Disclose Measure 110 conflict of interest

An open letter to the Journal of the American Medical Association

Kirsten Bibbins-Domingo, PhD, MD, MAS

Editor in Chief

JAMA and JAMA Network

330 N Wabash Ave.

Chicago, IL 60611

Dear Dr. Bibbins-Domingo:

I am writing regarding JAMA Psychiatry’s failure to disclose material potential conflicts of interest of co-author Haven Wheelock bearing upon the article “One-Year Association of Drug Possession Law Change With Fatal Drug Overdose in Oregon and Washington,” published September 27, 2023 (the “Article” - link to full article here; link to JAMA article abstract here).

The Article is a key part of a roiling policy debate in Oregon about the future of Ballot Measure 110, which decriminalized possession of user amounts of hard drugs in the state. Unfortunately, because the Article fails to disclose the significant conflicts of interest of Ms. Wheelock as required by JAMA’s conflict of interest disclosure rules, it is misleading to the public, medical professionals and destructive of trust in JAMA and medical research literature more generally.

In October, I published an article describing, for the first time, Ms. Wheelock’s conflicts of interest. JAMA staff did not respond to a request for comment for that article. Last month, I alerted JAMA’s editorial staff to Ms. Wheelock’s conflicts of interest and suggested JAMA amend the Article’s conflict of interest statement accordingly. An attorney for JAMA informed me the JAMA believes its disclosure that Ms. Wheelock works for Portland, Oregon-based nonprofit corporation Outside In is sufficient.

It is insufficient. I write you to ask that you cause JAMA to amend and expand the conflict of interest statement accompanying the Article to better inform the public and conform with JAMA’s stated conflict of interest disclosure policies.

Oregon voters approved Measure 110 in November 2020. The new law went into effect in February 2021. The law authorized by Measure 110 consists of two primary elements: (1) decriminalizing possession of small amounts of hard drugs including methamphetamine, cocaine and heroin; and (2) redirecting approximately $300 million in state marijuana tax revenue to increasing addiction treatment services.

Prior to and following the enactment of Measure 110, overdose deaths in Oregon increased dramatically, as observed in the Article. Many Oregonians assert that Measure 110’s decriminalization component contributes to increasing overdose deaths, and its treatment spending is ineffective at preventing them. Oregon’s increasing overdose fatality rate has helped fuel an effort to convince the legislature to repeal or significantly reform Measure 110’s decriminalization component.

The Article’s primary finding is that decriminalization of hard drugs in Oregon has not had a statistically significant effect on the state’s overdose fatality rate. Predictably, given the intense debate about Mesure 110’s future, the Article has garnered a lot of attention in Oregon and national media, including:

Oregon Public Broadcasting: “Study says drug decriminalization in Oregon did not cause more overdose deaths”

KOIN TV Portland: “Oregon, Washington drug laws not associated with fatal overdose rate: Study”

Time: “Decriminalizing drug possession doesn’t lead to more fatal overdoses”

No less than the Oregon Health Authority, the state agency implementing Measure 110, highlighted the Article in an October 13 post on the social media network X.

The Article is very much in the bloodstream of Oregon’s political and policy debate, which in turn is the epicenter of global drug policy conversation. This fact further demonstrates the necessity of disclosing all potential conflicts of interest of the Article’s authors.

Haven Wheelock was a chief petitioner for Ballot Measure 110

Ms. Wheelock was one of three chief petitioners for Ballot Measure 110. According to the Oregon Secretary of State, a chief petitioner for a citizen ballot measure prepares, organizes, signs and files with the state the paperwork necessary to begin the process of collecting the signatures necessary to get a measure on the ballot. A chief petitioner acknowledges liability for any violation of election laws or rules committed by paid petition circulators.

Ms. Wheelock was one of only three Oregonians legally responsible for getting Measure 110 on the November 2020 ballot. Once the measure was on the ballot, Ms. Wheelock continued her ardent support for it, appearing in a pro-Measure 110 campaign video.

Ms. Wheelock and her fellow Measure 110 partisans succeeded in convincing a substantial majority of Oregonians to vote for it in November 2020. The passage and eventual enactment of the measure unleashed a torrent of state spending targeted at addiction treatment, including to Ms. Wheelock’s employer.

