On February 1, 2021, Oregon became the first state in the nation to decriminalize drug possession, after ballot Measure 110 passed in November 2020. The two-fold mechanism reduced what had been deemed misdemeanor amounts of drugs to “civil violations,” similar to a traffic ticket, and simultaneously diverted the lion’s share of cannabis tax revenue to fund substance use services statewide. Per the law, the funding priorities are: harm reduction, peer services, housing, low-barrier substance use disorder treatment and supported employment.
Those funds were not to be issued piecemeal to a variety of siloed and disconnected providers, but rather to new, unified Behavioral Health Resource Networks (BHRN) in each county. The BHRNs would be comprised of individual organizations, each providing one, some, or all of the services.
However, an early allocation by the legislature meant that the first round of grants went out ahead of schedule and were not mandated to go to BHRNs. These “Access to Care” grants were issued in summer 2021. The request for BHRN grant applications was released that fall, with funding initially slated to go out by the end of 2021.
The process was unique from the start, and painful at times.
For a variety of reasons, that didn’t happen. Wanting to break from the status quo of government divestment and inequities, Measure 110 intentionally gave the power of grant review and distribution to the newly-formed Measure 110 Oversight and Accountability Council. This was to comprise 21 directly impacted Oregonians and experts in the field, including harm reduction.
In January 2021, I was appointed to the council—checking the boxes of harm reductionist, drug policy researcher, and formerly addicted and incarcerated person. With unprecedented racial and ethnic diversity for an Oregon statewide governmental body, and several of us formerly incarcerated, the council was handed the reins to determine funding priorities and oversee implementation of the law.
The process was unique from the start, and painful at times. The size of the group and the open-ended nature of the task produced occasional conflict and frequent delays. Yet progress was made, steadily. Instead of using previous government boilerplate requests for grant applications, we drafted one from scratch, with most councilmembers contributing. The Oregon Health Authority (OHA) provided us with very little guidance or feedback, however, despite the fact very few of us had grant experience. We created something of a Frankenstein’s monster, with disparate parts cobbled together as many people penned in their two cents.
The council also made the scoring rubric to gauge grant eligibility from scratch, without OHA advice. The result was a 300-cell spreadsheet with questions that did not always closely align with the applications.
Well over 300 entities applied, and they received sometimes conflicting advice on how to construct their applications. Dozens of harm reduction providers, grassroots organizations, and culturally specific organizations applied, which is of itself a win. Harm reduction was weighted equally to other services, a rarity in such a process. As councilmembers began evaluating requests, trouble soon arose.
The sheer labor of the task was monumental; as a volunteer, I was expected to spend a total of approximately 60 hours reading grant applications and filling out their rubrics. The spreadsheet was unwieldy and had many inapplicable cells; I ended up leaving much of it blank and filling out what I felt were the most salient points. The state considered it to be incomplete, even after I went back through multiple revisions, in a process that ended up taking well over 100 hours of my time.
It was unsustainable. So eventually, OHA staffers were tasked with reading each grant application and filling out its accompanying rubric. Each application was reviewed by two people. But the unwieldy nature of the rubrics’ spreadsheet as well as the nontraditional (and also unwieldy) grant applications led to further delays. Soon, Access to Care grantees were running out of money, forcing the OHA to offer them extensions out of other funding pots just to ensure continuity of care.
Evaluations finished months behind schedule. Still, for a first-of-its-kind process, it is remarkable that we have now allocated $270 million.
Finally, our council split into two grant review subcommittees in order to expedite the evaluations, meeting twice a week for four hours each time, in addition to the regular council meetings. The reviews are now complete—this dashboard provides an overview—and the grant recipients have been mailed “letters of intent to award.” The process now moves into government contracting, which can itself be onerous.
The evaluations finished several months behind schedule. Still, for a first-of-its-kind process, it is remarkable that we have now allocated $270 million (the available cannabis tax revenue for the current two-year budget) to substance use services.
The current funding cycle spans through December 31, 2023. The application process will resume in 2023 for the next cycle, but will likely be substantially revised and refined. The first time, with no precedents to lean on, is always the hardest.
Each county must have all services present—again: harm reduction, peer services, housing, low-barrier SUD treatment and supported employment—to be considered a full BHRN. The OHA will conduct outreach and direct awards to fill any service gaps across the state.
Outreach, in terms of providing information on services available through Measure 110, is a mandated component of all BHRNs. But currently this task is most often falling to police, which will widely be viewed as problematic, due to a lack of other resources.
