This month, a brief, ambitious and many would say calamitous experiment came to an end: Oregon rolled back Measure 110, its policy decriminalizing the possession of small amounts of illicit drugs. Rather than handing out small fines with a nudge toward treatment, the police are once again giving misdemeanors to people who are found with opioids or meth.

What can we learn from this first-of-its-kind experiment in the U.S.? Many would argue that it showed us what not to do. But an honest assessment of what happened in Oregon paints a more complex picture.

Let’s start with what almost everyone agrees on. Decriminalization didn’t turn things around in Oregon. The state walked into the policy change, approved by voters in late 2020 and enacted in mid-2021, with one of the highest rates of addiction in the country. It also had one of the worst track records for access to treatment. And while funding was earmarked for mental health and substance use services under Measure 110, training a workforce and building an efficient infrastructure takes time. Four years later and the state still does not have nearly enough clinics or workers to support its goals.

As one drug policy expert told me, without near-perfect execution, the experiment seemed destined to fail. And a failure is what many would call it. Homelessness, crime and addiction all rose, straining public spaces. Social services, including treatment services and housing support, didn’t ramp up fast enough.

And there was a sharp rise in drug overdose deaths. Fatal overdoses were up by 50% in 2021 compared with the prior year, then continued to rise another 30% in 2022 and another 45% in 2023, based on provisional data from Oregon Health Authority.

The core premise of Measure 110 was that “a health-based approach to addiction and overdose is more effective, humane, and cost-effective than criminal punishments.” That decriminalization not only failed to spare lives, but seemed to cost many more of them, was considered the most damning evidence of its folly.

Those bleak numbers are indisputable. But decriminalization wasn’t the only big change in the state in 2020. A recent paper in JAMA Open Network points to a different culprit behind that surge in deaths: Fentanyl. The potent opioid permeated the drug supply in Oregon at the exact moment that the guardrails were lifted on possession.

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The insidious impact of fentanyl on a community is by now well-known. As the drug spread from the East Coast to the Southeast and Midwest until finally reaching the West Coast, it left a terrifying body count in its wake. Since 2021, more than 100,000 people in the U.S. have died from overdoses each year.

Researchers wanted to winnow out how much of the rising death toll in Oregon could be attributed to the policy change and how much was due to the arrival of fentanyl. The results of their analysis, which compared Oregon with states that lacked decriminalization, stunned even the study authors, says Brandon del Pozo, an assistant professor at Brown University, who led the work. The rise in deaths was entirely due to fentanyl. All of it.

“The buried lead of that paper is that drug reformers make plans and fentanyl laughs,” said del Pozo. “Oregon’s overdose increase was tragically and boringly typical.”

In other words, the main lesson of Oregon’s experiment isn’t that a public health approach to drug use can’t work. It’s that fentanyl makes everything about addressing substance use harder and more complicated. Even if the state’s decriminalization experiment had been run under the best of circumstances with the perfect set of supports (it was not), sparing lives would have been a challenge with fentanyl showing up at the same time.

That should serve as a reminder for others analyzing other drug reform efforts, del Pozo says. Researchers have to model for the impact of fentanyl in order to capture the true effectiveness of harm-reduction efforts like overdose-reversing naloxone or safe syringe sites.

It’s likely that the fallout from Oregon’s measure has chilled acceptance of any effort that seeks to reduce addiction by shifting the emphasis from punishment to public health.

That’s a shame. Oregon got a lot wrong, and Measure 110 shouldn’t be seen as the ultimate word on decriminalization. And the U.S. desperately needs to try new things to address addiction. Early data from the Centers for Disease Control and Prevention suggest that overdose deaths recently began to decline for the first time since 2018 — a shift that public health experts are still trying to understand, but could be due in part to better access to the opioid reversal drug naloxone.

That’s welcome news, but still somewhere in the realm of 100,000 people will die this year from a fentanyl overdose. We have such a long way to go to get things right.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

 

What would you do?

