Frustrations mount as hundreds of millions of dollars set aside for Oregon’s underfunded drug and alcohol treatment and recovery providers continue to sit unspent in state coffers.

When voters passed Measure 110 to decriminalize the possession of small amounts of illicit drugs such as methamphetamine and heroin, they diverted marijuana tax dollars to a grant program to fund treatment and recovery services across the state.

But the lion’s share of that money for the current two-year budget cycle — $276 million — has failed to reach providers.

At a meeting Friday morning, the community oversight council tasked with distributing the funds once again voted on an extended timeline for distribution. The grant award letters were initially supposed to go out to providers the second week of January, but were delayed repeatedly while grant applications remain under review. As it stands now, grant dollars are estimated to begin rolling out the door, county by county, starting in June and ending in October, according to state estimates. 

Stakeholders say it’s the state, not the community council, that’s to blame for the hold-up, with the most prolonged delay occurring after the Oregon Health Authority took over the grant application evaluation process. Meanwhile the state says the unprecedented number of applications require careful review. But with more than 100 staff assigned to the project over the past month, those interviewed for this story say the state should have made more progress.

The delays pose challenges for many small providers that were counting on the money to sustain their services as they struggle amid behavioral health workforce shortages and a statewide addiction crisis.

With nearly 650,000 Oregonians aged 18 and older estimated to struggle with addiction, the state ranked second worst for its rate of substance use disorder and dead last in the nation for its access to drug and alcohol treatment, according to data from the U.S. Substance Abuse and Mental Health Services Administration. Meanwhile, the rise of fentanyl across the state is making addiction deadlier. Overdose deaths in Oregon rose 41% last year, according to the Centers for Disease Control and Prevention, compared with a nationwide increase of 16%.

“People are dying every day, and we just can’t wait any longer to get this money out,” said Tera Hurst, executive director of Health Justice Recovery Alliance. The alliance is a statewide coalition of social service, health care and social justice nonprofits advocating for a timely and successful implementation of Measure 110.

Small Providers Struggle Amid The Delays

After Oregon’s drug decriminalization law went into effect in February 2021, the volunteer Measure 110 Oversight and Accountability Council oversaw the speedy distribution of $31.4 million in initial grant funding.

But for much of the past 12 months, the council has met on Zoom weekly, sometimes more, to create a more involved grant program from scratch that’s designed to follow through with the law’s call for coordinated treatment and recovery networks in each region of the state. 

Some providers began expanding when they received funds last year, expecting that money to sustain that growth would be available much sooner.

One of those providers is the Miracles Club of Portland, which offers addiction-related peer services and housing to the Black community. Its executive director, Julia Mines, told The Lund Report that if the group doesn’t receive the Measure 110 grant the nonprofit applied for by the end of June, it will lose a six-bedroom house it recently purchased as transitional housing for Black women. Mines said she’ll also have to lay off five new staff members, out of a total of 13 staff who work for the organization.

The Miracles Club applied for $2.4 million in the current round of Measure 110 grant funding, which would sustain those services, grow its housing program and help it expand to Washington County. While Mines said she was among the nonprofits who received extension funds from the state to help get her through, that money runs out in June, and she’s already had to borrow $10,000 from another organization.

“Miracles has been around for almost 30 years — always been underfunded, struggled to keep the lights on to pay the telephone bill, to pay employees,” Mines said. She worries that if she lays off staff amid the current workforce shortage, “somebody’s going to snatch them up like that, and I can’t get them back,” she said. “I paid to get them trained and everything, and then I’ve got to let them go because you guys don't want to get the money out the door? You know, what a burden that would be for Miracles? It would be traumatic, and we’re not going to be able to keep our head above water.”

Mines and Hurst raised their concerns with top Oregon Health Authority officials — agency director Pat Allen and Behavioral Health Director Steve Allen — earlier this week. During that meeting, Hurst said they learned that one of the health authority’s models for finishing the awards process had funding being distributed as late as December and January.

“That was heartbreaking, and frustrating,” Hurst said.

Steve Allen explained in February — when The Lund Report first reported on the delays and dysfunction undermining Measure 110 efforts, that the program is transformational, and thus takes thought and time. But, he said, the goal is to get money in the hands of community providers.

Hurst argues that if the money continues to sit unspent, there won’t be any small, community-based providers left. She said it’s as if the health authority is “creating a process that only benefits people with budgets that can withstand this.”

Mines agrees, saying other small providers are also struggling while the need for them is dire.

“They’re dying out there,” Mines said. “This COVID hit, people are isolated. They’re homeless. They’re not getting the services that are needed.”

But some larger nonprofits, such as Portland’s Central City Concern, are also limiting services as they wait on funds. Its spokespeople told The Lund Report in a statement, “Further delays in M110 funding will affect the mental health of nearly 1,400 (Central City Concern) clients who’re in critical need of the services we offer. Additionally, today CCC has empty beds desperately needed for those in recovery which cannot be filled without M110 funding.”

Following the initial round of grants last year, Max’s Mission in southern Oregon attributed the reversals of more than 100 overdoses to the grant funds that allowed for the distribution of naloxone, which reverses opioid overdose. Now, Hurst said, some providers are running low on the life-saving drug.

