Few obtain treatment in first year of Oregon drug-decriminalization grants

More than 16,000 Oregonians accessed services through the new grant program set up under Oregon’s landmark drug-decriminalization law in its first year, but less than 1% of those helped with Measure 110 dollars were reported to have entered treatment, new state data shows.

Most of those who accessed the grant-funded services last year, nearly 60%, engaged with harm reduction programs such as syringe exchanges and naloxone distribution.

When voters passed Measure 110 in November 2020, they not only decriminalized low-level possession of most illicit drugs such as cocaine, methamphetamine and heroin, they also diverted hundreds of millions in marijuana tax dollars to drug treatment and recovery services. Since the Drug Addiction Treatment and Recovery Act went into effect in February 2021, the money has been distributed through grants, the majority of which the state-appointed Measure 110 Oversight and Accountability Council awards to providers.

A man, 23, sits on the sidewalk in downtown Portland, preparing what he says is heroin, June 25, 2021. Measure 110, a drug treatment and recovery act, aims to connect drug users to treatment and recovery services, including housing assistance instead of serving time in jail for possessing small amounts of drugs.

Kristyna Wentz-Graff / OPB

This week, the council is evaluating 281 applications for the next round of funding, about $270 million to be distributed in the spring.

While the newly released data has limitations, it gives an idea of how the program’s initial round of grants — for $31.4 million in all — is being spent.

What it shows is that while Measure 110 was pitched to voters as a way to expand access to addiction treatment and recovery, the early spending has only led to about 136 people entering treatment — and that’s out of hundreds of thousands in Oregon who need but are not receiving treatment for substance use.

Tera Hurst, executive director of the Health Justice Recovery Alliance, said Measure 110 was intended to expand the entire continuum of recovery and harm reduction services to support people in a “longer-term pathway” to recovery.

“I think that the money is going exactly where it needs to be going,” said Hurst, whose organization is focused solely on the implementation of Measure 110. She said harm reduction is the foundation of community support systems for people with substance use disorder, “because you can’t help anybody if they’re dead.

“So from our perspective, 60% of the people accessing harm reduction services means that we have more people alive today because of these funds, and because of the services that we’re invested in,” Hurst said.

Measure’s strategies went beyond treatment

The campaign for Measure 110, and the text of the measure itself, stressed increasing access to drug and alcohol treatment repeatedly. The first page of the measure opens with: “Whereas, Oregonians need adequate access to drug addiction treatment. Oregon ranks nearly last out of the 50 states in access to treatment, and the waiting lists to get treatment are too long. … Drug treatment and recovery ought to be available to any Oregon resident who requests it.”

The same page ends with: “The People of Oregon, therefore, propose this Drug Addiction Treatment and Recovery Act of 2020 to expand access to drug treatment and recovery services and pay for it with marijuana tax revenue.”

But the text of the voter-approved statute included a lot more than just treatment funding. The grants set up by the measure are also used to fund peer support and recovery services, housing for people with substance use disorder, harm reduction and incentives to expand the behavioral health workforce.

Asked about the early results, Oregon Health Authority spokesperson Aria Seligmann wrote in an email, “Measure 110 was created to facilitate pathways to recovery and to help empower and support people experiencing substance use concerns in making the choices that are right for their lives. Treatment may be one step on a path to wellness but is by far not the only one.”

The Oversight and Accountability Council set up to award the grants is a diverse group, composed of people representing behavioral health providers, tribal communities, culturally specific service providers, as well as people in recovery from substance use disorder. Seligmann also said the goal of the council is to meet people where they are at.

“That first step builds trust and can lead to people engaging with other supports and services,” she said. “Formal treatment is not a goal for many people using substances, at least not initially.”

Measure ‘was never designed to promote access to treatment’

Mike Marshall, co-founder and director of Oregon Recovers, said Measure 110 “was never designed to promote access to treatment.” His organization advocates for increasing access to treatment and recovery services across the state. It opposed Measure 110, arguing that the measure was misleading among other issues.