There is no other question that Israel’s government has posed to the world more often since Hamas invaded Israel on Oct. 7 and Hezbollah attacked Israel on Oct. 8.

What would your country do if terrorists crossed your western border and killed, maimed, kidnapped or sexually abused hundreds of Israelis they encountered and the next day their Hezbollah allies sent rockets over your northern border, driving away thousands of civilians — all cheered on by Iran?

What would you do?

It is a powerful and relevant question and one that Israel’s critics often dodge.

But they aren’t the only ones dodging it.

It was a trap. Netanyahu fell for it

This Israeli government, led by Benjamin Netanyahu, wants you and me and every Israeli and all of Israel’s friends — and even enemies — to believe that there was always only one right answer to that question: Invade the Gaza Strip, hunt down every Hamas leader and fighter, kill every last one and not be deterred by the civilian casualties, then pummel Hezbollah in Lebanon — and do both without spending time planning an exit strategy for either.

I’ve argued from Day 1 that it was a trap, a trap I’m sorry to say the Biden administration was not firm enough in stopping Israel from falling into and not firm enough in insisting on a better road, a road not taken.

This is no time to be pulling punches. The Jewish state of Israel is in grave, grave danger today. And the danger comes from both Iran and the current Israeli ruling coalition.

You see, I have never had any illusions about the macro reasons this war happened. It is the unfolding of an Iranian grand strategy to slowly destroy the Jewish state, weaken America’s Arab allies and undermine U.S. influence in the region — while deterring Israel from ever attacking Iran’s nuclear facilities — by using Iranian proxies to bleed Israel to death. That is the macro story.

Ring of fire

The immediate trigger and goal of the war was a Hamas-Iranian interest to scuttle the Biden team’s diplomatic initiative to forge Israel, the Palestinian Authority and Saudi Arabia into a ring of peace.

The Iranian-Hamas counterstrategy was to ignite a ring of fire around Israel, using Hamas, Hezbollah, the Houthis, pro-Iranian Shiite militias in Iraq and West Bank militants armed by Iran with weapons smuggled through Jordan. The Iranian strategy is exquisite from Tehran’s point of view: Destroy Israel by sacrificing as many Palestinians and Lebanese as necessary but never risk a single Iranian life. The Iranians are ready to die to the last Lebanese, the last Palestinian, the last Syrian and the last Yemeni to eliminate Israel (and distract the world from the Iranian regime’s abuses of its own people and imperialist control over Lebanon, Yemen, Iraq and Syria).

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The problem for Israelis and the Jewish people is that while the Netanyahu government was right in its diagnosis that this was a war of annihilation, it refused to conduct it in the only way that could hope to bring success — because that strategy ran counter to the political interests of the prime minister and the messianic ideological interests of his coalition.

Israel faces an existential threat from the outside, and its prime minister and his allies have been prioritizing their own political and ideological interests ahead of that. They have even lately resurrected their judicial coup attempt to crush the Israeli Supreme Court — in the middle of a war of national survival while hostages rot in Gaza. It is one of the most shameful episodes in Jewish history, and shame on the AIPAC pro-Israel lobby in Washington for not speaking out against it.

Israel needed four things

To counter this Iranian threat network, Israel needed four things: a lot of time, because this ring of fire could not be extinguished overnight; a lot of resources, particularly from the United States and other Western allies; a lot of Arab and European allies, because Israel cannot fight a war of attrition alone; and, perhaps most crucial of all, a lot of legitimacy.

President Joe Biden and his team offered Israel a road map for that counterstrategy but, sadly, they just never had the steel to impose it on Netanyahu with a combination of leverage, diplomacy and ultimatums. Such a road map would have involved persuading America’s Arab allies to fundamentally reform the Palestinian Authority in the West Bank with new, credible leadership and then getting Israel to agree to open negotiations with that Palestinian Authority leadership on a long-term pathway to a two-state solution.