Fingers Point At The State

Measure 110 gave people from communities harmed most by the War on Drugs control over the law’s grant program and the distribution of the more than $300 million in marijuana tax dollars that flows through it every two years. The 18 voting members of the Measure 110 Oversight and Accountability Council include people experienced in drug and alcohol treatment services, drug policy research, advocacy and other related areas. They are diverse and representative of impacted communities. Most members are in recovery from substance use disorder themselves, and many have been incarcerated. But they lack experience facilitating grant programs like the one they’re tasked with designing and executing.

Hurst said that’s why the council was paired with Oregon Health Authority, which is experienced in grant making.

But the health authority, Hurst said, “in our view, and from watching this as close as we watch, it has not staffed this council and has not given this council the tools that they need to be able to get through this process.”

Most recently, problems arose when the agency repeatedly sent grant application evaluations back to council members to re-do, saying they were incomplete. Eventually the work became too burdensome for some of the volunteer council members, many of whom have full-time jobs and other obligations.

“There were over 300 little boxes we had to fill — some were irrelevant, but they are requiring we put an answer there,” council member Amy Madrigal told The Lund Report.

The Oregon Health Authority took over the grant evaluation process, assigning 138 agency staff members to the project, according agency spokesperson Aria Seligmann.

That was a month ago, and since then, 11 council meetings have been canceled because evaluations were not complete.

This has caused confusion and frustration among council members, who are eager to get the funds to providers.

“A hundred (staff), and they can’t get them done in 30 days. That’s real embarrassing,” council member Morgan Godvin said. “I do not understand why so many meetings have been canceled, and the answers presented to us were not satisfactory.”

The state’s communication with grant applicants has been slow, with providers often learning that awards are delayed within days of when the award letters were supposed to go out.

There are 333 entities that applied in about 281 applications seeking more than $400 million in funds, and each one needs two reviews. The state accepted 184 reviews from the council, and as of Friday, had completed 140 on its own. Now, just over half the application evaluations still need to be completed, according to data shared during the council meeting Friday morning.

The many meeting cancelations and the hold-up with evaluations, said the health authority’s Seligmann, have been “due to the unprecedented number of applications received and the amount of time it has taken to evaluate each application in a deliberate, careful way to ensure the (Oversight and Accountability Council’s) values are maintained.”

She said each review takes several hours, but the process “is necessary to ensure we are carefully centering equity and considering each component of the services that will be provided to transform our system of care.”

But Hurst said she’s heard from providers that the state’s thoroughness is not surprising. “This is what happens when money goes out to communities of color,” she said. “All of a sudden, everybody wants to dot i’s and cross t’s even more, and we knew this was going to happen.”

Award notices to providers in Morrow and Baker counties will be sent out by the end of next week. The next counties to be voted on are Umatilla, Union, Harney, Gilliam and Grant.

Polk, Klamath, Lake and Jefferson counties are each one review away from being completed. Portland metro counties will be reviewed last.

But that money can’t go out soon enough, according to council member Madrigal, who works as a mental health specialist in Pendleton. She said there were four overdoses during a single day in Oregon’s sparsely-populated Umatilla County last month. 

“I have lost five friends in the last three months to fentanyl overdoses, and I’m tired of people dying needlessly,” she said. 

While proponents of drug decriminalization say it’s too soon to judge the success of Measure 110, Godvin stressed that there’s not much to judge while funds languish. 

“The important context,” Godvin said, is that “90% of the funds are currently tied up in bureaucracy, and we are out here on the ground, watching our friends die.” Godvin works in treatment and recovery services as the founder of Beats Overdose, a harm reduction provider.

As the council discussed the best pathway forward Friday morning, Godvin expressed concerns about Multnomah County applications being nowhere near completion.

Steve Allen said the state was evaluating the largest counties, including Multnomah, last because those counties had the most applications.

“Could I get OHA to accept a little responsibility?” Godvin asked. “I know harm reduction and drugs. That is my wheelhouse. That is why I was appointed to the council. I don’t know grant making. That was OHA’s duty, but you did not fulfill it, and the goalpost just keeps moving. And I have whiplash trying to keep up with this. But at no point, do I hear an acceptance of responsibility from OHA.”

“I hold myself accountable,” said Allen. “In terms of lessons learned and mistakes made, we certainly have made our share of those,” he said of the agency. “After we get through this next phase, I think there’s lots of opportunity to kind of look back and take a look at lessons learned, what we as an agency could have done differently to support you better along the way.”

The council ultimately voted to move forward with an option for completion that Oregon Health Authority estimated will get the funds out quickest. While it’s estimated money will get into the hands of providers from June to October, the timeline is not fixed.

After Friday morning’s meeting, Council Tri-Chair Blue Valentine told The Lund Report that members of the council are dedicated to completing the process as quickly as possible, and that things will be streamlined as the state works out the kinks.

“We have two dedicated subcommittees that are ready to put in the time to really try to move as fast as we can to get these applications reviewed, approved, and get money out the door,” she said. “Everybody is ready to move forward.”

But if all the funds don’t get out by June, Hurst said the members of her statewide coalition are ready to “make some noise. 

“The voters, especially when it comes to services, they were overwhelmingly in favor of Measure 110 and getting services set up,” Hurst said. “And they gave OHA a river of money to do that. Money is sitting there. … it’s not helping anyone, and communities are languishing.”

We’re tracking the implementation of Measure 110 and its impacts on the behavioral health care system in Oregon as part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. If you have a tip or comment that you think would be helpful, please contact Emily Green at [email protected] or enter your tip into this form.