A chill blows in from Oregon

The ideas and innovators shaping health care
Apr 01, 2024 View in browser
 
Future Pulse

By Carmen Paun, Daniel Payne and Erin Schumaker

AROUND THE NATION

Portland Police officer Eli Arnold talks about the progress made against drug dealers during a patrol on a bicycle following the decriminalisation of all drugs in downtown Portland, Oregon on January 25, 2024. When police officer Eli Arnold stops a homeless man smoking methamphetamine on the street in Portland, he simply writes him a ticket with a $100 fine. Since hard drugs were decriminalised in Oregon three years ago, there   are no arrests, just the fine and a card with a telephone number where the user can get help. "Give them the ticket number and they'll just ask you if you want treatment," he tells the man. There's no wrong answer to this question, he says. "Just call the number, the ticket goes away." In February 2021, possession and use of all drugs -- including cocaine, heroin, ecstasy and fentanyl -- was decriminalised in the western state. Sale and production remains punishable. (Photo by Patrick T. Fallon / AFP) (Photo by PATRICK T. FALLON/AFP via Getty Images)

Oregon rethinking its approach to drug policy could put similar moves in other states on ice. | AFP via Getty Images

An impending decision in Oregon to recriminalize drug possession three years after it stopped being a crime in the state is expected to have a chilling effect on similar efforts in other parts of the country to treat addiction as a disease and not a crime, Carmen reports.

If “people feel like public order and public safety are deteriorating around them, you will lose the citizenry and you will lose the politicians,” said Brandon Del Pozo, an adjunct professor teaching international drug policy at Georgetown University.

“Nationwide now, decriminalization is going to be off the table for a while,” he said.

What happened: Riding a wave of racial reckoning sparked by the death of George Floyd at the hands of a police officer, Oregon voters decided in November 2020 to decriminalize possession of small quantities of hard drugs for personal use.

Black Americans have historically been disproportionately arrested for drug-related offenses. To stop such arrests, Oregon elected to treat addiction as a public health problem instead of a problem for the police to fix.

At first glance, that change now looks spectacularly bad.

Drug overdose deaths spiked almost 50 percent, from 1,171 in 2021, when possession of drugs for personal use was decriminalized, to 1,683 in October 2023, according to the latest data available from the Centers for Disease Control and Prevention. Opioids, particularly fentanyl, caused most of the deaths, according to the Oregon Health Authority.

Public drug use in Portland — Oregon’s largest city — grew rampant, leading state and local leaders to declare a 90-day fentanyl emergency in January.

But decriminalization advocates said the ballot measure is unfairly blamed for rising drug use and homelessness. The spike in overdose deaths and public drug use were, in their view, caused by an unaffordable housing market exacerbated by the pandemic and the arrival of illicit fentanyl on the West Coast in 2020, years after it had hit other parts of the country.

Decriminalization also came at a time when the state ranked the lowest in the nation for its capacity to provide addiction treatment. And new funding for more treatment services didn’t roll out until some 18 months after decriminalization.

Last month, Oregon lawmakers voted to make drug possession a crime again, with users facing up to six months in jail if they don’t take one of the several ramps provided in the new measure to seek treatment.

“We knew we had to intervene in public drug use. And we needed to make sure that it wasn’t just easy to be a drug addict on the streets of Portland,” said Kate Lieber, a Democrat who’s the majority leader in the Oregon State Senate.

What’s next: Democratic Gov. Tina Kotek is expected to sign the bill in the coming days.

 

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WELCOME TO FUTURE PULSE

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Washington, D.C. | Danielle Barrow

This is where we explore the ideas and innovators shaping health care.

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Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com or Erin Schumaker at eschumaker@politico.com.

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EXAM ROOM

BERLIN, GERMANY - SEPTEMBER 05:  A doctor speaks with a patient about her high blood pressure, or hypertension, on September 5, 2012 in Berlin, Germany. Doctors in the country are demanding higher payments from health insurance companies (Krankenkassen). Over 20 doctors' associations are expected to hold a vote this week over possible strikes and temporary closings of their practices if assurances that a   requested additional annual increase of 3.5 billion euros (4,390,475,550 USD) in payments are not provided. The Kassenaerztlichen Bundesvereinigung (KBV), the National Association of Statutory Health Insurance Physicians, unexpectedly broke off talks with the health insurance companies on Monday.  (Photo by Adam Berry/Getty Images)

Doctors' use of AI is begging the question: how much do patients need to know about systems being used in their care? | Getty Images

Patients don’t need to fully understand the AI that doctors use for their care, most oncologists said in a survey about their prospective use of the technology published in JAMA Network Open.

The findings, drawn from more than 200 oncologists nationwide responding to the survey, offer a possible answer to the question of how much patients should know about the technology used for their care.

Most of the specialists said they themselves should be able to understand and explain the AI systems. But few said patients needed the same understanding of the tool.

That opens new questions about how much patients need to understand who or what creates their care plan — especially when a significant number of clinicians say a patient should decide how to proceed when their doctor and an AI system disagree on their diagnosis or treatment.

Even so: Patients should generally know that the tech is being used in their care, most of the doctors said.

But even that standard had caveats: 81 percent said patients should have to consent to AI use in their treatment. Fewer doctors — 56 percent — believed patients should have to consent to the use of AI in their diagnosis.

What’s next: The researchers suggest these findings highlight the need for further research on AI’s real-world use in clinical settings.

 

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CONNECTING THE DOTS

Sen. Chris Murphy looks on during a press conference at the U.S. Capitol.

Sen. Chris Murphy wants to use public policy to make you happier. | Francis Chung/POLITICO

Loneliness isn't Sen. Chris Murphy's only offbeat political platform. The Connecticut Democrat makes the case that politicians should also get in on the happiness business.

“I know that doesn’t sound right because your happiness comes from your personal decisions, the priorities that guide your day,” Murphy said during a speech on the Senate floor last month. “Our government isn’t in the business of delivering the last mile of happiness, but we absolutely are in the business of delivering the first mile of happiness,” he added.

By the numbers: Murphy pointed to the World Happiness Report, compiled yearly by the United Nations, Gallup and others. In the 2024 report, the United States lost its spot among the top 20 happiest nations, largely due to unhappiness among people younger than 30.

Older Americans fared better, with the U.S. ranking 10th for people 60 and older. By contrast, under-30s ranked 62nd among the 143.

The first mile: Murphy is convinced that regulating social media for kids would be a step in the right direction.

He put forth a bipartisan bill last year with Sens. Brian Schatz (D-Hawaii), Tom Cotton (R-Ark.), and Katie Britt (R-Ala.) that would require social media users to verify their age and get parental consent if they’re under 18. Meanwhile, states are taking matters into their own hands with bills that would require social media companies to create child-safe versions of their sites, Ruth reports.

But Murphy stopped short of endorsing a measure passed by the House last month that would force TikTok's Chinese owner to sell the app or contend with a TikTok ban in U.S. app stores. The Senate hasn’t yet taken up the bill.

"I would rather broadly regulate social media and have that apply to everything from TikTok to Instagram and Facebook," Murphy explained during a recent Semafor-Gallup event.

"The one option that is unacceptable is to do nothing."

 

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