Portland’s lethal prescription

Julie McConnell marched toward the homeless man who’d set up camp behind her church. It wasn’t the first time she’d had to ask someone to leave. He didn’t notice her at first. He was busy pummeling a small punching bag he’d hung on the chain-link fence at the back of the church’s parking lot. He’d also attached a blue-and-green tent to the fence with zip ties.

The fence was supposed to provide a buffer between First Orthodox Presbyterian Church in Portland, Ore., and the drug camp that had cropped up on the street behind it during the pandemic. But it hadn’t provided much of a deterrent.

The man finally glanced up when Julie spoke. “I just want you to know, this is private property and you can’t attach things to the fence,” she told him. “It’s something you’re going to need to take down.” She doesn’t remember what he said in response, but she remembers his eyes. They were menacing.

Officer Donny Mathew of the Portland Police Bureau’s bike squad stands next to a man who appears to have passed out on a sidewalk. Beth Nakamura/The Oregonian via AP

IN 2020, Oregon voters made history by decriminalizing possession of hard drugs in small quantities. Measure 110, as it’s known, was sold to the public as a kinder, gentler way to help addicts. Instead, it wreaked havoc across many layers of society, particularly harming the people it was supposed to help. Less than four years into their experiment, the people of Oregon were fed up. Lawmakers rolled back drug decriminalization earlier this year, but the ideology behind it remains. So does the small army of government and nonprofit workers who spend millions every year to manage the fallout. If the financial incentives and the ideology don’t change, conditions in Portland aren’t likely to improve.

Some of Julie McConnell’s fellow church members kept their distance from the drug camp out of fear and avoided interacting with its ever-changing occupants. Not Julie.

“I don’t know why this is in my personality, but I tend to go toward the problem instead of pulling away from the problem,” she told me. She had asked other homeless people to remove things from the fence before and saw no reason to stop. Sometimes she cut the zip ties herself.

But the man she confronted that Sunday morning in the late summer of 2021 was different. His hostile stare stopped her in her tracks. Unlike other people in the camp who were usually under the influence of drugs, he seemed fully aware of his surroundings—and capable of anything. Julie slowly backed away and slipped into the church. After that, she never confronted anyone in the camp again. It was the first time she grasped how dangerous that could be.

The homeless camp in tents in downtown Portland. Patrick T. Fallon/AFP via Getty Images

OREGON HAS A LONG HISTORY of tolerating drug use. In 1973, it became the first state to decriminalize possession of small quantities of marijuana. In the decades that followed, Oregon systematically weakened ­penalties for drug possession. Measure 110 doubled down on that approach.

Today, people caught with hard drugs (including heroin, fentanyl, LSD, and methamphetamine) should receive a $100 citation—max. But they can even have that waived if they call a toll-free number for a health assessment that can connect them to treatment and other services. Over 95 percent of people ignore the citations altogether. It didn’t take the police long to figure out writing them was a waste of time. They mostly gave up, which meant addicts were free to use narcotics openly, and they do.

Timothy Desper works at the Portland Rescue Mission, a Christian nonprofit that helps people struggling with hunger, homelessness, and addiction. He says Portland’s attitude toward illicit drugs is part of a larger ethos he calls “radical autonomy”—the idea that a person should be allowed to define his or her own reality free from outside influences like the law, moral systems, or community standards. Radical autonomy, or “left libertarianism” in political science parlance, extends to areas like physician-assisted suicide (Oregon was the first state to legalize it), sexual identity (7.8 percent of residents identify as LGBTQ versus 5.5 percent nationally), and other radical chic. In 2020, for example, Portland was an epicenter of Defund the Police protests. While American cities saw marches and even riots that summer, Portland’s stretched into October.

In keeping with this bent toward sweeping self-determination, Measure 110 was supposed to give drug addicts the freedom to seek treatment on their own terms. It ignored established realities such as the value of legal intervention in setting addicts on the road to recovery. Maybe that's why Measure 110 didn’t bring freedom, but death and destruction instead.

