strong assured a skittish first-time visitor, “You don’t have to sign in. No, I don’t need to see your I.D.”

Harm reduction of this kind—providing drug users with supplies to prevent death and disease—has been practiced for decades. In this part of the country, though, it is newly prominent. In November, 2020, Oregon launched a historic experiment: the Drug Decriminalization and Addiction Treatment Initiative, known as Measure 110. Approved by fifty-eight per cent of voters, it made Oregon the first state to decriminalize possessing small amounts of illicit drugs. It also funnelled hundreds of millions of cannabis-tax dollars toward addiction treatment, housing, peer support, and harm reduction. A citizen panel that included people with “lived experience”—histories of substance use—would decide how the money was spent. Programs in Black, Native, and other “historically underserved” communities would be prioritized. The law’s overarching goal, according to Tera Hurst, the director of the Health Justice Recovery Alliance, was to force “a shift in attitude toward people who use drugs and how we treat them.”

Measure 110 was inspired by a sense of desperation: the drug war had failed, and policing wasn’t curing people. In 2020, Oregon had the second-highest rate of drug addiction in the country, yet it ranked nearly last in access to treatment. Fentanyl was flooding in and being used alongside methamphetamine—becoming so prevalent that people expressed nostalgia for black-tar heroin, which seemed “bougie” by contrast. From 2019 to 2020, opioid-overdose deaths in Oregon increased nearly seventy per cent, and they have continued to rise.

Stabbin Wagon formed a few months before Measure 110 was passed. At the time, Jones was raising a teen-age son, running a resale business, and volunteering with a mutual-aid effort that served free lunches in Medford’s Hawthorne Park. Many of the people she met there were using alcohol and drugs, and those who wanted to enter rehab faced long waits and bureaucratic hassles. Jones, who is in long-term recovery from alcohol use, reasoned that she could at least help them stay alive. “I dove into serious self-education about harm reduction,” she said. “The more I learned, I was, like, ‘Oh, my God, this is the opposite of what we’re taught in recovery.’ ” Rather than trying to force abstinence, harm reduction works to “meet people where they are.” Its proponents advocate a basic rule—never use alone—and provide access to safe supplies. With the growing popularity of highly potent opioids, harm reductionists have focussed on distributing naloxone, the “Lazarus drug,” to reverse overdoses.

The approach took off early in the AIDS crisis, when activists shared the disinfection slogan “bleach and teach” and risked jail time to hand out clean needles. A large body of evidence now supports the idea that it saves lives. Syringe programs halve the spread of H.I.V. and hepatitis C; naloxone, when distributed to users and their peers, can cut overdose deaths by more than forty per cent.

But practitioners in small towns and rural areas tend to keep their work quiet, to avoid being accused of enabling drug use. Jones decided to be loud about it. In Hawthorne Park, she went tent to tent with a blue Ikea bag laden with naloxone and syringes. That was how her organization got its name, she said: “They were, like, ‘Oh, it’s the stabbin’ wagon.’ I thought it was funny and cute.”

After Measure 110 passed, a friend suggested to Jones that it might fund an upstart organization like hers. She applied, and Stabbin Wagon was eventually granted nearly six hundred thousand dollars—enough to buy the cargo van and to fill it with supplies. “I thought, after I got the 110 money, it would solve all my problems,” she said. Instead, Stabbin Wagon became a local flash point in the statewide debate over Measure 110. People blamed the law for an uptick in public drug use. Billionaire donors helped launch a repeal effort. Southern Oregon First, a “patriot” media group known for supporting the Three Percenters militia, made Jones and Stabbin Wagon a frequent target, saying that their work “creates all these piles of needles in our parks” and “keeps people addicted.”

As the sun began to set over the Greenway, an orange Camaro with tinted windows drove up to where Jones and Strong were working and lingered awhile before zooming off. Strong guessed that it was one of the right-wing activists who’d been harassing them online. “I’m not scared of them,” she told me afterward. “Complaining about people using drugs or being homeless—they’re upset about stuff that’s happening anyway. It just wasn’t in their face.”

