Trash and hypodermic needles were ubiquitous in downtown Portland on March 23, 2022.

Trash and hypodermic needles were ubiquitous in downtown Portland on March 23, 2022.

Dave Miller / OPB

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Statistics from 2020 show that Oregon had the second-highest alcohol and drug addiction rates in the nation and ranked last in treatment options. Oregonians passed Measure 110 almost two years ago. It decriminalized small amounts of illegal drugs and directed more money to addiction recovery services. But state bureaucracy has delayed the distribution of critical funding for providers. The advocacy group Oregon Recovers says the state is not doing enough to address the addiction crisis. We hear from Oregon Recovers Executive Director Mike Marshall and get a response from Oregon Health Authority Director Patrick Allen.


The following transcript was created by a computer and edited by a volunteer:

Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. A year and a half ago, about 60% of Oregon voters approved Measure 110. It decriminalized the possession of small amounts of illegal drugs like meth and heroin and directed more money, hundreds of millions of dollars more, to address the state’s addiction crisis, and it is indeed a crisis. According to federal data, the state ranks second worst in the country for its rate of substance use disorder and is dead last for access to treatment. Overdose deaths in Oregon rose 41% last year, more than twice as much as the national average. But bureaucracy has delayed the distribution of critical Measure 110 funding for addiction prevention and treatment. Only 10% of the funding for the current biennium has been given out. In a few minutes, we’re going to talk about this with Patrick Allen, who is the head of the Oregon Health Authority. We start with Mike Marshall, the Executive Director of Oregon Recovers, a nonprofit that advocates for addiction recovery services. Mike, welcome back.

Mike Marshall: Thanks, Dave. Good to be with you.

Miller: You were one of the chief opponents of measure 110 when it was in front of voters and your biggest argument was essentially that you didn’t think this was going to mean more people would get necessary treatment. What does it look like to you right now in the big picture, over a year and a half later?

Marshall: Our argument was, it was putting the cart before the horse – it was taking away a pathway to recovery before creating an alternative one – and that’s certainly been the case. But the thing is, it’s the law now and it’s doing some really good things in the context of, there are fewer people of color that’re being arrested for drug related offenses. And overall there are fewer people being arrested. And that was the primary purpose of Measure 110, was to stop criminalizing drug use and addiction. The challenge is, eighteen months later, the money is still stuck in the Oregon Health Authority, against the backdrop of as you pointed out, a much larger addiction crisis. Measure 110 was never intended to solve the addiction crisis. It was intended to end the war on drugs and fund recovery, but it was never going to deal with the challenge of access to treatment. And what I’d say is the reason it’s stuck is not just a bureaucratic reason, it’s a lack of vision. And my analysis, ultimately, and I think many people, is that the problem is that Governor Brown and her senior team view OHA [Oregon Health Authority] as the Oregon Health Administration and not the Oregon Health Authority. And so they’re trying to manage the addiction crisis instead of ending the addiction crisis. The voters gave them Measure 110 as a tool. There was never the intention of the voters to say, ‘Okay, Governor Brown, you’re no longer responsible for this. We’re going to give it to these 20 volunteers to figure out.’  It was always intended that the Governor continue to be responsible for this, and her team be responsible for it, and that this was a tool to do that.

Miller: When you talk about the 20 volunteers, are you talking about the Oversight and Accountability Council?

Marshall: That’s correct.

Miller: Ok, but this was included in Measure 110.

Marshall: Right.

Miller: This is state law, for these people to be in charge of grant making for service providers, meaning giving out something like $300 million dollars of taxpayer money, every two years. And as voters approved it, it’s largely made up of people in recovery or people from communities that have disproportionately been affected…

Marshall: Yep.

Miller: …by the war on drugs and sometimes that’s overlapping. But a lot of the members don’t have experience with grant making.

Marshall: Okay. But Dave the voters gave that responsibility for selecting those people to the Governor and the senior staff, the Oregon Health Authority. So their capacity, they’re really great people. I know a lot of them, they have worked unbelievably hard, but they’ve gotten really poor support from the Oregon Health Authority because the Oregon Health Authority wanted to put the whole thing on their shoulders, not recognizing that this was a, an amazing tool in which to inform the distribution of this money, but ultimately, the accountability still rests with the Governor, who is the Chief Executive Officer and responsible for the senior staff at

OHA, who are responsible for picking these people and making them successful.

Miller: Is your main beef here about just that, that the state has erred and needs to be much faster in getting the money out the door, or do you have a broader critique here?