Between 2020 and 2022, drug overdoses in Oregon more than doubled. That’s partly because it coincided with the widespread use of fentanyl, a synthetic opioid that is powerful, cheap, and exceptionally deadly. “Fentanyl is not mixed or measured at a rate that’s consistent,” Desper explains. “So you could have four pills in your hand and two of those pills would be very low doses of fentanyl.”

And the other two pills could kill you.

Desper works at the Portland Rescue Mission’s Burnside Shelter in the city’s Old Town, near the Willamette River. The shelter’s bright yellow door welcomes visitors 24 hours a day, 365 days a year. Inside, homeless people can obtain a variety of services, including meals, overnight shelter, and options for longer-term stays. The most-used service is also the most basic: public restrooms. But amid Portland’s radical autonomy, even something so simple becomes complicated.

Case in point: the special lighting system that tells staff and volunteers in the office when one of the restrooms is occupied. If a door stays locked longer than 10 minutes, its light starts blinking. That’s because the person inside may have overdosed on drugs. Staff and volunteers are trained to knock on the door twice to ask if the person is OK.

One morning Desper was working at his computer when a volunteer alerted him that she’d just knocked twice and gotten no response. Desper immediately got up and grabbed a white container of nasal spray: Narcan, or naloxone, a ­powerful medication that can reverse an opioid overdose.

At the restroom door, he knocked loudly and called out again. When he got no response, he opened the door with his key. A young man lay on the floor inside. Desper rolled him onto his back and called 911. He’d worked with Portland’s addicts long enough to recognize the signs of an overdose: labored breathing, pale or blue-tinged skin.

Skin can turn blue when a person isn't getting enough oxygen to their extremities. This man wasn’t turning blue yet. Desper didn't know if the man had dosed himself in the restroom or shortly prior to entering the building, but he did know the man had only been in the restroom 10 minutes. During an overdose, every minute counts.

Already on with the 911 operator, Desper sprayed the Narcan up the man’s nose and waited about two minutes. Desper and the operator were talking about CPR and a second Narcan dose when the man started to wake up. Desper helped him sit against the restroom wall.

“We brought you back,” he told him. “You were dying, and we brought you back.”

First responders arrived soon after, but the man refused further help. He simply got up and wandered away.

An overdose in the mission's restroom is rare. Still, Desper has personally administered Narcan 20 times. Working from the supply of at least eight doses the Burnside shelter keeps on hand at all times, his team sometimes goes through two or three a week. Most of the time, it's when a person comes into the shelter to alert the staff that someone on the street needs help. In two of those 20 cases, Desper arrived too late. In the other 18, those whose lives he saved refused further help. “That’s the biggest heartbreak for us,” Desper said.

Measure 110 allowed fentanyl addicts to use the drug with impunity. In Old Town Portland, it’s been common to see crumpled shards of the aluminum foil used for fentanyl consumption strewn on sidewalks. Oregon has recriminalized hard drugs, and its new laws go into effect Sept. 1. But residents still have to come to terms with the need for accountability and compassionate intervention, Desper said, both of which remain foreign concepts.

A security guard in downtown Portland performs CPR on a man who overdosed. (He regained consciousness soon after.) Erin Schaff/The New York Times/Redux

IN PORTLAND, spiraling death has become a fact of life. Between 2019 and 2022, homicides in the city nearly tripled. In 2021, the city broke its own record with 90 reported murders. Two of those occurred on Aug. 10, 2021, on the block behind First OPC, shortly after Julie McConnell’s confrontation with the homeless man. Two men were shot in a trailer, and four other people were wounded by gunfire during the same incident.

In 2022, Portland set another record with 101 reported murders. Among them: two more men shot to death behind Julie’s church, one in January and one in March. The Oregonian newspaper published a long story on the murders and dubbed the area around First OPC “Portland’s deadliest block.”

