A new audit from the Oregon secretary of state’s office found that the implementation of Measure 110, the drug decriminalization ballot initiative, faced a number of challenges with unclear results. The audit notes that despite the roughly $800 million dedicated to programs aimed at helping in-recovery and substance-use treatment, the outcomes — including the number of people served — are unclear. Beyond that, the audit also says frequent revisions “undermined confidence in the program.” Secretary of State Tobias Read joins us to share more on the audit and M110.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The vision laid out in Oregon’s Measure 110 to replace the criminalization of substance-use disorder with a public health approach remains unfulfilled. That’s the big finding from the latest state audit of the voter passed program. Auditors from the Secretary of State’s office said that Measure 110 has been hamstrung by persistent structural and operational weaknesses across Oregon’s behavioral health system. Tobias Read is Oregon’s Secretary of State. He joins us with more details. It’s good to have you back on the show.
Tobias Read: Thank you, Dave. Glad to be here.
Miller: Lawmakers fundamentally changed Measure 110 last year when they recriminalized the possession of small amounts of drugs. Given that, what does it even mean to audit Measure 110 right now?
Read: Well, I think there’s an urgent issue here. This question of substance use disorder affects everybody in Oregon, communities, individuals, the state as a whole. We have to make sure that the policies that we are pursuing are well designed, that tax dollars are being used effectively, and that’s the job of the audit – to narrow the gap between good intentions and great execution, and we stand by the very common sense recommendations we make in this audit and we want to make sure that we’re delivering for Oregonians who need and deserve progress on a critical issue.
Miller: I want to turn to some of the specific problems that the audit highlighted, and I should say this is, if I’m not mistaken, this is the third audit done by the Secretary of State’s office as asked for by the legislature. One of the problems you highlighted, it has to do with grant guidance and oversight. What did your office find?
Read: We talked about the need for consistency and efficiency in those processes. I think one of the common themes throughout the audit and in a place where we have to just continue to improve those processes. There’s a lack of consistency. There’s a lack of long-term thinking. There’s a lack of coordination throughout the program, and that’s what we’re really about highlighting in this audit.
Miller: What has that meant in practice?
Read: It’s meant that we have not paid off the promise of this program, and the fact that we are not in a place where we can evaluate progress, I think, speaks to the need to devote consistent attention to this question.
Miller: The audit found that the Oregon Health Authority did not integrate the Measure 110 provider network into the broader system of care. What does that mean?
Read: It means that in order to be effective, there has to be connections between providers and the rest of the behavioral health system, and we’re seeing, as I said, a lack of coordination. There’s not the places where people are talking to each other. As people who are dealing with addiction, as people who are providing services, those things are separated. They exist in silos to a degree that it is hampering the ability of people to get into treatment, to get into recovery, that’s what we’re trying to produce here. We need that kind of long-term strategy to give ourselves a chance, and it’s urgent. You don’t have to look around and think very hard to see the impact when we’re not taking this seriously. People are not safe in communities. People’s lives are being affected. Communities are not living up to their full potential, and we have to be urgent about this.
Miller: What did the auditors find in terms of data collection?
Read: Not enough, frankly. In order to know where we are going and if we are making progress, we have to know where we have been. And it’s true that things have changed over the course of this program, but in order to be able to talk to Oregonians in a common sense way and say you are getting what you need and want from your tax dollars. We are doing things well. We have to be able to compare data. That I think is a self-evident thing, whenever we’re doing something new, we’ve got to know what’s changing and what’s not, and that should be based on data.
Miller: This was one of the areas where the Oregon Health Authority, which did agree to most of the recommendations put forward by your office, where they did push back. Specifically, your office said that they should include data about whether or not Measure 110 programs have led to a decrease in overdoses, and they said, if I understand correctly, basically two things. One, that the legislature removed that requirement from them. And two, and I think maybe more importantly, that it’s too complicated a question to answer in a simple way, that one single program can’t be responsible or seen as responsible for lowering overdoses. And fentanyl, which arrived sort of simultaneously with this big policy change, that upended things and created so much havoc and so many overdoses that that alone sort of invalidates the need for this particular data analysis. What’s your response?
