With legal leniency, Oregon's liberal stronghold tries to chart a path out of the fentanyl crisis. Can the city find a balance between care and enforcement?
A man waiting at a bus stop on West Burnside Street looks dead: he's stretched out on the sidewalk with his eyes rolled back. Fortunately, he overdosed on a weekday just five blocks from downtown Portland, Oregon, near a fire station where a rapid response team is on duty and their call comes in minutes later.
Paramedic Justin de Jesus, with a coolness and experience that allows him to perform such procedures many times, injects the man in the shoulder with a shot of naloxone, a drug that can reverse the effects of fentanyl, a powerful synthetic opioid that has become a major factor in the overdose epidemic in the United States. His partner puts on an oxygen mask, and gradually the man's breathing is restored. After a quick knuckle rub on his chest, he comes back to life.
However, facing death is not his wake-up call.
A man waiting at a bus stop on West Burnside Street looks dead: he's stretched out on the sidewalk with his eyes rolled back. Fortunately, he overdosed on a weekday just five blocks from downtown Portland, Oregon, near a fire station where a rapid response team is on duty and their call comes in minutes later.
Paramedic Justin de Jesus, with a coolness and experience that allows him to perform such procedures many times, injects the man in the shoulder with a shot of naloxone, a drug that can reverse the effects of fentanyl, a powerful synthetic opioid that has become a major factor in the overdose epidemic in the United States. His partner puts on an oxygen mask, and gradually the man's breathing is restored. After a quick knuckle rub on his chest, he comes back to life.
However, facing death is not his wake-up call.
If someone takes too much and has to be resuscitated, Justin de Jesus explains, «They tend to look for that dealer because, in their words, ‘it's good stuff’. They'll do a little less so it doesn't die. But because there's no standardization, you can get a fentanyl pill that has nothing in it, or 10,000 times the usual therapeutic dose — and then the person just drops dead».
Drug overdoses killed about 87,000 Americans in the 12 months ending September 2024 — more than the Vietnam, Afghanistan and Iraq wars combined. Despite a significant drop in the number of deaths from a peak of nearly 114,000 a year earlier, Oregon and other states in the West remain at the center of a decade-long fentanyl crisis.
The social and economic impact is particularly pronounced in Portland, a progressive city of more than 600,000 that was recently one of the most attractive places to live in the U.S., despite a steady rise in homelessness and drug addiction.
In late 2020, Oregon voters overwhelmingly voted to pass the most liberal drug law in the nation. The law decriminalized possession of small amounts of hard drugs such as fentanyl and methamphetamine. Instead of incarceration under Measure 110, the focus was on expanding drug treatment programs with hundreds of millions of dollars in cannabis tax revenue and savings from reduced arrests and incarceration. Funding also went to harm reduction services: naloxone distribution, needle exchanges, test kits, all to make drug use «safer».
The aspiration was to emulate countries that put health care above punishment: Portugal, France — where a subtle, help-oriented approach has reduced overdoses and drug use in public places. In some ways, the city resembled the «Hamsterdam» of the TV series «The Wire»: drug zones where police officers allow drug dealers to operate if they don't conflict over territory and limit sales to a few blocks so treatment services can focus on helping.
But the worst of the time had not yet passed. Months after decriminalization, Mexican drug cartels stepped up the supply of fentanyl across the border and along the Interstate 5 corridor, leading to its massive distribution on city streets. Prices dropped to less than a dollar a pill. Amid COVID-19 pandemic despair and social tensions, protests following the killing of George Floyd escalated into months of downtown clashes and violence. Police, deterred from responding, made Portland a magnet for addicts looking for cheap and free use. «It was the perfect storm» — says Rick Graves of Fire and Rescue Services, The city went from a vibrant center to a tourist area for drug users.
Fentanyl is a painkiller 50 times stronger than heroin. Two milligrams (about five to seven grams of table salt) is considered a lethal dose, and its black market counterparts are thousands of times stronger. Dealers mix fentanyl with other drugs to maximize profits. Its effects are compounded by additives such as xylazine («trank»), an animal tranquilizer that, when injected, can cause tissue rot and amputation.
Many addicts in Oregon use fentanyl along with methamphetamine, which causes psychosis, greatly increasing the risk of overdose and complicating their treatment.
In January 2024, Governor Tina Kotek declared a 90-day state of emergency to combat the fentanyl crisis in Portland. Shortly thereafter, state legislators voted to repeal Measure 110, ending a nearly four-year experiment with decriminalization. At the same time, the district attorney for Multnomah County, where the city is located, was suspended after an internal vote — a sign that the community is demanding more accountability.