Portland—Oregon’s largest city, and one of its most liberal and diverse—voted overwhelmingly in favor of Measure 110, but in Medford the politics were more complicated. The city has about eighty-six thousand residents, most of them white; it is the seat of Jackson County, which is split politically, tilting Republican. During the national protests that followed the killing of George Floyd, hundreds of people wound through Medford, yelling, “Black lives matter.” Jones was among them, and said that white supremacists came out to heckle the protesters. The scene was even more fraught in Grants Pass, one county over, where armed counter-protesters assembled under a giant American flag.

People working in recovery were used to navigating these political divides. Everybody in Jackson County seemed to know someone who’d lost a job, a home, child custody, or a loved one to drugs. Sommer Wolcott, the executive director of OnTrack, a treatment-and-housing nonprofit in southern Oregon, told me, “We’re all in this work for a reason.” Wolcott is an equable type with cropped dark hair and a preference for business-casual attire, which in the Pacific Northwest qualifies as formal wear. After studying psychology in college, she managed a locked institution for minors, many of whom had endured traumatic childhoods with severely addicted parents. “I saw kids who didn’t have somebody who was safe,” Wolcott said. Later, she worked with adults, and realized that she was treating the people her young clients might have become.

Addiction is a disease with no single cure. Those seeking relief must navigate a twisty, spotty “continuum of care.” There’s detox and transitional housing; residential and outpatient rehabilitation; peer support, meetings, and sponsors; counselling of all kinds; and medications such as methadone and buprenorphine. To coördinate services, Measure 110 required grantees to form a behavioral-health resource network, or BHRN (pronounced “burn”), in each county.

In Jackson County, a consortium of seventeen providers, including the public-health department, requested funding, and Wolcott helped guide the application. In her view, the biggest gaps in the system were medical: detox and inpatient rehabilitation. Measure 110, however, prioritized services that Medicaid didn’t cover, such as harm reduction, housing, employment assistance, and peer support. As she worked on the application, she tuned in to meetings of the citizen panel that made funding decisions, the Oversight and Accountability Council. “The way they talked about treatment agencies was very disrespectful,” she said. “We know harm reduction’s effective, but it’s an effective part of the continuum. You need to have the whole thing.”

One former member of the O.A.C. described traditional treatment providers to me as “shame-based”; a current member said that inpatient treatment “has very shaky outcome metrics.” Still, a great deal of money went to detox facilities and to groups that provide inpatient treatment. Wolcott’s consortium was granted nearly seventeen million dollars. But the Oregon Health Authority announced that the county BHRN would have to accommodate another member: Stabbin Wagon. Reactions ranged from annoyance to disbelief. Even some harm reductionists told me that Jones was giving the approach a bad name. Her voice-mail greeting started with a sweetly intoned “Hey, fuckers.” On TikTok, she posted videos that trolled conservatives. One showed Stabbin Wagon giving out naloxone at a drag show, set to a techno track with the lyric “The drugs are working.”

Jones had her own feelings about joining the BHRN. The local providers were run by professionals who collaborated with city hall and used terms like “pathways to desirable solutions.” Jones dismissed them as the “nonprofit industrial complex” and questioned their methods, including mandatory urine tests, which she considered inaccurate and degrading. “Twelve-step, abstinence-based programs didn’t work for me,” she said. “I didn’t find stability that way or healthiness and happiness.”