That would have done the following: 1) Opened the way to isolating and pressuring Hamas to agree to a cease-fire in which Israel gets out of Gaza in return for all the hostages — ending the war there and eliminating Hezbollah’s excuse for attacking Israel from the north. 2) Opened the way for Saudi Arabia to normalize relations with Israel — a devastating blow to Hamas and Iran. 3) Opened the way for the United Arab Emirates to partner with a reformed Palestinian Authority to put troops on the ground in Gaza and do the thing Hamas would hate most — replace it as the governing authority there, backed by hundreds of millions of dollars for rebuilding Gaza, which would probably make it the most popular Palestinian force in Gaza overnight.

Up to now, though, Netanyahu has turned Biden down (while openly playing footsie with Donald Trump) because the prime minister would have had to break with the right-wing crazies who brought him to power and form a different governing coalition with more moderate parties. Netanyahu has prioritized his personal political security over Israel’s national security. And for months, he’s been spinning the world and his own people to disguise it.

Bibi, you don’t have a clean story

Netanyahu thought he could just tell the world that Israel was defending the frontier of freedom against Hamas, Hezbollah, the Houthis and Iran and everyone would fall in line behind Israel. What would you do? But the only place in the world that that gets you a standing ovation is in the U.S. Congress.

The rest of the world, particularly the moderate Arab states and the Europeans, told Netanyahu: Bibi, you don’t have a clean story. You cannot tell the world you are defending the frontier of freedom against Hamas and Hezbollah while expanding — increasingly violently — Israel’s settler occupation over Palestinians in the West Bank. You don’t have a clean story.

So the Israeli prime minister opted instead for the Netanyahu doctrine: Fight alone on three fronts — Gaza, Lebanon and the West Bank — with no plan for the morning after anywhere. In doing so, he rejected the Biden strategy: Embed Israel in a U.S.-Israeli-moderate-Arab coalition that would isolate Iran and its proxies, provide some hope that maybe one day we’d see two states for two indigenous peoples between the Jordan River and the Mediterranean and make clear to the world that the source of trouble in the region is not the Party of God in Israel but the Parties of God in Lebanon, Yemen and Iran.

Over and over and over

Netanyahu’s strategy is a disaster. As a veteran U.S. military commander who has observed close up Israel’s war strategy in Gaza told me privately, anyone with two eyes in his head knows that the only way to way to defeat Hamas is a strategy of “clear, hold and build”: Destroy the enemy, hold the territory and then build an alternative local, legitimate Palestinian governing authority. Israel’s strategy in Gaza, he said, has been: “Clear, leave, come back, clear again the same place, leave again, come back and clear again.”

It is a textbook example of how to transform Hamas, he added, “from a quasi-military to a classic insurgency.” Did you read the lead article on Haaretz online the day of the remarkable Israeli pager attack on Hezbollah? If you did, you’d have found four young Israeli soldiers killed that day battling Hamas in Gaza staring back at you — almost a year after the war there started. Almost daily now you also read of large numbers of Palestinian civilians killed in an Israeli operation against a few Hamas fighters living among them. Meanwhile, no one is governing Gaza.

Yes, yes, I know the criticism: You are delusional. What Israeli or Palestinian leader would come together on such a plan? Well, two friends of mine have done just that: former Israeli prime minister Ehud Olmert and former Palestinian Authority foreign minister Nasser al-Qudwa. Biden should invite them both to the Oval Office as soon as possible to embrace their plan for a two-state solution, which is totally in line with U.S. interests.

‘Israel is in terrible danger’

I repeat: Israel is in terrible danger. It is fighting the most just war in its history — responding to the brutal, unprovoked murder and abduction of women and children and grandparents by Hamas — and yet today Israel is more of a pariah state than ever.

Why? Because when you fight a war like this with no political horizon for this long — one that denies any possibility for more-moderate Palestinians to govern Gaza — the Israeli military operation there just starts to look like endless killing for killing’s sake. That is just what Hamas, Hezbollah and Iran want.