Now anyone caught with illegal drugs without a valid warrant can choose to go to jail for possession or get treatment in the community. While the drug laws are back on the books, their form has become more stringent, with an emphasis on the «tough love» characteristic of the liberal part of town.
I visited Portland twice last year to get a sense of how the city is experiencing change. In an environment that values empathy and rigor, can support and control be combined? When does non-intervention and harm reduction turn into support? And what is more effective with a dangerous drug like fentanyl: compulsory treatment or voluntary help-seeking? The city's decisions on this issue could be a model for other major American cities struggling with drug abuse, homelessness and public safety.
In the wind outside the old Greyhound bus station in Chinatown, homeless addicts gather near a white van offering free coffee. The Oregon Mental Health and Addiction Organization, supported by Measure 110, hires former addicts who use their experiences to help their peers. They help them get to resource centers where they can shower, do laundry and eat for free. If necessary, they assess mental health and match them with treatment or housing.
Bruce Ferguson, 35, is ready to undergo detox, and Mejia greets him with a smile and a handshake. Ferguson, a strong skater with red hair and a sincere look, says he started with Adderall and weed to deal with anxiety but fell into bad company. After dental surgery, he got a prescription for Percocet, which turned into heroin. Eventually fentanyl came along.
Ferguson dreams of being a decent man, regaining his family's trust, and becoming a proud son. But his habit of stealing to provide addiction brings shame and fear of possible arrest or death. «If I don't get my act together, I'll lose everything forever».
When Mejia and Ferguson arrange a meeting, his ex-girlfriend shows up. She has recently fallen ill and looks worse for wear. He admits that he introduced her to fentanyl, a fact that haunts him. After the meeting, he tells Mejia that her presence «adds a little fuel to the fire».
A few hours later, Ferguson shows up at the resource center — showering, getting a haircut, gathering supplies for inpatient treatment at Recovery Works Northwest, which is funded by Measure 110. He's nervous but determined — he wants to get sober and rebuild his relationship with his father, a schoolteacher who lives in Italy. He knows the hardest part is feeling normal again.
When it is time to depart, Ferguson informs Mechia that he has a few more errands to run and that he will return in the afternoon. However, he never returns.
Mejia is unfazed. Having been through detox 15 times, he knows better than most that the road to recovery is rarely a straight line.
After so many relapses, he believes that being in supportive housing with outpatient treatment finally helped him move from «public danger» status to an asset. The people around him were willing to help when he was ready for it, and they will continue to support him.
People without a permanent home who are addicted to drugs like Ferguson are 51 times more likely to die of an overdose, according to the Multnomah County Health Department. In 2023, the deadliest year in the region's history, at least 456 of the roughly 7,000 homeless people in Portland died on the streets.
Despite more than $1.7 billion in investment since 2015, homelessness in the area continues to grow faster than authorities have had time to provide housing. Prolonged underbuilding has led to a severe shortage of affordable housing, causing rents and real estate prices to rise while making street drug use more attractive to some addicts.
To combat this shortage and attract more people to safe homes, Multnomah County is opening temporary housing developments with low barriers to entry.
In Portland's Clinton Triangle neighborhood is a fenced-in «village» that occupies the space between the railroad tracks and includes 140 residential bays and 20 tent platforms that are free of charge. It's part of a network of about 750 such bays throughout the city. No one is turned away because of substance abuse; the facility is primarily staffed by people in rehab, and mental health counselors help connect residents with needed substance abuse treatment if they seek it.
I meet 39-year-old Sean Smiden, locked in one of the small houses, sweating profusely after detoxing.
Despite the fact that there are many active fentanyl smokers on the premises, Smiden, a self-proclaimed «nomad» from Alaska, is grateful to have a place to call his own. After four sleepless nights, his withdrawal is subsiding a bit, and he's looking for work as a dishwasher. If he can stay sober, he wants to get certified as a computer programmer and secure more stable housing. «I'm going through it right now» — he says, «and it's okay because I feel alive. Suffering or not, that feeling makes me feel alive».
In downtown Portland, the expansion of low-barrier affordable housing, treatment centers and harm reduction services is facing resistance from local businesses that invested in the area during times of economic prosperity. More than 2,600 businesses have already closed, affected by the pandemic and street riots caused by homelessness and crime. Unemployment in the city's office buildings has reached 30 percent, the highest among major metropolitan areas, and job losses are the highest in the country.
San Francisco and Seattle are experiencing similar declines, raising fears of a «cycle of urban blight»: declining employment and real estate values are reducing the tax base that funds police, first responders, and other critical services, only exacerbating the problem.