As a matter of style, Stabbin Wagon seemed more of a piece with Portland, New York, San Francisco, or Vancouver, where harm reduction is embedded in public policy. Last summer, I visited Vancouver, whose Downtown Eastside neighborhood is both a model of harm reduction and a public bogeyman. At the office of the Vancouver Area Network of Drug Users, I met with an Indigenous harm-reduction leader and watched people inject opioids under the supervision of a peer. Since 2016, British Columbia’s Ministry of Health has permitted safe-consumption sites, funded alerts for dangerous batches of street drugs, and empowered doctors to prescribe pharmaceutical-grade fentanyl and meth. This has not put an end to overdoses—2023 was particularly deadly—but it has likely saved lives. On a Sunday evening, I followed a team of firefighters as they responded to opioid-related calls, hauling oxygen tanks up the stairs of dim S.R.O.s. A few times, they prepared to administer naloxone, but found that a friend of the person overdosing had already done it.

Vancouver’s program was backed by extensive research, but it was too radical for just about anywhere in the U.S. “I do not believe the state of Oregon is ready for safe-consumption centers,” Floyd Prozanski, a state senator who represents Eugene, told me. In Jackson County, many politicians and traditional providers feared that Stabbin Wagon was a forerunner of such methods. They were willing to tolerate harm reduction—the county itself operated a limited syringe exchange—but only to a point. Before Stabbin Wagon came along, a supporter of the group told me, “people were apologizing for having to do harm reduction—they were maintaining the status quo.”

Outside Stabbin Wagon’s van near the Greenway, a lanky woman in jean shorts pulled Jones aside. In a whisper, she explained that the Medford police had come to her tent and taken her belongings. She’d lost prescription medication, among other things. “I’m so sorry,” Jones said. “The police used to send notice of sweeps, but now they’re immediate.” She told the woman that she’d look into locating her stuff.

In the spring of 2021, Medford passed a strict anti-camping ordinance, meant to remove homeless people from view. Officers started giving people seventy-two hours’ notice to evacuate, under threat of arrest. The city’s shelters were full, though, and Jones was furious. During a city-council discussion about the homeless, she said, “None of you give a shit,” before her microphone was muted. The police soon mounted a sweep of a large tent community on the Greenway, and in the coming months hundreds more people were forced out. With tents forbidden, some resorted to sleeping in the open, and on one frigid morning that December a young man named Manuel Barboza-Valerio was found dead, apparently of hypothermia. “We’re responsible for this,” a city-council member said afterward. “Manny’s death is on us.” Still, the sweeps continued.

Jones is a self-described police abolitionist, who argues that law enforcement should be barred from responding to substance use. Her view is informed by the recent history of police in southern Oregon. A decade ago, the former sheriff of Josephine County was reportedly involved with the Oath Keepers and local militias. In 2019, Medford police and the Jackson County Sheriff’s Office were accused of mistreating a paraplegic man during his arrest: county-jail employees had stripped and slapped him. (Lawsuits stemming from the incident are pending; neither Medford nor Jackson County would comment.)

At events, Stabbin Wagon hands out stickers reading “ACAB” (“All cops are bastards”); online, it shares footage of police using backhoes to clear homeless people’s belongings. Other videos have shown outreach workers from fellow BHRN providers, which has stoked resentment. “A lot of people don’t know these organizations work with the police,” Strong explained. “When we post about that, people can be, like, ‘O.K., now I can make a decision about whether to access their services.’ ”

Strong told me that Jones’s assertiveness had attracted both allies and enemies: “While it’s a blessing for people who are, like, ‘Fuck the cops,’ it also isolates you.” In Medford, law enforcement is tightly linked to city hall. The mayor is a former police chief, and one of the council members is a corrections officer. Local officials rely heavily on Rogue Retreat, a charity that receives public funds to run an indoor shelter, a sanctioned tent site, and a tract of tiny houses—some of the only facilities for homeless people in the area. When Jones heard allegations that the director, a pastor, advocated for gay conversion therapy, she joined an effort to expose him, and he was subsequently fired. (He denies pushing the therapy.) Then, last August, Stabbin Wagon hosted an “H.I.V. testing party” and the police came looking for one of the participants, who they said was a teen-age runaway. Jones and Strong yelled in protest, and were arrested for harassment and interfering with an officer. (Strong later resigned from Stabbin Wagon, in part because of that experience; Strong and Jones have ongoing criminal cases.)