Read: Well, there’s a lot in your question, Dave. I think fundamentally the question is not about legislative mandates. The question about is whether we’re doing this work well, whether we are producing the results that we want, whether more people are getting treatment, whether more people are in recovery, whether less people are dying, are we saving lives is the question. And if we can’t do that via data, I don’t know what we’re doing.
Miller: I was struck by one of the pieces that you’ve pointed out, that your recommendations don’t require new resources, new public money. What changes are you saying can be made without spending a single new penny?
Read: We have to track data. We have to communicate with all of the various elements that are responsible for a program like this. We need consistency from the legislature. We need long term thinking. And another way of saying this - if we are constantly changing directions, we cannot expect to get very far.
Miller: When you say constantly changing directions, are you laying that blame at the Oregon Health Authority or at lawmakers who three or four times, sometimes very significantly, sometimes with tweaks here and there, they have really changed this voter passed law.
Read: The answer to that question is yes, both. Anytime we’re changing those directions, whether it’s policy or implementation, we run the risk of slowing progress, and this is a place every Oregonian needs progress. Lives are at stake here. Communities are at stake. The economy is at stake, and we need leadership to make sure that we are making the progress that Oregonians need and deserve. This is a decades in the making problem and we’ve got to get serious about it.
Miller: The end point of this audit, the end of the time period that you looked at was, if my math is correct, just about six months into the introduction of the new paradigm in most of the state, which is these county deflection programs. So it’s a limited amount of time for your office to look into them, but what did you find broadly in terms of how deflection is working?
Read: This audit is focused on the role that OHA has, and it’s a legislatively mandated timeline, so I wouldn’t pick that, but I will say we found that the deflection progress is uneven. We’re going to continue to look at this program as we think about what our audit plan is going to look like going forward. We don’t have the assets to do every audit that someone might come up with, but this is a place where real lives are at stake. We will make sure that we’re monitoring this. It’s a question of choices that counties are making with respect to deflection, but this is, there’s more than enough questions to continue to monitor when it comes to something like substance use disorder and the state’s response to it.
Miller: There are so many different players here. I just want to look at them before we say goodbye, at the biggest picture because the biggest focus in terms of places where changes can be made rests with the agency that is overseeing the majority of this, the Oregon Health Authority.
We also talked briefly about the lawmakers who have changed this law a number of times and then now with the county level, there’s deflection programs, but this was a voter passed law to start with, something like six in 10 Oregonians approved this, including some aspects of the system that your office has found problems with. For example, the duplicative nature of the behavioral health networks that, before voters said yes to this, critics looked at Measure 110 and said, wait, why are we doing a new system? This doesn’t make sense. So some of these things people talked about before voters said yes. I’m curious, in the big picture, how much you look at the problems of Measure 110 and say, this is a problem with voter-passed initiatives?
Read: Well, it’s a different question there, I suppose. If we want to talk about how initiatives work, that could be a week or a month of Think Out Loud. Our job here is to evaluate where we are, and it is hard to evaluate this policy when implementation has not really lived up to the expectations. I think bold ideas are good, but implementing those ideas is just as important, if not more important. That’s what this review is about, the implementation of a policy, and we could have a separate debate about whether that policy is a good idea. We’re evaluating the implementation here.
Miller: I take your point. It is a separate issue, but let me just try one more time. We live in a state that has been, historically, very reliant on experimenting with policies at the voter level and has this experiment, which got a lot of nationwide attention, has it made you as an Oregonian, as an elected official for a long time, made you think about voter passed initiatives in any different ways?
Read: Interesting. I haven’t considered it so much, but I think this is a much broader philosophical question. I think we, in state government and government generally, need to be faster at starting and trying new things, and we need to be faster at admitting when something doesn’t work and changing course. That’s what excites me about the role I have, as state auditor, to try to narrow that gap between good intentions and great outcomes and be able to say this is not working, let’s change course.
Sometimes voters will be able to do that. Sometimes the legislature, sometimes somewhere else in the executive branch. But a good policy is not worth anything if it’s not implemented well. If the state can live up to the people’s visions, that’s fantastic. That’s what we need to be promoting and celebrating. And when it’s not, we need to hold people accountable and change direction so that Oregonians get the results that they need and deserve. And in this case, it’s particularly acute because people are literally dying.
Miller: Tobias Read, thanks very much.
Read: Thank you.
Miller: Tobias Read is Oregon’s Secretary of State.
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