He said because the state pays for treatment as part of a Medicaid match, it can’t use marijuana tax dollars to fund treatment because the federal government still considers marijuana illegal.

“They wanted to create decriminalization, and they recognized that they couldn’t win decriminalization without linking it to increased services,” he said of New York-based Drug Policy Alliance, which largely funded the Measure 110 campaign. Marshall said Oregon Recovers pushed them to stop leading voters to believe the measure would fund therapeutic treatment.

“It’s so awesome that there’s a whole line of revenue that will be granted to harm reduction and recovery support,” he said, “which are the least funded in a poorly funded system. But too many people personally believe that it’s going to increase access to treatment and it’s going to help reduce the addiction rates — and it’s not designed to do that. That’s an unfair expectation to place on Measure 110.”

Adding to the dynamics of the measure’s funding, the program is intended to fund a particular type of treatment. The text of the law lists “low-barrier substance use disorder treatment” at the top of the list of grant-eligible services. Neither Measure 110 or Senate Bill 755, which filled in many details of the law for implementation, defined what “low-barrier” means. However, it typically means a program that provides fast access to services, is flexible and encourages people to return to care as soon as possible if they have a relapse, rather than ending their treatment.

Of the entities that received grant funds, 31 cited substance use disorder treatment as a service the money would help support. Of the other purposes to be funded, 25 entities listed harm reduction, while 52 listed peer support, 28 listed housing and five listed employment support.

Advocates say the program is designed to focus on services that are not already funded by the Medicaid-funded Oregon Health Plan, which provides free care to low-income people. They say it’s those non-Medicaid eligible services complementing treatment that are really the focus of Measure 110 spending.

“Residential treatment is covered by Medicaid for the most part,” Hurst said. “The funding that Measure 110 is focused on is non-Medicaid funded services. And so the $302 million that was allocated for this biennium, from our kind of back-of-the-envelope math, is about five times more than Oregon has ever spent on these services. And that’s going to show up in communities like it already has — by keeping people alive, getting people housed and getting them the wrap-around services.”

“A major focal point of M110 has always been providing funding for wrap-around services like peer support and recovery housing that aren’t Medicaid eligible in many instances,” Brent Canode, who is the Alano Club of Portland’s executive director and was a vocal Measure 110 supporter, told The Lund Report in an email. He said when those services are provided, they “tend to produce much stronger outcomes” for individuals with a substance use disorder. His nonprofit was awarded a Measure 110 grant of $32,900 for peer services last year.

Access to treatment needed in Oregon

It turns out the state’s situation was even worse than voters thought when they approved the measure. Oregon is no longer ranked “nearly last out of 50 states in access to treatment” as the measure and supporting campaign materials emphasized. Last year it slipped to dead last, according to newly released data from the same source of the original talking point, the U.S. Substance Abuse and Mental Health Services Administration.

Specifically, 2020 data from the National Survey on Drug Use and Health showed that just over 18.08% of Oregonians need but are not receiving treatment for substance use. The survey also ranked Oregon second in the nation for prevalence of substance use disorder, up from fourth the year before, indicating that 18.22% of the population are affected.

Advocates agree that needs to change.

“There is no doubt that we need a lot more money going into the residential treatment space,” Hurst said but added that the state’s ongoing Medicaid substance use disorder demonstration project, or waiver, should handle some of that demand, improving access to residential treatment, recovery support services and access to transitional housing support services.

The waiver, which went into effect this past April, allows Oregon to receive federal funding for Medicaid services for individuals with a substance use disorder in residential treatment facilities with more than 16 beds.

The Oregon Health Authority is currently exploring options to improve Medicaid reimbursement rates for substance use disorder treatment providers, which would lead to improved access to services.