While Stabbin Wagon and its allies praised Measure 110 for limiting the role of law enforcement in fighting addiction, the Medford police felt unfairly constrained. At headquarters, I met Richard Josephson, an officer of twenty-three years, who wore jeans and a short-sleeved shirt that revealed a mosaic of tattoos. From his desk, he reviewed surveillance video of a footbridge downtown, which appeared to show a man selling drugs and others taking them. “Users don’t care anymore,” he said. “I’ll drive a police car up to them, and they don’t even care.” Josephson took a personal interest in drug enforcement and treatment. “I grew up in a drug house,” he said. “My mom still uses meth. I thought we were camping one summer, but we were just homeless.”

In September, 2019, the police department established a Livability Team to patrol downtown and the Greenway, addressing “concerns such as homelessness and chronic nuisance houses.” Josephson, who helps lead the team, told me he liked that it had “this whole social-services side.” Officers sometimes patrol the parks along with outreach workers, who hand out phone numbers for treatment centers and emergency shelters. But police also arrest unhoused people for trespassing and evict them from tents.

What they don’t do much is apprehend people for drugs. Measure 110 forbade police to arrest someone for carrying small amounts of fentanyl, meth, or crack, or for consuming those drugs in public. Instead, they were supposed to issue a ticket that requires the person to either pay a hundred-dollar fine or call a statewide hotline to discuss treatment options.

In the three years before Measure 110 took effect, the Medford police made more than forty-seven hundred arrests on drug charges. In a similar period afterward, they issued approximately fifteen hundred citations for minor possession and made some two thousand arrests for higher-level possession and dealing. The lower total was caused partly by less intensive policing during the pandemic and partly by a lack of interest in ticketing drug users. “There’s no consequences to the hundred-dollar ticket,” Josephson complained. “They can’t pay the fine. What’s the point?”

One goal of decriminalization was to replace police with peer-support workers. Wolcott considered this misguided and naïve. Drug users need “external motivators” in order to change their lives, she said. Josephson, too, argued that people who might have detoxed in jail and opted for treatment were instead languishing on the streets. At a taco truck downtown, he pointed out a woman he’d arrested on possession charges who was now clean and working for a charity.

There are certainly many Oregonians who attribute their recovery to the criminal-justice system. In Grants Pass, I visited tent encampments with a peer-outreach worker who had been arrested multiple times during her addiction; a decal on her car read “#drugcourtssavelives.” But just as many people told me that their drug use got worse in jail. “I was incarcerated because of my substance use,” Brendon Kinzel, who until recently worked at Medford’s Family Nurturing Center, said. “Jail didn’t change me.” The county jail, in any case, was overcrowded, and there was a statewide shortage of public defenders.

A criminal record entails its own obstacles to recovery: debt, stigma, exclusion from work and housing. In Portland, I visited the Miracles Club, a nonprofit that primarily serves African Americans. It was hosting a clinic on an Oregon law that allows certain convictions to be expunged. At one table, a lawyer named Emilie Junge sat with a client, helping him fill out paperwork. “I deal with people every day who have long criminal records, and they want to talk about their drug arrests—they’re clearly traumatized,” Junge told me. “If Measure 110 has done anything, it’s to stop that.”

To mark International Overdose Awareness Day, late last summer, a resource fair and vigil was held in Hawthorne Park. Amid a ring of informational tables was a homespun memorial: a bulletin board marked “We Remember,” covered with handwritten notes. A video of dead family members played on a loop. The host of the event was Max’s Mission, a nonprofit run by Julia Pinsky, a former publicist. A decade ago, Pinsky’s son Max started taking oxycodone after a car accident. Less than two years later, he died of a heroin overdose.