There was always a road not taken. Do I know for sure it would work? Of course not. The only thing I know for sure is that the road that Netanyahu has Israel locked on now is a road to ruin, encircled by a ring of fire. Stay that course, and Israel’s most talented people will start to leave, and the Israel you knew will be gone forever.

Thomas Friedman writes for the New York Times.

The Twins’ playoff chances are on life support and attempts to resuscitate them were unsuccessful on Thursday.

To realistically keep their playoff chances alive this week, the Twins were going to need to sweep the Miami Marlins, the National League’s worst team — or at least win two out of three — and get some outside help, as well.

They got no outside help — the Tigers and Royals, whom they are chasing in the wild card race, both completed sweeps — and though they did battle back twice late in Thursday’s game, they ended up falling 8-6 to the Marlins in a 13-inning crushing defeat, missing chances all night to grab a win.

Otto Lopez’s double off Scott Blewett put Miami up for good and Griffin Conine then added a two-run single off Justin Topa, helping the Marlins (59-100) pull away after a dramatic few innings before that in which the Twins could not capitalize on their many chances.

“It sucks,” catcher Ryan Jeffers said. “We had every opportunity put in front of us to win that baseball game. Our season is on the line and we weren’t able to execute to get that run across. It’s a really, really shitty feeling.”

The Twins (82-77) finished the day 2 for 19 with runners in scoring position, leaving 15 runners on base, many in the later innings of the contest as their bullpen did what it could to keep them alive on the other side.

“To have that many baserunners, we  did something right, but clearly there’s something missing when we get guys on base,” manager Rocco Baldelli said. “We’re really struggling. … We had baserunners galore. They were everywhere, all night. But to win, you have to bring them in.”

In the ninth, the Twins stranded Byron Buxton, whose speed after an 11-pitch at-bat, helped place him on second with just one out. An inning later, the teams traded sacrifice flies, scoring their automatic runners. The Twins could have had more, but center fielder Derek Hill made a great falling catch on the warning track to prevent Willi Castro’s sacrifice fly from becoming a game-winning hit.

“He made the catch and it was like, ‘What else do we need to do?’” Buxton said. “That kind of was a sucker punch because we thought we had it.”

Neither team scored in the 11th with the Marlins using a five-man infield to cut down a Twins runner trying to score at home. In the next inning, Jeffers, who made a critical error in the fifth inning missing a catch at the plate and allowing a runner to score, bunted into a double play with Carlos Santana getting caught off second, helping squash the Twins’ opportunity to walk it off.

“Personally I feel like I let a lot of guys down,” Jeffers said. “Personally just didn’t do what I needed to do to help the team win a baseball game.”

The chaotic late innings were set up by an eighth-inning rally that kept the Twins alive, started by Royce Lewis, who drew a one-out walk. Santana followed, just missing a two-run, game-tying home run, instead settling for a long single off the limestone overhang in right field.

Rookie Brooks Lee then came through with the biggest of his career, hitting a double off the wall in right field to bring them both home and tie up the game.

But though the Twins forced their way back into Thursday night’s game, overcoming a four-run deficit, they never could get themselves a lead, with the offense that has led to this dramatic slide out of the playoff picture unable to convert.

So, the Twins will enter the final weekend of the season with a chance at postseason play — albeit a tiny, highly unlikely one.

Both the Tigers and Royals have a magic number of one, meaning the Twins would need to win out and have one of those two teams lose their remaining three games.

The Twins will host the playoff-bound Baltimore Orioles, the Tigers get the historically-bad White Sox and the Royals will play the Braves, who themselves are fighting for a playoff spot.

Minnesota, which trails both teams by three games with three games to go, holds the tiebreaker over both so, which is why it has yet to be mathematically eliminated.

“It’s one of those that hurts,” Buxton said. “We know what’s at stake and we’ve got to keep pushing.”

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