First OPC’s neighborhood has long been troubled. The church was founded in the 1940s to serve people relocating to Portland for the war effort. They met in a space that is now a pot shop before constructing their own building in the 1960s. Mark McConnell, Julie’s husband, thinks the neighborhood’s struggles are rooted in its proximity to a highway.

“Highways isolate one side of town from the other,” he said. “It’s always been a place where there were used car lots and strip clubs and seedy bars.” During the pandemic and after Measure 110, the problems coalesced to one block. Church members worry in particular about the motel that squats directly behind First OPC. They say it could be a hub for drug dealing and prostitution.

In 2022, with their city in the grip of “radical autonomy,” members of the church decided to practice a little self-determination of their own. They went door-to-door in the surrounding area to sound out people’s views and learned their neighbors, too, were fed up. Then church members and neighbors joined with police and government officials to clean up the problems.

Even though Portland police are severely understaffed, Mark McConnell said they were happy to find a neighborhood that supported them and quickly got to work.

“They set up rules for the street, like you can’t park after midnight. They started to put pressure on the people that were living in the camp, so it’s just not as comfortable,” he said. The police also removed, or “swept,” the drug camp several times. During such sweeps, occupants often wait nearby and return as soon as police leave. But with enough pressure over time, the street behind the church stayed free of tents.

The Portland Rescue Mission has also had to be creative and persistent. In 2019 it introduced a “community card” system. Each person who wants to enter the shelter must give a name and date of birth—neither have to be verified—and get their photo taken. They are issued a card with a barcode they must scan to enter the building. People often lose the cards, but the staff can quickly print replacements. Holding a community card means adhering to Portland Rescue Mission’s community standards.

These are very basic rules like no violence, no stealing, and no using drugs in the building. Anyone who violates the standards must have what Desper calls “a restorative conversation” with a staff member. The man who overdosed in the restroom had his card flagged. Desper says he hasn’t returned. “Prior to our community card system, you would see a police officer here at minimum once a week,” Desper said. “We’ve seen that plummet. We’ve seen acts of violence against other people or our staff go down 90 percent, just from the idea that when people come in here, they know that they’re known.”

The community cards represent both accountability and intervention, which are, of course, anathema to Portland’s belief in autonomy. Other nonprofits criticized the cards when the mission introduced them, Desper recalled. “People would say, ‘Well, what if someone says that they don’t want a card?’ And I’d say, ‘Well, unfortunately, that means that they can’t be a member of our community.’ And they said, ‘Well, that’s an inappropriate boundary to hold for someone experiencing houselessness.’”

Such groups say every person should be served without barriers. The reality, says Desper, is that every nonprofit in Portland has had to adjust its services in light of safety concerns. Daytime “safe spaces” have almost completely vanished. Instead, some homeless people are spending their days in libraries, which are not designed to serve that function. Yet, the community card system has allowed Portland Rescue Mission to continue to operate much as before.

Police tape surrounds a body on a street in town. Erin Schaff/The New York Times/Redux

BETWEEN 2015 AND 2023, homelessness in the Portland area more than tripled, from 1,887 to 6,297 individuals. The budget for addressing the problem has ballooned as well. Homelessness has become big business.

The Joint Office of Homeless Services (the body that oversees services to the homeless in Portland and Multnomah County) had just 21 full-time employees in 2019. Three years later, its staff had grown to 106. In 2023, the agency had an annual budget of over $250 million.

Some of that money goes to support the Clinton Triangle Temporary Alternative Shelter Site. Residents—who are called “guests”—stay in sleeping pods and have access to services. But the goal is to transition them into permanent housing.

In April, the week after Easter, I visited the site with staff from the Union Gospel Mission, a Christian nonprofit that helps the homeless and those struggling with addiction. Their job that day was to deliver lunch to the guests. We drove up in a big white van with the words “Search + Rescue” emblazoned on it in conspicuous red letters. Less noticeable was a small hole on the lower left side. The van caught a stray bullet while parked at the mission headquarters.