Marshall: Yes, The broader critique is, as you said, we have the second highest addiction rate, we ranked last in access to treatment. Those numbers have not changed in five years. There is no plan to end the crisis. There is simply a plan within the Oregon Health Authority’s senior staff; there are amazing people working at OHA, who, throughout the pandemic that worked overtime. But there is this vision that they are not responsible for ending the crisis, but simply managing the programs the Legislature throws at them. And that’s why you talked about the drug overdose rates going up, alcohol-related deaths went up 73%. And yet there hasn’t been one action taken by the Governor to try and mitigate that, or by the Oregon Health Authority staff. And in fact, what they did was they hit pause on the one thing that OHA was doing, which was launching an alcohol-awareness campaign called ‘Rethink the Drink.’ They indefinitely paused it because senior staff were spending their time reading applications for Measure 110, they said they couldn’t do both at the same time. So there’s just a lack of ‘How do we solve this problem,’ as opposed, ‘How do we manage the problem?’

Miller: Your highest level critique here, which you’ve now voiced a couple times, is that the state, that the highest leaders at the state, and we’ll talk to one of them after you. But you’re really going above Patrick Allen at OHA, you’re talking about the Governor, you’re saying you don’t see a plan to end this crisis. What would a plan to end the addiction crisis look like, if you were going to devise it?

Marshall: We have issued a 12-Step Plan for ending the addiction crisis and people can find it on the Oregon Recovers website. But the first one is create a coordinated response, get the Oregon Liquor Control Commission, Oregon Health Authority, the Department of Corrections, everyone who is in this space, all under one roof, work, driving in the same direction, and look at the taxpayer dollars going into this and making sure that they all are aligned with very specific outcomes, reducing addiction rates and increasing access to recovery. That single sort of coordinated effort doesn’t exist. And then on top of it, there’s no one in charge. We need a Recovery Czar, a Drug Recovery Coach, whatever you wanna call it – someone that reports directly to the Governor who is saying to all of these different agencies, ‘No, you need to do this… You need to do this.’ And then because we lost so much capacity during COVID, so we are down, something like 40% of adult residential treatment beds, 60% of youth residential treatment...we have fewer than 30 youth residential treatment beds that accept Medicaid right now. And then we’ve lost about 45% of detox capacity. There is no one at Oregon Health Authority today who went to work and said, ‘Okay, I’m working with the providers to claw back that lost capacity, let alone increase capacity.’ And what we argue in our 12 Step Program is coordinated effort – one person in charge. But then on top of it, let’s  create 2,000 residential treatment beds that are ‘No Barrier,’ so that the police in Portland or the Sheriff down in Medford, they find someone on the street that they’re trying to work with, they can drive them to a treatment facility. Doesn’t matter what their insurance is. It doesn’t matter what the cost is. They have immediate access to treatment because that’s hugely important. If someone’s ready at a given moment, I can tell you as someone in long term recovery, There was a moment of opportunity where I walked through the door to a treatment center because I had $15,000 I could borrow to do that. We need that ‘No Barrier’ access to treatment and detox, in order to begin to move people into a recovery stream. There is no coordinated… …

Miller:  What role do you think, are you arguing, that Measure 110 money or services provided by Measure 110 money, what role should Measure 110 play in everything you’re talking about?

Marshall: So Measure 110, the people that have applied for it, the organizations are amazing, and I will give OHA credit in that in the last month they’ve begun to approve, to green-light some of those funds. But that money is going to non-Medicaid expenses. So harm reduction programs, access to peer services, the most efficacious way in which to engage people in their recovery. Recovery housing is hugely important as well, here in Oregon. All of that money, but not one dime of it’s been distributed. So one of the things that OHA could do right away..

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Miller: Well, no, $30 million has been distributed. So, 10% has been distributed, right?

Marshall: Ok.

Miller: Not… and that’s,

Marshall:  Sure…

Miller: Which is more than zero cents.

Marshall:  Right. But since December, when everyone applied there, people have been waiting on the allocation of $270 million, that is just sitting in a bank account Oregon Health Authority…these organizations are clear how they’re going to spend the money, they have a track record in doing so, and the

bureaucracy is just keeping it from being distributed. And while they are beginning to say you are going to get this money, one of the next bureaucratic hurdles is going to be, they’re gonna require county by county that the 10 agencies that are getting money have to have a memorandum of understanding between the 10 of them, in order to move on this, before they can receive the money. They need to waive that delay, whatever the case may be, and just get the money into these organizations so they can begin to do the good work. Most of these organizations are amazing and their ability to expand the number of people that they engage, particularly with peer services, particularly with harm reduction is going to save lives and get more people into recovery. It’s not going to fund residential treatment beds or detox beds and we need to simultaneously build that capacity.