Grant outcomes still incomplete

Last year, the $31.4 million in Measure 110 grants were awarded across 67 organizations, including 11 tribes and tribal organizations through a tribal set-aside of $3 million, and $6.8 million that was awarded in amended existing Oregon Health Authority contracts by the agency. Portland’s tri-county area received the bulk of the grants.

According to preliminary data from Oregon Health Authority, these grants paid for:

  • 115 new positions, including 37 peers and peer support specialists, 12 certified recovery mentors and 10 certified alcohol and drug counselors and others
  • 12 vehicles — used for harm reduction supply distribution, mobile medically-assisted treatment and mobile exam rooms
  • recovery housing consisting of four leases plus one motel, a four-bedroom duplex and a gender and a culturally-specific recovery house
  • 56 tents, 10 tiny homes, 91 phones and data plans, 150 TriMet one-day passes, three peer support and crisis lines, $1.8 million in harm reduction supplies and $589,000 in naloxone, an opiate and opioid overdose-reversing medication

The grant recipients have not yet spent all the money. The funds were distributed in May and June 2021, and grantees were required to spend most of those funds by the end of the year. However, the deadline was extended to June of 2022 when many hadn’t achieved that goal.

At least one grantee, that received a grant for just under $34,000, shuttered. Achieving Change Together NW, a Portland nonprofit serving youths with co-occurring substance use and mental health disorders, closed its doors in August citing staffing shortages, and the pandemic and accompanying rising adolescent hospitalizations in Oregon as the reason.

When the health authority presented the Measure 110 Oversight and Accountability Council with an aggregated overview of the grantees’ progress on Jan. 5, its Measure 110 Health Strategist Onelia Hawa explained that the data had limitations, citing the failure of some grant winners to submit progress reports, due to staffing and capacity issues, and non-uniform data reporting as reasons.

“We’re not seeing a complete, 100% accurate picture of how Access to Care funding might have increased access and low barrier service,” she told the council.

Amy Ashton-Williams, executive director at Oregon Washington Health Network, told The Lund Report that her organization used the $354,968 Access to Care grant it was awarded last year to open three drop-in peer centers, located in Hermiston, Pendleton and Milton-Freewater. At these centers, people can get assistance with food stamps or other social services, use a computer or simply get something to eat, watch TV and charge their phone. More than 2,500 people used the peer services between September and December, she said. Oregon Washington Health Network also helped 140 people access permanent or temporary housing.

Ashton-Williams said her organization doesn’t track the number of people who accessed drug and alcohol treatment through the peer services, though most people who utilize the drop-in centers are not in recovery.

Other outcomes funded through Measure 110 grants, according to health authority data, include:

  • Max’s Mission, awarded $215,408, distributed 1,516 doses of naloxone, 454 Fentanyl test strips and collected more than 8,400 used syringes across Jackson, Josephine and Klamath counties. The nonprofit reported it reversed 111 drug overdoses.
  • Portland’s Oregon Change Clinic, awarded $228,613 for substance use disorder treatment, harm reduction and housing, reported serving 28 people in its temporary housing program.
  • New Directions Northwest, awarded $353,415 for substance use disorder treatment and peer services, increased progress on partnerships to provide peer services to local hospitals, primary care offices, law enforcement and jails in Baker, Union and Wallowa counties.
  • OnTrack Rogue Valle, providing substance use disorder treatment focused on the Latinx communities in Jackson and Josephine counties, reported its encounters rose 208% in 2021 over the previous year, with people who speak Spanish attending linguistically specific services at a higher rate.
  • Rogue Retreat, awarded $166,675, served a combined 1,317 individuals at its Urban Campground and Kelly Shelter in Medford, with 18 of those people exiting to detox or a substance use disorder treatment facility.

The Lund Report is closely tracking the implementation of Measure 110 and its impacts on the behavioral health care system in Oregon as part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. If you have a tip or comment that you think would be helpful, please contact Emily Green at [email protected] or enter your tip into this form.