A year behind schedule, Oregon’s novel approach to drug addiction has reached primetime.
In November 2020, voters overwhelmingly approved Measure 110, making Oregon the first state nationwide to decriminalize the possession of small quantities of drugs and establish service centers to help people tackle their mental health and addiction problems. The centers were supposed to be operational by October 2021. This month, after a rough approval and funding process, those networks have been established.
“We’ve reached a true milestone,” Steve Allen, behavioral health director at the Oregon Health Authority, said Tuesday during an online news conference. “Measure 110 funds are in the hands of local communities. Now is the moment that Measure 110 can truly begin.”
It could be months before many patients receive the array of help the Measure mandated, however, as providers hire and train staff, buy equipment and supplies and renovate buildings.
County-based service networks are funded through marijuana taxes, providing about $300 million through June 2023. A specially appointed council largely composed of people in recovery from addiction has overseen the funding, spending more than $260 million on 44 treatment and recovery networks statewide.
Known as Behavioral Health Resource Networks, they offer a range of services, from health screenings and addiction treatment to help with housing and job support. The networks in Baker, Harney, Jefferson, Lake and Morrow consist of one provider.
Other counties have more, depending on how many Medicaid patients, drug arrests and overdose deaths they have and the size of their homeless population. Multnomah County, Oregon’s most populous, has 41 providers, the most statewide.
The networks are supposed to drive a shift in the state’s response to drugs away from the criminal justice system toward treatment and recovery. By establishing networks in each county, the system aims to help people where they live.
Thousands of lives are at stake: Oregon has consistently ranked in nationwide surveys at the top or near the top in the prevalence of people with addiction problems and at the bottom in terms of access to treatment.
The problem has deepened in recent years.
In 2017, overdoses accounted for 618 deaths in Oregon, the second leading cause after falls, which took 790 lives. In 2020, overdoses moved to the top place, with 900 fatalities compared with 832 deaths from falls.
Critics have blamed Measure 110 in part, saying it has made drugs more accessible. Approval of the measure also coincided with an uptick in deadly pills laced with fentanyl that have flooded the West Coast from Mexico. They have also blasted the health authority for its rocky rollout of Measure 110.
Allen acknowledged the problems.
“There was a lot of learning on the fly during a time (when) the Covid-19 pandemic was depleting Oregon’s behavioral health care workforce, diverting critical resources and driving a spike in demand for these services,” Allen said. “When you do something for the first time, you’re going to make mistakes and often learn hard lessons.”
State officials and advocates hope the networks will lead a transformation of Oregon’s behavioral health care system, which critics say has been plagued by underfunding for years.
Allen warned not to expect a change overnight.
“We still have a lot of work to do,” Allen said. “The behavioral health system continues to recover from the Covid-19 pandemic. Measure 110 will support a more effective and coordinated strategy, but it won’t solve all of our problems overnight.”
An array of services
Each network offers behavioral health care assessments, case management, addiction treatment, peer support, recovery services, housing help, employment support and harm reduction services that are designed to keep people alive through opioid reversal medication or keep them as healthy as possible through needle exchanges, for example, to prevent the spread of HIV and hepatitis C.
The networks are mandated to provide services that are sensitive to people’s cultural heritage and in languages other than English. They’re especially aimed at Black residents, Hispanics and other people of color who’ve often had difficulty accessing services.
“We prioritized service delivery to communities … and people most impacted by the war on drugs,” said Sabrina Garcia, an enrolled member of the Klamath Tribe and co-leader of the council overseeing the Measure 110 rollout.
Measure 110 services will be free to remove a common barrier to treatment. They are also designed to fill gaps by providing services that are not paid for by Medicaid or commercial health insurance.
Nevertheless, the establishment of the networks doesn’t mean that Oregon no longer has a behavioral health problem. The state lacks residential treatment beds, access to medication to treat opioid addiction and counselors, medical assistants and other staff.
Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance, an organization dedicated to implementing Measure 110, said building networks in each county means that people won’t have to travel from Malheur County to Multnomah County to get residential treatment, for example, when they might be better helped by staying at home and receiving outpatient care and housing help.
“It’s really about meeting folks where they’re at,” Hurst said, with a focus on “non-stigmatizing and trauma-informed care.”
The council’s initial distribution of $30 million has had an impact by helping 1,600 people, she said. The HIV Alliance, which has five service centers in Oregon, bought opioid reversal drugs and saved 500 lives. Bridges to Change, a Portland-based nonprofit, kept its recovery center in Wasco County open and expanded its presence in The Dalles. And the Miracles Club, a Portland recovery center, doubled its staff to step up outreach to Black Oregonians, Hurst said.
Much of the latest funding, however, will take time to bear fruit as providers build more robust services
“The reality is you can’t fix a system that is broken in just 18 months,” Garcia said. “What we can do over the next 18 months is support these networks by making sure they operate as intended and make sure there is a stable source of funding.”
The state will monitor the networks. They have to report their policies and procedures to the state and periodically report their service and fiscal data. The secretary of state’s office will audit the networks on their performance, and the Oregon Health Authority is in charge of certifying health workers, peer support specialists and addiction treatment and recovery programs.
The state will also log complaints.
Hurst, who said she’s struggled with addiction and lost loved ones, said the rollout gives her confidence in Oregon.
“This is the first time in a long time that I’ve had hope for Oregon’s recovery landscape,” Hurst said.
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