On an elevated stage, Pinsky’s husband and daughter demonstrated how to administer naloxone: spray into nose, breathe into mouth, wait. Many people gave testimonies of mourning and recovery. “I lived on the Greenway for three years,” a woman named Crystal said. “Fentanyl is a pandemic.” An employee talked about naloxone kits funded by Measure 110, which Max’s Mission had used to reverse more than a thousand overdoses. Yet when Pinsky’s husband told the crowd to call local legislators to support the law, only a few people clapped.

Many Oregonians saw Measure 110 as responsible for an increase in public disorder, drug use, and overdose deaths—which leaped from seven hundred and thirty-seven in 2021 to nine hundred and fifty-five in 2022. In fact, a recent study by N.Y.U. found “no evidence of an association” between decriminalization and fatal-overdose rates in Oregon and Washington. The drugs in circulation were unusually lethal—and given that being arrested can actually increase the risk of overdose, the authors wrote, Measure 110 might help to alleviate the problem. But if users couldn’t be picked up off the street, their activities became far more visible. “People’s patience is wearing thin,” Haven Wheelock, who manages the harm-reduction program at Outside In, in Portland, said. “I don’t want to downplay the moral injury of seeing such poverty and despair.”

In Medford, complaints about drug use overlapped with complaints about homelessness. “I don’t feel safe walking around at night—and I’m from Baltimore,” Alyssa Bartholomew, a public defender, told me. “Hawthorne Park used to be my kids’ playground. Now there are needles and people who are homeless.” During the spring and summer, residents asked officials at town halls how they planned to handle people “who don’t want help” and called for more aggressive prosecution of “homeless who vandalize and destroy property.” Eventually, the city council passed a resolution condemning Measure 110. Harm reduction, it said, had done “nothing to help individuals overcome their addictions,” and had caused drug paraphernalia to proliferate in public places.

The backlash reflected broader anxieties about Measure 110. In many places, the law had funded fledgling groups and encouraged existing providers to do work that they’d never done before; about half the grantees were either brand new or very small. To incumbents, this looked like folly. Andy Mendenhall, a physician and the head of Central City Concern, a large nonprofit in Portland, criticized the rollout of the law for “prioritizing the voices of individuals who did not have operational experience.”

In Medford, it didn’t help that the Oregon Health Authority awarded Stabbin Wagon $1.5 million, on top of the Measure 110 money, to build a peer-respite center—a facility that offers people in acute mental distress a quiet place to sleep, bathe, eat, and talk to someone understanding. When O.H.A. announced the grant, last year, other nonprofits expressed dismay. According to e-mails published by Sam Becker, an independent reporter, Medford’s city manager wrote to a lobbyist, “All of the legitimate non-profits in our area are outraged that [Jones] is getting any funding.”

Lori Paris, the director of a large treatment agency called Addictions Recovery Center, told the Medford police chief, “Everyone is in shock over this.” She accused Stabbin Wagon of planning to “create a safe injection site” at the respite center. (Jones denied this.) The police chief asked what he could do to stop Stabbin Wagon from getting funded, and Paris gave him contacts at O.H.A.

Wolcott seemed almost pleased by the controversy. When the deputy police chief asked if she had heard about the grant, she responded, “Yep, O.H.A. did get an earful.” She implied that news of the respite center would embarrass O.H.A. for funding a group that was out of its depth. “This could blow up into an interesting media sh*t show,” she wrote. “If anything, giving her 1.5 million might help blow things up faster.”

Throughout 2022 and 2023, there seemed to be a new op-ed or county resolution each week calling for Measure 110 to be repealed. “Did Measure 110 take away ‘rock bottom’? Oregon cops seem to think so,” KGW News proclaimed. It did not escape notice that almost no one used the hotline number that police were supposed to give drug users. In its first fifteen months, there were only a hundred and nineteen callers, at a cost that worked out to more than seven thousand dollars per conversation. A report by Oregon’s secretary of state dryly noted, “It is unclear if the M110-specific hotline provides the best value.”

