Mar 12, 2024 - Health

Blue states usher in tougher drug and mental health policies amid backlash

Illustration of a giant pencil drawing a line in front of a lone woman looking down at the line.

Illustration: Aïda Amer/Axios

Some of America's bluest cities and states are abandoning progressive approaches to drug use and homelessness, instead embracing harder-line measures amid political backlash.

Why it matters: The worsening drug overdose, mental health and housing crises that are often intertwined and increasingly spill into U.S. streets are fueling the shift away from more compassionate approaches.

Driving the news: Oregon is backing away from its controversial experiment with decriminalizing drug use, while San Francisco voters last week approved a ballot measure requiring drug screening for people receiving public benefits suspected of illicit drug use.

  • Oregon's about-face was made official late last week when Gov. Tina Kotek announced she will sign a bill that partially reverses voter-approved Measure 110, which just over three years ago decriminalized possession of small amounts of illicit drugs.
  • In California, the outcome of a ballot measure that would overhaul the state's approach to mental health and homelessness — which some advocates warn could force more people into involuntary treatment — remains too close to call.

The big picture: Public debate about behavioral health treatment, whether for drug addiction or severe mental health conditions, can pit supporters of individual liberties against those more in favor of compelled treatment and more stringent legal penalties.

  • The intent of the new Oregon measure is "to balance treatment for individuals struggling with addiction and accountability," Kotek said in a statement.

Between the lines: Although drug addiction experts generally agree about the importance of harm reduction over punitive measures, some advocates say especially lax policies have come at the expense of the general public — and the ensuing backlash will ultimately hurt drug users.

  • "We've had kind of a libertarian movement, the past two or three years," said Keith Humphreys, a psychiatry professor at Stanford. "I think there's been a return to realizing that neighborhoods matter and people who don't use drugs matter, and it's not unreasonable for people to want to walk down the street safely."
  • That doesn't mean every tougher new policy is "sensible," and he said San Francisco's drug-testing measure in particular is "a bad idea."

Drug addiction, severe mental health conditions and homelessness are three distinct issues that can have a lot of overlap, and they each raise complicated questions about law enforcement and the role of government.

  • When those crises intersect, it can have an escalating impact on politics.
  • With the surge in meth, for instance, "there are a lot of externalities that people care about, like violence," Humphreys said.
  • "People are going to feel different about someone who is homeless, lives in the park and sleeps 18 hours a day, versus someone who lives in the park and is running around screaming, shouting, breaking things, threatening people."
  • At the same time, "if meth and fentanyl didn't exist, homelessness would be a less brutal experience," he added.

The other side: Some advocates worry the recent reversals will make accessing treatment even more difficult.

  • "Oregonians were given a false promise that [the new measure] would use the threat of jail as a way to get people into treatment, but in reality, people will be cycled through the criminal legal system with no meaningful connection to treatment," the Drug Policy Alliance said in a statement.

The California ballot measure, which as of now is leading by a razor-thin margin, was championed by Gov. Gavin Newsom but opposed by groups who say it would enable forced treatment and strip funding from other crucial mental health programs.

  • That includes the ACLU's Northern California branch, which called the measure "a zero-sum initiative that pits California's housing and voluntary community-based mental health needs against one another while taking us back to a dark era of forced treatment and institutionalization."

The bottom line: Progressive opposition to what could could be a legacy-defining effort for one of the country's most prominent Democrats is illustrative of how deeply behavioral health issues have begun to divide the party and its traditional allies.

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