Miller: Mike Marshall, thanks very much.

Marshall: Thank you.

Miller: Mike Marshall is a Co-Founder and Executive Director of Oregon Recovers. We’re talking now about Oregon’s addiction crisis and the role that money from Measure 110 can play in addressing it. I want to know, we got a statement from the Health Justice Recovery Alliance, the Statewide Advocacy Organization focused on implementing Measure 110, and reads in part, ‘Measure 110 is the first step in repairing the ongoing multigenerational harms of the war on drugs and investing in the communities that have been most targeted and impacted.  The bureaucratic delays and setbacks are an important part of the Measure 110 implementation story, but the complete story includes the actual implementation that is happening on the ground. Already, the law has averted thousands of arrests, which means that people are no longer being saddled with lifelong barriers to housing, employment and more, with only 10% of the funds out. And in a six month period, the Oregon Health Authority reports that over 16,000 people have accessed harm reduction and addiction recovery services through Measure 110 funding. Soon, the statement says, ‘$270 million more will be distributed to providers across the state, which is five times more than what Oregon spends on these life saving services.’ Patrick Allen joins us now. He is the Director of the Oregon Health Authority. Patrick Allen, welcome back.

Patrick Allen: Thanks for having me.

Miller: I want to give you a chance to respond to some of the specific critiques made by Mike Marshall. But I’m curious first, just to get your overall take on the situation, how would you assess the first year of the implementation of Measure 110 in Oregon?

Allen: Well, I think the really important thing to think about Measure 110, we’ve talked a lot already, about the fact that it accomplishes a really important step by decriminalizing addiction, which is huge. And as you’ve quoted a couple of times, it’s recognized by people as a big step. But I think the other thing that is really important to understand is, it also calls, the ballot measure does, for a complete reinvention of the actual service delivery system. It recognizes that the existing service delivery system was not meeting the needs of people with addictions well, that people weren’t at the table who needed to be, to make decisions. So you talked about the Oversight and Accountability Council and how it’s constructed, and the providers weren’t the kinds of providers we needed to be able to adequately meet the needs of the community. And so part of what the ballot measure did was, it called for the complete reinvention of that system. It feels, and it is a long time since the ballot measure passed, but I guess the other way of looking at it is in just 18 months, the Oversight and Advisory Council has completed that reinvention, and completely changed how we think about how addiction services work in our communities, how we create behavioral health resource networks around the state. We’re now able to put money into the system. I think we at OHA significantly underestimated how difficult a lift that was going to be. And I think in an effort to try to get out of the Council’s way in terms of decision making, we didn’t provide the grant-making assistance that we needed to that could have moved that process along somewhat faster, but money is going out now. We have dollars that have hit the ground in our first behavioral health resource network, last week in Harney County. I think Jefferson County is going to be approved today, by the end of June, we’ll probably have about a dozen counties where dollars are actually going out the door to be able to to meet those needs. So it’s been a big lift and we did this all during a pandemic, which was a huge claim on some of the very same resources to get this work done at OHA.

Miller: I want to give you a chance to respond to the biggest critique made by Mike Marshall. And this is obviously not the first time you have heard this, but that there is not enough from the top down accountability and oversight of the addiction crisis facing the state from OHA or from the Governor. What’s your response?

Allen: I can speak to the work that we’re doing at OHA and people talk about accountability, and they mean all kinds of different things and I don’t know exactly what we’re looking for here. What we’re trying to do in this space is identify what are our shortcomings and weaknesses and how do they fill those, both with the work that we do and with resources. The Legislature made a historic commitment in its last two sessions to behavioral health generally, and we’re working really hard to not only get those dollars out the door, but to do it in a way that really looks wholistically at the entire behavioral health system, including addictions, to try to identify what those gaps are and fill those gaps and do that work. It’s a big lift and it takes horsepower here at the agency to be able to do that. When I got to OHA, I found a behavioral health program that was sort of scattered and kind of really reduced to a little bit of a shell, and we had to take some time to rebuild that system. Again, the pandemic has been a huge impact on doing that work as well. My Behavioral Health Director spent six months in 2020 focusing work on how to save lives in long-term care facilities during the pandemic because that was the most important thing to do at the time. We’re still coming out of that work, and we’ve been able to reallocate staff, but we’re very much focused on trying to identify what are the most significant gaps and how do we fill those gaps in this overall system?