Clinton Triangle is surrounded by chain-link fences with privacy screens. Nathan Powell, a staff member at Union Gospel Mission, pulled up to the gate and waited. When it opened, Powell used a black bullhorn to announce that lunch had arrived. The guests lined up patiently as Union Gospel Mission staff handed out tubs containing warm pasta with beef and vegetables, water bottles, and a choice of chips. That week they also brought a special treat: small bags of Easter candy. To express their ­gratitude, the guests gave the Union Gospel Mission staff a thank-you card with purple butterflies that many of them had signed.

Clinton Triangle has 160 sleeping pods, 8-foot-by-8-foot white structures clustered in groups on gray pavement. Each features a single black-rimmed, tinted window and a prominent electrical cord extending out the back. Each pod can hold up to two people, but most contain just one. The pods have heating, air conditioning, and Wi-Fi. The residents share communal bathrooms, kitchen, and laundry facilities. A few wooden planters with green bushes make the atmosphere slightly less sterile, but Powell is not impressed. “It looks like a dystopian city,” he said.

Also dystopian is the price tag for a camp like this one. Each sleeping pod costs around $16,000. The ratio of guests to staff is 15:1, and Urban Alchemy—the nonprofit that staffs the camp for the city—spends about $5 million each year running it. Founded in 2018 in San Francisco, Urban Alchemy rapidly expanded operations into other cities like Portland. By January 2023 the nonprofit, which mostly employs former inmates, had 28 contracts totaling approximately $62 million.

Desper believes sleeping pod sites like Clinton Triangle have a place on “the spectrum” of addressing homelessness. But he points out that what he calls “congregate shelter,” such as bunks or mats in one space, can be built at much lower cost. And doing so could quickly get large numbers of people off the streets. He worries that it’s the ideology of autonomy that drives the focus on expensive individual sleeping pods.

Roxanne Simonson, 60, removes a long-sleeved shirt after being told by Rapid Response Bio-Clean that she has 72 hours to vacate her illegal campsite in Portland. Associated Press/Photo by Craig Mitchelldyer

THE SITUATION around First OPC has improved significantly since 2021, but problems remain. The church has lost members because people got fed up with the challenges of life in Portland and moved elsewhere. The drug camp is gone, but it’s been replaced by prostitution: dozens, Mark McConnell said, “out there on a sunny day.”

I saw one of them the day I visited the church. A rainy afternoon in April. A prostitute was standing opposite the church parking lot, wearing only a thin pink jacket, black underpants, and high heels despite the cold. As I watched, a black pickup truck pulled up next to her. She climbed in, and they drove off. Each week, church members and other Christians in the surrounding neighborhood get together to reach out to the prostitutes by giving them small care packages and offering to pray for them.

Mark hopes planned improvements to the highway will make the neighborhood less isolated and encourage an influx of new businesses. Julie is less optimistic. “There’s too much organized crime involved, and too much neglect by the city and county,” she said. She also fears the next expression of Portland’s radical autonomy will be legalizing prostitution.

A week after my visit to First OPC, someone dumped an old couch on the sidewalk near the church. Soon, a woman named Vicky, whom church members have encountered several times over the years, began sleeping on it. When Mark told Vicky he had asked the city to remove the couch, she screamed and cursed at him.

Mark feels compassion for people like Vicky. “Every single day is worse for them than any day you’ve ever had,” he said. “But that misery is compounded by the mindset of Portland’s leaders, who say, ‘We’re going to affirm you in your homelessness, we’re going to affirm you in your drug use, we’re going to affirm you in your sex work. We’re going to build up your sense of self-worth, so that you are empowered to make choices.’ That’s the idea they have, but it’s based on a false understanding of human nature. It doesn’t work like that.”