Unlike the form of decriminalization just announced for British Columbia, drug possession in Oregon sees police officers still writing citations, with the power to confiscate someone’s drugs. And thresholds are regrettably set low, with anything over 1 gram of heroin being an arrestable quantity.
In practice, very few Oregon jurisdictions are seeing many citations for amounts below the thresholds. To waive the $100 fine for a citation, a person must call a phone number and undergo a behavioral health assessment, which offers connection to services but does not mandate it. Once BHRNs are fully established, this hotline will be joined by brick-and-mortar services, and the decision whether or not to continue the phone line beyond its current contract will be brought to the council. One critique of Measure 110’s implementation is that most eligible people are not calling the hotline; people who have just been cited by police are wary of calling any number they provided.
Another issue is that fentanyl was not originally scheduled in Oregon’s Revised Statutes to reflect Measure 110—meaning that when misdemeanor quantities were reduced to civil violations, fentanyl was not included. This omission was rapidly rectified with the passage of Senate Bill 755 in summer 2021, but rumors on the ground abound that you can still be arrested for small-quantity fentanyl possession, even though this is not so.
Law enforcement regularly lament the lack of punitive and coercive options, and cite it in their ongoing opposition to Measure 110.
Police mostly can’t be bothered with writing a citation when little will come of it; beyond a citation and request to call the hotline, there are no further coercive measures built into the law. A failure to pay the $100 fine does not result in an arrest warrant, license suspension or other punitive consequence. Law enforcement regularly lament the lack of punitive and coercive options, and cite it in their ongoing opposition to Measure 110.
After years of ranking last, or next to last, in access to substance use disorder treatment services, Oregon has a long way to go to even be brought up to average. This biennium’s $270 million is a great start; the next biennium’s allotment will be bigger. Outreach into communities of people who use drugs, as mandated by the BHRN grant funding, will disseminate information about which new services become available—and when this information is delivered by credible messengers, as opposed to police, uptake in services should increase.
For the majority of Measure 110 services, abstinence is not a requirement—though it can be, and often is, the self-chosen goal of the participant. We did fund a substantial amount of recovery housing, where drug use is prohibited, but tried to ensure that people who resume using drugs will not face sudden homelessness. While some frontier counties (a designation that means population density is well below standard “rural”) simply cannot sustain the same level of services, in most counties Housing First options will be present.
If a person chooses recovery housing that requires abstinence (medications for opioid use disorder are universally permitted without exception) but then starts using drugs again, they will not be immediately evicted. If they continue to use and no longer qualify for recovery housing, the memoranda of understanding with other organizations that provide Housing First models or shelters should ensure a ready alternative. In practice, there may be kinks, but the goal to have roofs over heads no matter what is central to Measure 110 values.
Another critique within the Portland metro area has been people’s objections to public drug use. This was never particularly rare before Measure 110, although the pandemic accelerated houselessness and severely impacted the economic core of the downtown area, with up to 100,000 office workers no longer commuting in. With a reduction in city sweeps of encampments, homelessness became more visible, much to the ire of many housed Portlanders. Drug use in some public spaces is inevitable when so many people don’t have private spaces. Safe consumption sites would be a sensible and lifesaving response, but opposition and legal challenges remain before these can be opened in the state.
With dedication and the right support and coordination, things will improve from here.
Unlike the vast majority of medical care in the United States, the BHRNs will truly be a coherent network, with each entity having memoranda of understanding with all other funded entities in that county that form the BHRN. All services are free-of-charge, though Medicaid must be billed whenever possible so that funds stretch further. Innovative interventions such as peer mentoring, contingency management, housing stipends for peer workers, drop-in and recovery centers, and more are all being supported with Measure 110 funds, which are relatively unrestricted.
The goal is to increase capacity by funding infrastructure projects as well as direct services. There is a nationwide behavioral health workforce shortage, but Measure 110 funding requires that staff are paid living wages. With a living wage comes higher levels of retention. As housing costs spiral, other innovations, such as housing stipends, become more and more important to the future of the workforce.
So yes, implementation of Measure 110 has been bogged down and beset by challenges. But thousands of people have already accessed services that weren’t previously available, and with dedication and the right support and coordination, things will improve from here. Thousands of Oregonians have avoided drug arrests and subsequent criminal records since the passage of the law, an obvious success. First rule, do no harm. Secondly, begin the healing process. That process will take years, but it has now begun to reach full swing.
Photograph by Ian L via PublicDomainPictures.net
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