Setbacks and delays hindered the rollout of Measure 110, which Oregon voters approved in 2020 to decriminalize drug possession for personal use and increase funding for treatment services.

That’s the message from Oregon Secretary of State Shemia Fagan, who released an audit Thursday of the $150-million-per-year initiative funded mostly with cannabis tax revenue. It arrived against a stark backdrop: Oregon has the second highest rate of substance use disorder in the United States and is 50th in the nation for treatment access, Fagan noted, citing 2020 figures from the Substance Abuse and Mental Health Services Administration.

Among the findings: The state’s health authority inadequately supported the volunteer council convened to distribute grants to providers in all 36 Oregon counties; council members lacked expertise, which slowed funding approval; and the state and service providers inconsistently collected data, making it difficult to track the measure’s effectiveness.

That sparse data collection left auditors unsure of how grant recipients spent $33 million — or how the money improved people’s lives.

Fagan, who called Measure 110 “a matter of life and death,” experienced her mother struggle with addiction. Now her brother is undergoing treatment. “Oregonians passed this with the expectation that people would get better – that they would have access to treatment,” Fagan said. “Those services need to be there.”

Here’s a look at four major takeaways from the audit:

Council struggling

The audit is the first of three and focused on how the Oregon Health Authority and the Oversight and Accountability Council, the volunteer body with about 20 members from the recovery community, have implemented the measure thus far. The council, whose members are eligible for stipends if their employers don’t pay for their participation, is responsible for allocating about $300 million in grant funding over two years.

A lack of expertise among Oversight and Accountability Council members and their heavy, sometimes confusing workload caused delays and strained relations with the Oregon Health Authority, auditors said.

While council members are required to have experience in substance use recovery services, auditors found they generally lack experience in carrying out their primary responsibility: overseeing and awarding government grants. And the Oregon Health Authority, which faced high staff turnover and unclear expectations about who was responsible for what, failed to provide the council with the help it needed, the audit states.

Council members – many of whom have full-time jobs – told auditors they spend as many as 40 hours per week completing evaluations and attending council meetings. Their work has also been delayed by “unclear, inefficient, and difficult to use” grant evaluation rubrics.

Frustrations on the council ran high.

One council member reported spending over 100 hours on grant evaluations, only to have the work returned and marked “incomplete” by reviewers with the Oregon Health Authority. Two members removed themself from the evaluation committee out of frustration, and 19 meetings were canceled between February and April 2022.

To resolve these issues, auditors said the Oregon Health Authority – not the council – needs to shoulder more of the administrative work, including reviewing grant applications and providing financial analyses. Council members also need more training from the health authority on how to carry out their work. But both entities need to collaborate on a better system for evaluating grants that can be rolled out in the future, the audit said.

Council facing turnover

All members of the Oversight and Accountability Council were appointed in February 2021 and have the same term limit, which ends this year. Unless state legislators revise and stagger those appointments, the entire council could turn over this year – putting the work of the council and Measure 110 at risk, the audit said.

Data missing

Gaps in collecting, reporting and analyzing data made it difficult for auditors to gauge Measure 110′s effectiveness.

Auditors found the Oregon Health Authority awarded $33 million in grants during the initial implementation of Measure 110, but collected almost no data showing how the funds were spent or how they improved access to substance use treatment and services.

Health authority officials said many of the providers funded under Measure 110 are new to the state health care system and can’t handle conducting rigorous data collection. The nature of some treatment services also makes data collection difficult. For example, a provider may offer needle exchanges but struggle to get demographic data from someone workers encounter on the street.

But until consistent data is captured, auditors say it will be difficult for policy makers and the public to tell whether Measure 110 is working, or to suggest improvements to the program.

Services offered statewide

It took longer than expected, but every county and tribal area in Oregon now has at least one Behavioral Health Resource Network, an organization that provides free services through grants approved by the Oversight and Accountability Council. Services include substance use disorder screening, case management, low-barrier treatment, peer mentoring and housing.

The Oversight and Accountability Council was supposed to approve funding for networks statewide by January 2022, but failed to do so until August. Funding approval was held back by delays and “public friction” among the council that auditors said could have been avoided with more help from the Oregon Health Authority, according to the audit.

What did the audit recommend?

The audit made eight recommendations. Four are directed to the Oregon Health Authority and four to the Legislature.

The Oregon Health Authority agreed to:

1. Publish its first iteration of a strategic plan for how it will integrate Measure 110 into the state’s overall behavioral health system by the end of September.
2. Identify and document ways to close gaps in data collection and reporting by the end of 2024.
3. Provide better support to the Oversight and Accountability Council, including conducting trainings on grant funding and identifying conflicts of interest before voting on funding decisions.
4. Expand collaborations with the Department of Corrections to address substance use disorders among the state’s prison population, along with state housing and substance abuse treatment services.

Auditors recommended the Legislature:

1. Direct the Oregon Health Authority and Oversight and Accountability Council to collect enough data to assess Measure 110′s effectiveness.
2. Update statutes to eliminate overlaps in requirements for a statewide substance use recovery hotline, individual Behavioral Health Resource Networks hotlines and the Drug and Alcohol Prevention Hotline.
3. Direct the Oregon Health Authority to provide more support, assistance and training to the Oversight and Accountability Council.
4. Revise and stagger appointment terms on the Oversight and Accountability Council to prevent all council members from leaving at the same time this year.

James Schroeder, OHA’s interim director, agreed to implement the audit recommendations by the end of 2024. Two more audits focused on the measure’s finances and performance will be released by the end of 2024.

— Catalina Gaitán, cgaitan@oregonian.com, @catalingaitan_

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