Oregon became the first state in the nation to decriminalize possession of all types of drugs when voters approved Measure 110 with 58% of the vote in November 2020. Measure 110 didn't just decriminalize drugs, it also pledged to support addiction and recovery services, partially funded through cannabis taxes.
Latest results from the National Survey on Drug Use and Health show Oregon as the second-most addicted state in the nation, with about 20% of teens and adults reporting they had a problem with drugs or alcohol in 2020, the year Oregon voters approved Measure 110. The survey also ranked Oregon last in access to addiction treatment in the self-reported survey — about 18% of respondents said they were unable to get treated, about half the national rate. The Oregon Health Authority recorded 472 overdose deaths in 2020 and 745 in 2021, a 63% increase — largely driven by an increase in usage of fentanyl, while stimulant-related deaths such as meth also steadily increased.
Critics of Measure 110 have called the law a failure that hamstrings law enforcement, encourages drug use and too hastily decriminalized drugs before support services were in place. Hope Smiley-McDonald, a sociologist who led studies measuring the impacts of Measure 110 told Willamette Week that law enforcement representatives they interviewed would often draw a direct line between Measure 110 and increases in crime, but that data she reviewed puts crime trends in line with regional trends.
"We're really not seeing any change in Portland's calls for service initiated by the public after Measure 110 was enacted. It's pretty surprising to see that Portland mirrors its sister cities because there is a perception that, after Measure 110, crimes have increased and the public is no longer as supportive as in 2020," Smiley-McDonald told Willamette Week.
"I think that if the communities give us a little bit of time to start to show, then we're going to see an impact. The numbers will be able to prove that what we're doing, what we've asked for this money to do, what the voters, by voting yes, to Measure 110, what their vote is really going to do."—Josh Lair
Though there's no way to track exactly how much Measure 110's popularity wavered, a Data for Progress poll found the law is about as popular as it was in 2020 out of a sample of 1,051 people. Funds were meant to be distributed at the beginning of 2022 but were delayed after the Measure 110 Oversite and Accountability Council struggled to create a complicated grant process. In June the Council agreed on the selected applicants who would receive funds and money started flowing across the state over the following couple months.
"It's been the worst procurement process I've ever seen in 40 years of my career," said Rick Treleaven, executive director of Best Care Treatment Services, which received the largest grant in Deschutes County.Treleaven said the 20-person oversite council lacked experience in running large treatment programs, managing procurement processes and grant writing. The Oregon Health Authority had to lend about 130 staff members to take over the application process. Outgoing OHA Director Patrick Allen told the Senate Judiciary and Ballot Measure 110 Committee that the agency underestimated the complexity of implementing the program, along with challenges from COVID-19 and staff shortages. With resources finally getting into service providers' hands, there's more optimism about the program but concerns remain over the next round of funding in 2023.
"Broad strokes, I think the result was OK. Certainly, Best Care did well in the process, but it really needs to be overhauled dramatically," Treleaven said.
Measure 110's programs in Deschutes County
The state considered designating over 335 entities as "Behavioral Health Resource Networks" to provide specified services related to substance use disorders. Nonprofits, private businesses, local governments, federally recognized tribes and urban Indian health programs were all eligible to apply. In Deschutes County six organizations are BHRN grantees: Best Care Treatment Services, Boulder Care, Ideal Option, Healing Reins Therapeutic Riding Center, Rimrock Trails Treatment Services and Deschutes County Health Services Behavioral Health Division.
"Broadly speaking, the BHRNs are supposed to do two core things. One is stand up regional 24/7 drop-in opportunities for people struggling with addiction, to encounter people with lived experience, engage in support, and be engaged in recovery if they're willing to do that," said Janice Garceau, Deschutes County's Health Services director. "Then other kinds of services are things like substance use disorder, expanded treatment options, housing options, harm reduction services, other kinds of peer support services."
Best Care is taking the lead as the county's 24/7 drop-in services with the engagement center, where people can drop in and get connected to services. Services run the gamut from medication supported recovery treatment, access to the overdose reversing drug naloxone, employment counseling, housing vouchers and supplies for people experiencing homelessness.