Legislators came under pressure to either reform the law or dismantle it. A group bankrolled by Phil Knight, the Nike co-founder, and by Tim Boyle, the C.E.O. of Columbia Sportswear, filed paperwork to gather signatures for a partial repeal. Max Williams, a former Republican legislator and corrections official who helps lead the effort, told me, “I don’t think it should ever be the policy of a state to accept that people have a legitimate choice to use lethal drugs.” In Portland, he said, “we’ve got an exodus of capital, a cratering out of the central city.” Last June, the state recriminalized minor possession of fentanyl. Governor Tina Kotek, who had remained largely silent on Measure 110, recommended recriminalizing most drug possession and public use.

In December, a legislative committee on addiction and community safety held a hearing at the state capitol. Measure 110 was not intended to be the sole topic, but people were stirred up, and the hearing drew a crowd. Had everyone who signed up been allowed to speak, the session would have stretched into the night; as it was, it lasted four hours.

The critics of Measure 110 were polite but sharp-tongued. The mayor of Tigard, a Portland suburb, said that drug users had been locking themselves in public bathrooms and overdosing, which required the city to break open doors and then pay for costly repairs. Business groups said that people who were homeless, addicted, and mentally ill were ruining commerce. A woman named Juanita Swartwood complained about an irresistible flood of street drugs in her community. (Though the connection to Measure 110 was murky, Swartwood was one of the petitioners behind the repeal effort, and the committee gave her extra time to speak.) In the most affecting moment of her testimony, she held up a photo of her granddaughter Emily, a young woman with long blond hair. Measure 110, she said, had stopped the police from intervening when Emily was caught with drugs. It had taken months to persuade her to get counselling.

Supporters of the measure were clearly on the defensive. Julia Pinsky, of Max’s Mission, drove in from Medford and explained that her son had overdosed after an “entanglement with law enforcement” prevented him from getting help. “Going back to punishing people for their addiction will cost lives, not save them,” she said. Larry Turner, a founder of Fresh Out, a nonprofit that aids Black people with criminal records, said that the funding had helped increase his organization’s capacity sixfold. He pleaded for patience: the war on drugs had been given fifty years. “It took us time to get here, it’s going to take us time to get out,” he said.

In fact, timing was one of the crucial problems with Measure 110. Decriminalization had gone into effect as soon as the law was enacted, in February, 2021—but, amid the pandemic, most of the grants weren’t rolled out until late in 2022. There were long waiting lists for detox, inpatient rehabilitation, and transitional housing, which could take years to address. Harm reduction and peer outreach, on the other hand, were easy to ramp up quickly. What most Oregonians thus saw of Measure 110 were naloxone kits and syringes and volunteers handing out sandwiches in parks—which they linked, in their minds, to tent encampments and the acrid smell of fentanyl smoke.

The expansion of traditional services was harder to perceive. In the first year of funding, according to O.H.A., county BHRNs reported more than a hundred and fifty thousand interactions with people seeking treatment for substance use, and another hundred and fifty thousand with those accessing harm reduction. Billie Cartwright, a physician assistant with BestCare in the ski town of Bend, told me that she had voted against Measure 110 but now saw positive effects. “One of the things we changed is, anyone who walks in the door, we’ll see that day,” she said. A peer-support worker in her office had recently picked up a client from jail and brought him straight in for treatment.

Southeast of Portland, I visited a new men’s home, on a tree-lined residential block, not far from a nature trail. Gabriel, one of the first residents, was a twentysomething sheet-metal worker recovering from a fentanyl relapse. Before he got a spot in the house, he said, “I was living in downtown Portland, in not a great place. I was seeing people using. I saw an overdose, a shooting. Two people died in my building during a three-month period. Here, I’m away from all that chaos.”

