SALEM, Ore. — After a slow, rocky rollout, Oregon's Measure 110 has successfully distributed more than $260 million to drug treatment service providers, according to a newly released audit — however, there remain gaps in data-gathering needed to determine how effective that funding has been, and delays have hurt the expansion of programs.
The Oregon Secretary of State's office released the results of its financial audit on Wednesday, the first of several mandated follow-ups to an audit earlier this year that looked at Measure 110's rollout. After the previous audit, lawmakers and state officials made efforts to improve how the program is administered, culminating in a bill passed during the legislative session.
According to the new report, the Measure 110 oversight council awarded $264 million to Behavioral Health Resource Networks (aka BHRNs, the entities within each county that provide drug treatment and related services) through December of this year. They expect to award another $150 million through June of 2025.
From the data that the Oregon Health Authority (OHA) has managed to gather, Oregon's BHRNs have increased their spending and the number of clients served. But according to the audit, many of these groups struggled to hire staff and ramp up their spending, suggesting that the state's 42 BHRNs may not be providing all of the services required under Measure 110.
The audit also ran into issues with the actual breadth of data available on Measure 110 programs. While the OHA tracks BHRN spending and clients served, it doesn't report details on staffing, services or capital expenditures at those entities.
Auditors acknowledged that OHA is working on a new system for collecting better data, but it "remains uncertain if the agency will have adequate data to demonstrate M110's effectiveness."
The new audit does not specifically address some of the issues connected to Measure 110 about which Oregonians have expressed the most concern, namely the actual performance of services funded through Measure 110 or the outcomes of drug decriminalization. Those will be the focus of a future audit, one due by Dec. 31, 2025.
“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," Oregon Secretary of State LaVonne Griffin-Valade said in a statement accompanying the report's release. "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.”
Where is the money going?
It's worth noting that drug treatment, as the public would likely understand it, does not represent anywhere near the majority of Measure 110 spending. The largest number of service providers, 168, signed up to provide peer support and mentoring, with reported spending of $10.95 million between April and June of 2023. Providers served 14,447 clients with peer support during this period, at a cost per client of $759.
By comparison, 109 grantees signed up to provide "low-barrier substance use treatment," with spending between April and June of $4.51 million. At 8,284 clients served during that period, the cost per client was $545. Treatment came in third for total spending during that period, after peer support and housing services.
But the audit did point to evidence that community-based services, which lean heavily on outreach and peer support, provide better outcomes for clients than if they receive treatment alone.
From the beginning of 2022 to late 2023, the report noted, the number of active peers in Oregon have doubled from 1,400 to 2,800. They helped connect clients with basic needs, such as food, clothing and transportation, providers reported; helping get clients to recovery meetings and doctor's appointments; making connections with housing and other treatment services.
In some cases, BHRNs have had difficulty actually spending the funding they received through Measure 110, the audit found, in part due to local conditions. Grants were slow to roll out, first of all, which hampered spending for the first full year.
Between April and June of 2023, provider networks in 12 of Oregon's 36 counties said that they served no clients in at least one of the service categories required under Measure 110. Networks in five rural counties served 15 or fewer total clients, and Gilliam County's two providers noted that they served no clients whatsoever, citing hiring challenges and low awareness of their services.
Spending did gradually ramp up, the audit noted. But looking at the growth rate throughout 2023, auditors said that providers would still fall about 36% short of spending their original grant totals by the end of the year if that rate remained steady.
The audit noted that some barriers to spending should resolve with time, like delays in receiving the funding or in starting construction. But others, including difficulties in hiring staff and limitations on referrals, are likely to continue.
"In general, expanding services or starting new services takes time to scale up and awareness of new programs takes time to build," the report states. "In M110’s case in particular, some providers said uncertainty about funding also delayed hiring. Property purchases and construction projects have also faced delays."
Filling in the blanks
Auditors acknowledged that many of the service providers funded through Measure 110 are short on time and staff, which naturally limits their ability to gather and report data to the OHA. Nevertheless, they said, the state needs to gather more information — especially when Measure 110 has been taking so much fire in the public sphere.
"M110 is a particularly high-profile program," the report says. "Working with grantees to provide more detail about their efforts would help improve public reporting and further demonstrate program impact and statutory compliance."
In some cases, OHA has tried to read the tea leaves in order to demonstrate what Measure 110 has accomplished, soliciting explanations from providers on their progress alongside the hard data on quarterly spending and client counts. But without rigid guidelines on what information to provide, provider responses run the gamut from "rich descriptions" to others that provide little in the way of specifics, the audit said.
Few providers have detailed their staffing levels before and after Measure 110 funding. OHA suggested that a little over half of providers, 55%, indicated increased service hours, locations or staffing.
"OHA can improve its public reporting by working with providers to supply more specifics on staffing and service expansion details in quarterly reporting, and by asking providers to note when M110 funds have maintained existing service levels rather than expanded them," the report states.
Youth services, in particular, were not tracked or evaluated when the Measure 110 oversight council approved provider applications, despite the fact that most substance use disorders begin before age 25, the audit noted. As a result, a majority of Oregon counties do not have providers focused on youth or parents, and only 16% of clients with known ages were under age 26 between April and June 2023.