Haven Wheelock’s employer has received $2.1 million in Measure 110 funding

To spend the $300 million authorized by Measure 110, the Oregon Health Authority solicited grant applications from nonprofits working in the addiction space. One such grant applicant was Portland-based Outside In, Outside In’s website says the organization uses “cutting edge and sometimes controversial wraparound services” to support “youth experiencing homelessness and other marginalized people.”

Ms. Wheelock’s LinkedIn page says she has been employed as Outside In’s Injection Drug Use Health Service Program Coordinator since 2006.

The Oregon Health Authority’s Measure 110 dashboard shows that Outside In has received $2.1 million in grants funded by Measure 110’s reallocation of marijuana taxes to addiction treatment. The grant issued to Outside In included funding for harm reduction services, which are often targeted at intravenous drug users, including those availing themselves of Ms. Wheelock’s program.

Measure 110, if left in its current form, promises to deliver additional grants of the type received by Outside In. As an established grant recipient, Outside In, and Ms. Wheelock’s program there, would likely be well-positioned to receive additional funds.

JAMA’s failure to disclose Ms. Wheelock’s conflicts of interest violate JAMA’s conflict disclosure policies and could mislead the public

The Article identifies Ms. Wheelock as an employee of Outside In. It does not disclose her role as chief petitioner or advocate for Measure 110. It does not disclose Outside In’s receipt of $2.1 million in Measure 110 funding. The vast majority of readers of the Article, excepting only those very familiar with Measure 110, those with the interest and ability to research Ms. Wheelock’s personal and financial interest in the measure or those who read my October 5 article about her conflicts, have therefore been oblivious to the potential conflicts of interest of one of the Article’s co-authors.

The disclosure only of the identity of Ms. Wheelock’s employer falls short of the standards JAMA sets for its authors and its published studies. JAMA requires authors to disclose to it government grants received by the author’s organization and related to the subject matter of the study. In a 2018 editorial co-authored by then-JAMA editor in chief Howard C. Bauchner, MD, explains that JAMA insists upon complete disclosure by authors in order to allow readers to draw their own judgment about whether the conflict is relevant:

[B]ecause a potential [conflict of interest] can depend on individual perceptions and beliefs about what may represent a conflict or pose a bias, the approach at JAMA and the JAMA Network journals is to encourage authors to provide complete and broad disclosure, thereby allowing readers to be aware of authors’ potential COIs and enabling readers to decide whether a COI disclosure is important in their interpretation of the article.

As you are aware, JAMA is a member of the International Committee of Medical Journal Editors (“ICMJE”), which consists of a handful of the world’s prestigious medical journals. ICMJE recommends its member journals publish all relevant activities and relationships of study authors in order to allow readers to judge the full merits of the study:

[R]eaders must be able to make their own judgments regarding whether an author's relationships and activities are pertinent to a paper's content. These judgments require transparent disclosures. An author's complete disclosure demonstrates a commitment to transparency and helps to maintain trust in the scientific process.

When you assumed your current position as Editor in Chief of JAMA last year, you wrote:

The true power of a scientific journal stems not from its scores on the proliferating comparative metrics, but rather from the trust that it engenders. Clinicians trust that they are gaining important knowledge, vetted by the review process, and as transparently free from bias and conflict of interest as possible. Authors and scientists trust that their work will be impartially reviewed, ideally improved, and promptly and widely disseminated. The public trusts that they are reading vital content and understanding the implications of new discoveries. Even when there is disagreement and controversy, all trust that the discourse is rooted in science, and that views will be aired fairly and openly.

JAMA’s failure to disclose Ms. Wheelock’s financial and non-financial potential conflicts of interest regarding Measure 110 fall far short of the standard you, JAMA and ICMJE have set. The Article is central to a policy debate in Oregon and beyond. Transparency is both crucial and, for now, lacking.

I urge you to correct the Article to include an adequate disclosure of Haven Wheelock’s potential conflicts of interest, and to take such other editorial action with regard to the Article as you see fit to ensure transparency and foster public trust in science, aired fairly and openly.

Best regards,

Jeff Eager

Bend, Oregon