"We've been doing this in a smaller scale, so we have some experience with it. And this funding has allowed us to take this all to scale," Treleaven said.
"Treatments at scale" typically involve a broader outreach and engagement for people with serious drug and alcohol problems. Treleaven described it as all carrot and no stick rather than the criminalization and jailing of people just for substance abuse.
"We are setting up this outreach and engagement system that develops relationships that bring people into treatment on a more voluntary basis," he said.
Best Care is the only BHRN in Deschutes County that offers housing services and supported employment, two of seven metrics the state is using to allocate funding. While all six BHRNs have low-barrier substance use treatment services, some are a bit more niche. Deschutes County Health Services is the only BHRN with an emphasis on harm reduction in the county.
Harm reduction includes efforts like overdose prevention, syringe exchanges, testing for communicable disease and introducing treatment options. Since the rise of fentanyl, Deschutes County Health Services harm reduction program has had to nearly double the amount of naloxone used to reverse an overdose. In 2020 it took an average of 1.7 doses to reverse an overdose, but this year it's risen to almost three.
"We've watched the influx of fentanyl in the community and the impact it's had, the impact of the COVID crisis on people just having higher rates of overdose events and really struggling with isolation and with addiction," Garceau, Deschutes County's Health Services director, said. "I think we'll reach more people and prevent more people from dying as a result of their addiction and living long enough to maybe get into recovery."
Deschutes County's also added peer support positions and outreach coordinators for those experiencing homelessness and youth struggling with addiction. Peer support specialists act as mentors, and usually have their own lived experience recovering from addiction.
Though Measure 110 is at times fraught politically, organizations working in recovery hope the public gives services time to make an impact before deeming the measure a failure.
Ideal Option hired a peer support specialist with its funds, and in 2023 will start working in the Deschutes County Jail to offer treatment to inmates. Boulder Care, a telehealth addiction recovery specialist, is funded to expand treatment in Deschutes County. Healing Reins Therapeutic Riding Center got funding to do non-traditional equine therapy — usually for people further down the road in recovery. And Rimrock Trails Treatment Center is expanding services to youth with addiction struggles in Deschutes County.
"What Measure 110 ideally is trying to do is set up a system of outreach and engagement and harm reduction into that population of people who have serious drug and alcohol problems," Treleaven said.
The Future of Measure 110
BHRN started getting funds in the summer, and organizations got about 40% of the funds they're set to receive right off the bat. Remaining funds will trickle down to organizations quarterly until 2025 when organizations must re-apply for continued funding. Legislators haven't decided what amount of money will be allocated for the next round of funding and will have to figure that out in future legislative sessions. Though Measure 110 is at times fraught politically— two candidates in Oregon's close gubernatorial race vowed to end the program —organizations working in recovery hope the public gives services time to make an impact before deeming the measure a failure.
"Most organizations, smart businesses, you don't start making the changes or doing the things that you're going to do or acquiring employees until you have the money. We're four months into this. People are still trying to fill positions," said Josh Lair, community outreach coordinator at Ideal Option. "I think that if the communities give us a little bit of time to start to show, then we're going to see an impact. The numbers will be able to prove that what we're doing, what we've asked for this money to do, what the voters, by voting yes, to Measure 110, what their vote is really going to do."
Expectations for what this program could do are high. If successful it could provide a model for treating addiction medically rather than criminally. Tera Hurst, executive director of the Health Justice Recovery Alliance, who sat on Measure 110's oversite committee, called it the, "First step in providing the communities most traumatized by the war on drugs with the tools they need to heal," during a media briefing in September. The end result could mean fewer overdose deaths, fewer crimes to support habits to addictive drugs, fewer children in the foster care system and fewer people in jails.
"The outcomes that we're looking for, I think, in this social experiment, would be these questions," Treleaven said. "I would hope to see the number of people with serious substance abuse disorders who are engaged goes up, number of overdoses going down, the rate of drug related crime going down, the number of people entering and staying in treatment going up and I would hope also for a decrease in the number of child abuse cases. Those would be sort of the data points, broadly speaking, that we as citizens should be looking at to judge whether it's working or not."