In Jackson County, Stabbin Wagon was serving about a hundred and twenty people a month, with help from two new peer-support workers. O.H.A. agreed to extend Jones’s funding, and finalized the contract for the respite center. Max’s Mission expanded its naloxone distribution and dispensed aid in rural areas. The H.I.V. Alliance treated people for hepatitis C, provided addiction telemedicine, and covered rent payments to prevent evictions.

OnTrack spent its grant money on a row of bungalow-style apartments for pregnant women waiting to get into treatment, an emergency-lodging complex for single adults, and Spanish-speaking staff. “It’s been a steep learning curve, because people are in such difficult circumstances—coming off the street, actively using, and trying to get a treatment bed,” Wolcott said. Before Measure 110, the agency had served around three thousand clients a year, and that number had not budged, as people waited months for residential treatment. “What is increasing is low-barrier housing, the accessibility of outpatient, and the amount of support services,” Wolcott said. “But it’s not nearly as neat and tidy to report on.”

The money distributed through Measure 110 was both a lot and not very much. A single round of residential addiction treatment runs to tens of thousands of dollars. A small sober-living house can cost hundreds of thousands to get up to code. Even setting aside Measure 110, Oregon is poised to spend some $1.5 billion on behavioral-health care between 2021 and 2025.

As Kate Lieber, the majority leader in the Oregon Senate and a former prosecutor, told me, Measure 110 was designed to be “like water, to fill the gaps around what Medicaid doesn’t cover.” But decriminalization turned out to be more unsettling than many imagined, and fentanyl continued to blast through the state. Still, as more services came online, I noticed calls for repeal being blunted by calls for reform; people wanted to restore aspects of the old enforcement model while keeping the focus on treatment. In Oregon and around the U.S., there was a grim sense that our systems were insufficient to cope with the threat of fentanyl. New York City opened two safe-consumption sites, and Vermont is considering a bill to decriminalize possession. Illinois eliminated cash bail and limited pretrial detention for people charged with low-level crimes. Seattle, though, went the other way: drug possession, which had been effectively decriminalized, was reclassified as a gross misdemeanor. Vancouver is also seeing a backlash.

In Medford, I visited Recovery Café, which offers support groups, counselling, and hot meals in an industrial-chic dining hall. At a chow line, volunteers served roast chicken with corn and potatoes. Some sixty attendees sat at tables, and a host with the vibe of a youth pastor invited them to share their accomplishments. People announced the number of days they had been sober, and thanked their higher power. Some spoke of new jobs, or of resuming contact with kids lost to child welfare.

Across the room, I noticed a tall, bearded guy who’d been at the vigil in Hawthorne Park. He introduced himself as Rocky, a roofer from the area. He had just finished an inpatient program at OnTrack, and was living in transitional housing with a few other men. His wife, Kerissa, with whom he’d long used fentanyl and meth, was also in treatment. In the worst of their addiction, they’d squatted in an abandoned house and signed over custody of two young sons. Rocky’s parents died while he was in prison for drug trafficking. “That was a wakeup call,” he said.

Many of their friends had died from overdoses; others had been revived with naloxone, which Rocky once used on Kerissa. This was their eighth collective attempt to get sober. When I caught up with them in mid-December, he told me that they’d found a new place to rent and were “working through stepwork with our sponsors.” They saw a doctor affiliated with OnTrack for injections of buprenorphine, which helped them stay off opioids. Rocky had a job with a distributor of roofing materials. Kerissa was preparing for an interview at a sporting-goods store, and hoped that her criminal record wouldn’t get in the way.

Recovery Café emphasizes the end goal of abstinence, and the staff I interviewed didn’t have much to say about harm reduction. When I went, every visitor was required to have been free of all drugs and alcohol for at least twenty-four hours. But Recovery Café got funding from Measure 110, as did the other providers that helped Rocky and Kerissa. Recovery was messy, and the couple had needed different things at different times: medication to reverse an overdose, support from peers, a rehab center, a place to live and a way to pay for it. “You need to give these addicts a way to get clean, to get housing. You need stability,” Rocky said. “We’re in survival mode.”