Measure 110 audit finds low spending on treating addicts, few clients
Oregon has awarded $264 million in grants for drug treatment and recovery under Measure 110, but some providers have spent little money and some counties are at risk of not providing all required services, state auditors said in a report released Wednesday.
The measure decriminalizing possession of small amounts of illegal substances, including heroin and cocaine, was approved by Oregon voters in 2020 and went into effect in 2021.
Oregon's addiction crisis persists despite the measures expansion of drug treatment with a 28% increase in the overdose death rate and the fastest-growing youth drug death rate in the country. The measure established Behavioral Health Resource Networks with money from the state's marijuana tax revenue. The networks are required to provide client screening, assessment and planning, substance use treatment, peer services, housing, and harm reduction services. A BHRN can comprise one community network or several to provide the six required services.
The Secretary of State audit, mandated by the Oregon Legislature, reviewed where the funds went.
“Since it’s been implemented, the top question on everyone’s minds has been: Is Measure 110 working?” Audits Director Kip Memmott, said in a press release. “It’s a complicated question to answer and much of the public conversation about Measure 110 is outside the scope of this review."
Memmott said auditors identified progress, "but it’s clear there is still much work to be done."
There were 233 BHRN providers approved in the initial grant period and established in July 2022. Of those, 168 provided peer support and mentoring services, 110 provided behavioral needs assessments, 109 provided substance use treatment, 87 provided housing services, 84 used grants for harm reduction, and 52 directed funding to support employment.
Secretary of State LaVonne Griffin-Valade acknowledged the public interest in Measure 110 in a statement about the audit.
“There has been a lot of interest around Measure 110, and I have no doubt that many will want to look to this audit as a measuring stick for the law," Griffin-Valades said. "That would be a mistake, as this report is narrowly focused on answering questions about the OHA’s grant making program. Within that scope, it’s a valuable tool.”
Behavioral health resource networks spent one-third of grant money
The auditors found network providers in the BHRNs reported spending $95 million, one-third of the $261 million in active grants through December 2023, two-thirds of the way through the initial grant period.
In 12 of Oregon's 36 counties, provider networks reported serving no clients in one of the six required service categories from April to June 2023. In five rural counties, networks reported serving 15 clients or less across all six categories.
Auditors said the networks were an important expansion of needed treatment and services in a state with "substantial gaps" in substance use services.
An Oregon Health and Science University and Portland State University inventory and gap analysis found a 49% gap in substance use disorder services needed in the state. The state had the 6th highest substance use disorder rate in the United States according to the 2021 National Survey on Drug Use and Health.
Measure 110 is a "substantial addition" to the state's investments in substance use disorder services, auditors determined. The Oregon Health Authority estimates the funding will be a quarter of total spending on substance use disorder services and half of non-Medicaid spending, they wrote.
Other reasons for low spending, issues implementing Measure 110 grants
The auditors also identified the following barriers that resulted in low spending and services:
Concerns with the stability of funding related to concerns that M110 could be repealed or modified
High housing costs that made it difficult to attract staff and provide housing for their clients
Opposition against M110 and stigma against providing substance use services
Low calls to the hotline established by M110 which was meant to serve as a source of new clients
Reduced referrals from drug courts during the pandemic and after decriminalization
The report suggested the OAC and OHA take a "more strategic approach" in the future when funding grants. The approval process for grants did not include analyzing potential demand for services by county, the report noted.
They also suggested the OHA improve its public reporting by working with providers to clarify and add additional details to their responses to quarterly reports of client counts and expenditures.
The report released Wednesday also took a closer look at denials for grant funding. The OAC received 328 grant applications and denied 87 of them, about a quarter. One applicant, Boulder Care applied in all 36 counties and was denied 28 times.
The OAC also denied applications in 17 of the 26 Oregon counties. They denied 46 of 129 applications in Multnomah, Benton, Clackamas, and Washington counties according to the report. The four counties accounted for more than half of all denials.
The most common reasons for denials were unclear applications, high salaries for administrative staff and directors, and high barriers to treatment including random house calls or requiring sobriety for housing.
Audit IDs improvements for new grants
The audit also identified three areas to improve ahead of the next round of grants: application quality, transparency and consistency.
The report cited the volume of applications, vagueness of some applications and pressure to review applications quickly after funding delays as some of the reasons behind inconsistencies and a lack of public discussion.
The report released also looked at how much total funding went toward administrative costs. According to provider reports, there was an average of 7% in administrative costs but there was a large range from 0% to 20% in some networks.
Auditors also were tasked with analyzing how much of Measure 110 funding went toward culturally specific providers to improve outcomes for populations most impacted by addiction. The exact number was unclear, they determined, and suggested the grant process could be improved to better attract community-based applicants.
Memmott said the Oregon Audits Division will conduct another audit of Measure 110 to more directly assess program efficacy.
Lawmakers are expected to introduce additional legislation during February's short session addressing Measure 110.
Three committee meetings have been held in the interim to discuss the state's addiction crisis and potential policy changes.
Dianne Lugo covers the Oregon Legislature and equity issues. Reach her atdlugo@statesmanjournal.com or on Twitter @DianneLugo.
This article originally appeared on Salem Statesman Journal: Measure 110 audit finds low spending on treating addicts