Thus far, OHA has not been able to proactively check on provider spending, the audit found. Though Measure 110 grants to three organizations have been terminated, those originated with outside complaints rather than any kind of active oversight. Measure 110 has just five grant managers for more than 230 grants, which limits the program's ability to support or monitor providers.
But things are improving somewhat, the audit noted. OHA plans to hire two more grant managers, and some additional checks are being built into the grant application process.
Meanwhile, the Measure 110 oversight council is a group without a leader. Under a law passed earlier this year, the group is supposed to have an executive director to help lead the program. But the position remained open as of this month, the audit said. Two people who were offered the job decided to pass on it, citing the political volatility of Measure 110.
Then there's a problem looking ahead to future evaluations of Measure 110. Auditors warned that while Oregon is now putting in place a system to track essential metrics, they will not have been in place long enough for there to be complete information by December 2025, which is when lawmakers expect it. As a result, it will be difficult to judge how effective Measure 110 is proving to be.
Question marks include client health outcomes, whether there were increases in treatment providers, how many culturally-specific providers there were, access to harm reduction services, and client access to housing.
Types of treatment
The secretary of state's office audit confirmed the basis of an underlying concern that's been around since Measure 110 grants started going out — that inpatient drug treatment has been largely passed over for direct funding through the program.
While Measure 110 did not require that grants go toward residential treatment, Oregon suffers from a chronic shortage of treatment beds, and the oversight council "did not prioritize" funding them. But, the audit noted, it did fund at least five projects that will result in added detox or withdrawal management beds, including two that expand residential treatment capacity.
Those five projects alone represent roughly a third of Measure 110's $62 million in capital spending thus far. Other funding, $57.4 million, went to organizations that do provide residential treatment or detox, even if the funding didn't go toward those programs in particular. The Measure 110 oversight council was more likely to fund low-barrier housing, outreach and community-based staff.
"Research indicates that the best steps to prevent client relapse after treatment include providing stable housing and employment, helping build positive support networks, and providing services to meet basic needs," the report notes. "These services are part of the M110 program’s approach, and are generally not covered by Medicaid."
While residential treatment is "not required" for recovery, the auditors said, it may be a particularly important piece of the puzzle for people with more severe substance use disorders, and state-level reports have repeatedly pointed to Oregon's lack of capacity in this regard as a major barrier. But a bill proposed in this year's legislative session that would have expanded residential treatment by 311 beds at a cost of $93 million failed to gain traction.
Recommendations
Due to its focus on the financial aspects of Measure 110, auditors' final recommendations covered the things that the OHA and oversight council can do to better administer the program and track outcomes. First, they should develop a strategic plan, with specific metrics and timelines, to be presented in the upcoming legislative session — working with outside researchers if needed.
Auditors recommended that the OHA work with providers to better track specifics on staffing, expansion of services, capital projects, youth and virtual services, and the availability of culturally and linguistically-specific services.
In order to improve the grant application and review process, the auditors recommended that the OHA and oversight council work with communities and providers to identify the most critical service gaps by county in order to work toward filling those gaps. Applications should also be more clear and direct, with the review process more transparent and consistent.
Finally, the auditors said, providers should clearly detail what they intend to do with Measure 110 funds, as well as their capability and plans for providing services to clients from linguistically diverse or culturally-specific backgrounds.
In a letter of response to the audit, OHA leaders said that they agreed with all of the recommendations and planned to address them, with deadlines ranging from the end of this year to July 1, 2025.
"State health officials appreciate the Secretary of State’s recognition of the progress that has been made in the implementation of Measure 110," OHA Behavioral Health Director Ebony Clarke said in a statement. "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."
Potential upsets
Under the legislation that undergirds Measure 110, the Oregon Secretary of State's office has been operating on a set schedule to audit the program's progress. But there's a good chance that by the time the next audit is published in late 2025, the legal landscape will have changed — perhaps significantly.
Frustrated with the surge in overdoses and public signs of Oregon's addiction crisis, much of it fueled by the influx of fentanyl, there's been an increasing backlash to Measure 110's decriminalization of drugs in user quantities; not all of which distinguishes decriminalization from the other aspects of the measure.
A poll of Oregon voters published in August reported that over half of respondents would prefer to see Measure 110 repealed instead of being left alone. By an even larger margin, 64%, respondents supported a return of criminal consequences for drug possession.
Since then, a well-heeled group calling itself the Coalition to Fix and Improve Ballot Measure 110 has proposed two potential ballot measures that organizers said they will distribute if lawmakers do not act quickly enough to amend the law. Both proposals would recriminalize drugs, albeit with more offramps for treatment than existed prior to Measure 110, and would criminalize public drug use. One of them would also radically overhaul how Measure 110 funding is administered and distributed.
Meanwhile, lawmakers in Salem have been gathering testimony in order to determine what the legislature should do to address Oregon's addiction crisis — including potential changes to the law under Measure 110. It's too early to tell what will emerge from that bipartisan committee.