Miller: When Oregon voters overwhelmingly said yes to Measure 110, removing drug abuse from the criminal justice system was absolutely a part of it, as a sense we’ve gotten in covering it. But I also think that many people did so because they thought this would lead very specifically to more treatment for drug and alcohol abuse. But when we look at the numbers of just the first ten percent (10%) of  the money for the current biennium that has already been then sent out and the data from the state about what that was spent on, about 60% of it was harm reduction programs like needle exchanges or Naloxone distribution. Less than 1% of those helped with that first batch of Measure 110 dollars, entered treatment. I’m curious, how you think about the balance overall, of what this particular big pot of money, what it should go towards?

Allen: Well, a couple of things in terms of the balance, I think it’s tempting to look at the first dollars out the door and assume that they’re going to describe the pattern of how money will be spent for the long haul, and I think that would be wrong. The measure calls for behavioral health resource networks and requires that they provide a full spectrum of the services necessary in this space. And so that includes residential treatment capacity, detox capacity, harm reduction, the things you’ve already talked about; all of that is necessary, to be able to do this system. But I guess the other point is, in some sense, what I think isn’t necessarily as important as what the community and the providers think, that’s a big piece of what this ballot measure did in creating the Oversight and Accountability Council. That’s not a nice group of volunteers who provide OHA advice. That’s a group charged with the actual decision making for this program. And that’s a really important and valuable thing to do. When we talk about health equity, we talk about allocating and reallocating resources and power. Who’s at the table? Who’s making decisions? And are those the people most affected by the decisions that are being made? And this is one of the first big attempts to do that. And it really makes a difference to be able to have people at the table who come from the communities most impacted by these decisions.

Miller: What have you learned at the state in terms of the best way to support this Council? Without taking away their autonomy and power to make the kinds of important decisions you just outlined, because you, yourself, said earlier that in retrospect, you had perhaps too much of a hands-off approach as an agency in terms of supporting them. I guess I’m wondering how you support them without stepping on their toes?

Allen: Yeah, it’s a very fine line to walk and I think we’ve been getting better at it as we’ve gone by over time. One example that maybe doesn’t sound like a big deal, but it’s operationally proved to be huge is, as we’ve gone through these over 300 applications from providers to be part of behavioral health resource network for Burns, our staff – and we’ve allocated a bunch of staff to do that work – came primarily from pandemic work,  make recommendations to the Council. We managed to get the Council to agree to divide itself into two sub-committees to be able to divide that work. So the whole Council didn’t need to review each and every application from each and every, every provider out there. That was the kind of thing that would have been hard to do. I think six months ago, until we had built enough trust between the Council and staff to be able to make recommendations that, that they understood were rooted in in a sense of how do we get this work done the way that’s most effective for Oregonians, and not rooted in a sense of ‘we’re trying to take power away from them or usurp their ability to make decisions,’ and its individual steps like that, that I think we’ve gotten better at and will continue to improve over time.

Miller: One of the specific points that Mike Marshall made near the end of our conversation just now was what he sees as the next potential bureaucratic chokepoint, or something that could delay money actually arriving in individual counties and in the coffers of individual Service Providers, which is the ‘County by County Memorandum of Understanding’ that he says has to be signed before the money can actually go out. He says it’s time to to waive that somehow – is that something the state is considering?

Allen: You know, I agree, at least in spirit, with an awful lot of what Mike said during that segment, but that one he’s just way off base. First, there are in some counties, dozens of these providers and they’re supposed to function as a network, not as just simply a collection of providers. And so it’s not enough to fund an individual entity that’s providing recovery beds. They need to understand how they fit within that larger system of services because you need to treat people with addictions wholistically, looking at the whole range of services they need, not just the one particular service at a particular provider is engaged in. Secondly, and even more important, probably most counties’ applications totaled more than the dollar amount that was allocated to that county. And so part of what needs to be negotiated in that MOU [Memorandum of Understanding]  is how are those budgets going to be adjusted so that you come in within the amount of money that’s available, but still provide wholistic set of services that meet the needs of people with addictions in that County.

Miller: Patrick Allen, thanks for your time today.

Allen: Thanks for having me.

Miller: Patrick Allen is the Director of the Oregon Health Authority.

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