State audit finds Measure 110 grants have helped expand drug treatment, but ‘significant challenges remain’

(Update: Response statements from secretary of state, OHA official)

SALEM, Ore. (KTVZ) — Funds from Ballot Measure 110 have expanded community-based treatment and recovery services for drug and alcohol use, but challenges remain to fully implementing these services and measuring results, according to a review released Wednesday by the Oregon Audits Division.

Measure 110 was passed in 2020 to decriminalize possession of small amounts of drugs and provide additional funding for treatment. Since then, Oregon has continued to struggle with an epidemic of drug use, fueled in part by an explosion in fentanyl use. In 2018, 690 pills were seized in Oregon and Idaho’s high-intensity drug trafficking area; in 2022, it was more than 3 million.

Wednesday’s report is a legislatively mandated auditor review focused on services provided through Behavioral Health Resource Networks established statewide in July 2022. The networks have helped expand community-based treatment (including peers who have been through treatment themselves), harm reduction services, and housing for people awaiting treatment, in treatment, and in recovery.

“Since it’s been implemented, the top question on everyone’s minds has been: Is Measure 110 working?” said Audits Director Kip Memmott. “It’s a complicated question to answer and much of the public conversation about Measure 110 is outside the scope of this review. We identified important progress being made, but it’s clear there is still much work to be done. We’ll be conducting another audit of Measure 110 where we plan to more directly assess program efficacy.”

Measure 110’s Oversight and Accountability Council (OAC), supported by the Oregon Health Authority (OHA), approved $264 million in grants through December 2023 to 233 network service providers. The OAC, which includes members with experience in substance use disorder services, expects to award another $150 million through June 2025, drawing on tax revenue from cannabis sales.

However, significant challenges remain. In the first year of the grants — two-thirds of the way through the initial grant term — providers reported spending just over a third of grant funds amid difficulty hiring staff and other obstacles. It also remains unclear if OHA will have enough data to demonstrate Measure 110’s effectiveness by the end of 2025, five years after the measure passed.

Findings from Wednesday’s report include:

• The $260 million in grants has successfully helped expand community-based services and, despite some challenges, helped deliver accessible services to highly vulnerable people.
• The OAC prioritized cultural competence among grantees. This focus is likely to improve service access statewide and help address inequities in substance use treatment and outcomes.
• BHRN providers have increased spending and clients served, but the first year of reporting showed limited spending and services. During this time, there was difficulty hiring staff and other challenges, meaning some of Oregon’s 42 networks may not yet be providing all required services.
• It’s not clear how many providers of culturally specific services were funded to help serve populations most affected by the war on drugs, an important part of the measure. Auditors found the grant process needs improvement to better attract community-based applicants.
• OHA publishes BHRN spending and the number of clients served, but the agency could better demonstrate impact through additional reporting on staffing, services, and capital expenditures.
• OHA is developing a new system for collecting more detailed behavioral health service data, but it remains uncertain if the agency will have adequate data to demonstrate M110’s effectiveness.

“Measure 110 has been a topic of intense interest and public scrutiny both here in Oregon and nationwide,” Memmott said. “It’s the reality of being the first state in the nation to adopt such a unique and unprecedented approach to substance abuse treatment. As it says in the report, collecting, assessing, and reporting key performance and outcome data is critical for determining if this unparalleled drug treatment approach is effective.”

This is the second report focused on Measure 110 released by the Oregon Audits Division. The first, a real-time performance audit, was issued in January 2023. Another legislatively mandated audit is due for release before the end of 2025.

Read the full report on the Secretary of State website.

Following is a statement from Oregon Secretary of State LaVonne Griffin-Valade about the Oregon Audits Division’s financial review of Measure 110:

“The information in this report will help the Oregon Health Authority put the right structures in place to administer the treatment side of Measure 110. I encourage the OHA and state leaders to follow the auditor’s recommendations.”

“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. 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.”

Oregon Health Authority Behavioral Health Director Ebony Clarke issued the following statement in response to the Secretary of State’s Measure 110 audit update:

State health officials appreciate the Secretary of State’s recognition of the progress that has been made in the implementation of Measure 110. As the audit shows, the services Measure 110 funds play a vital role in expanding access to care in Oregon and putting more people who have substance use disorders on the road to recovery and sustaining healthier lives.

We agree with each of the audit’s recommendations. OHA staff are committed to presenting the legislature with a plan to report Measure 110 outcome metrics, better report on staffing in Measure 110 funded programs (including youth programs and culturally relevant services), improve the consistency of data collection, identify gaps in care and barriers to service in each county, and continue to improve the Measure 110 grantmaking process.

We appreciate the work of all the Oregonians supporting individuals reduce risks, find treatment and stay in recovery every day. We know many people would not have the opportunity to receive the lifesaving and life-changing services without the funding that Measure 110 provides.