This is a transcript of a recent episode of Think Out Loud on Oregon Public Broadcasting. You can listen to the episode here.
It’s now been almost two years since Oregonians passed Measure 110. That ballot measure decriminalized small amounts of illegal drugs and directed more money to addiction recovery services, but it has taken a long time to distribute those funds. The bulk of the money for the first budget cycle has finally been distributed to a wide variety of service providers.
Some have blamed the measure for what they see as an increasingly lax response to drug use on Portland’s streets. Others have criticized it for failing to fund sufficient residential treatment options. And those who opposed the lack of punishment for drug use that was ushered in by the measure still think it’s not working.
But more than 16,000 Oregonians have gotten help they wouldn’t have received without the measure, according to Tera Hurst, the executive director of the Oregon Health Justice Recovery Alliance. The alliance is an advocacy organization focused on successfully implementing Measure 110.
Hurst urged people to have patience as the newly funded programs are able to make use of the newly stable funding stream.
“This is five times more money than we have put into these types of services before, as a state,” Hurst told Think Out Loud host Dave Miller. “There will be transformational changes from it, but we do have to give it time.”
The following is a transcript of their conversation, edited for length and clarity.
Dave Miller: Why did you support Measure 110?
Tera Hurst: As a person in long-term recovery, and with a lot of friends and family in my community, I recognize that substance use is not something that should be treated as a criminal justice issue, but really needs to be treated as a health care issue.
The war on drugs that has been going on for 50 years has been a failure. It has been not only ineffective for getting people into recovery, but really saddles them with lifelong barriers to housing, employment and education, and that just exacerbates the problem.
Measure 110 is shifting to a health-based and science-backed approach to substance use, and that’s why I think it’s such an important law.
It will also have a huge impact on those communities that have been most impacted by the war on drugs. In Oregon, we know that’s our Black, Latino, Native, Indigenous and tribal communities.
Miller: I think that what a lot of Oregon voters thought or assumed they were voting for or getting was a measure that was going to trade investments in jail for investments in residential treatment. But it seems like what we’re actually getting is different from that.
Hurst: Yes. There’s kind of a societal misconception that residential treatment is the only kind of treatment and anything else is an aside. That’s a narrow definition of the types of services that people struggling with substance use actually need. And so what Measure 110 does is it funds low barrier treatment services, which for one person may mean intensive outpatient services combined with supportive safe housing and a mentor. For another person, it could be that they need medication-assisted treatment combined with peer support.
So what Measure 110 does that I think absolutely honors the will of the voters is it meets people where they’re at and it connects them with the resources they need.
Those services are only sometimes residential. There’s no wrong door to treatment. There’s no wrong door to services. And the cost will no longer be a barrier because Measure 110 makes sure that cost isn’t a thing that keeps somebody from getting the services they need.
Miller: Have you already seen an increase in people who are accessing services or treatment?
Hurst: Yeah. We were able to get an early infusion of funds in the second part of 2021. What [the Oregon Health Authority’s] report found was that 16,000 Oregonians were able to access services due to these new funds.
This was about $30 million, which is only 10% of the funds that are getting infused now.
It’s an incredible amount of people served in such a short time, and we should get new numbers about what the latest access to care grants were able to do by the end of this year.
Miller: And what about the broader projections once more of this money, the biggest slice of it, has actually been distributed? I’m thinking about the kind of treatment options that maybe people in the past may have associated more with drug treatment, detox beds or residential treatment beds, and also the kinds of services or harm-reduction services that you say we don’t think enough about.
How many more of these options should be available, or will be available a year from now?
Hurst: It’s hard to say exactly a year from now. What I can tell you is that we had about $260 million that is going out to the community and has been going out since about June. And it’s about finished. We only have two counties left out of 36 that have not finalized their agreement and had the money go out to their accounts.
That being said, what they’re setting up are these things called “behavioral health resource networks.” There will be at least one network in every county. These will be a network of providers who are predominantly community-based providers who are able to offer the services that people need.
If you look at an organization like Core, which was one that you had on your program not too long ago — they serve in Lane County. Their grant is about a little over a million dollars and they’re one of the only harm-reduction distribution programs for youth in the state of Oregon. Research shows clients engaged with harm reduction are five times more likely to enter treatment and about three times more likely to stop using drugs than those who don’t use these programs.
They’re also going to be able to get a permanent space – this is a program that operated out of tents and in parks. Now they’re creating an advocacy center for youth in Eugene and they will be providing programming anywhere from art therapy classes to resume and other life skills workshops.
The Miracles Club, which is operating in Washington and Multnomah County, the 110 fund will create 18 new transitional housing beds. And this includes the first and only transitional housing for LGBTQ+ African American women in recovery. They’re also going to be able to expand their street outreach efforts in Multnomah County and have a new presence in Washington County.
Bridges to Change got over $13 million for services in four counties: Clackamas, Multnomah, Washington and Wasco counties. And that grant is going to fund 202 new supportive, low-barrier housing beds. Bridges is also going to be able to hire 67 new staff to expand their outreach.
Miller: We talked again about the enormous problems that meth, in particular, is causing in Oregon. We also heard that there doesn’t seem to be a concerted statewide effort to respond specifically to methamphetamine addiction.
What is Measure 110 going to mean for meth addiction?
Hurst: What we do know is that “contingency management” is an intervention that has been shown to be really effective for folks with a methamphetamine addiction, and it is one of the services that is now being funded through Measure 110.
Contingency management at the core basically encourages and incentivizes folks to stay off of meth by offering, sometimes financial, incentives to have a clean drug test. And there’s a lot of documentary research that shows that this really is one of the only effective ways to get people started on that path to recovery.
Miller: And you’re saying that there’s going to be more access to services like this directly as a result [of Measure 110]?
Hurst: Measure 110 creates flexibility for these types of programs that we know are evidence-based and trauma-informed, and we’re able to have the flexibility to get those up and running.
It is also stable funding. This is not just for this biennium. That means that people and providers can get these programs up and running and then also know that they’re going to have the stability of funding to be able to keep them going. We can’t keep asking our providers to do these things without stable funding. And that’s really how we’ve been operating as a state, which is why we’re 50th in the nation on access to services.
I just want to make sure that we’re really looking at the full picture and not just isolating one drug at a time because ultimately we’re not going to be able to solve this crisis unless we look at everything.
Miller: What do you say to people who regularly see people shooting up in broad daylight in the middle of Portland, and who then come to the conclusion that Measure 110 is not working?
Hurst: There’s a simple scapegoat of Measure 110, when the reality is that these are pretty complicated and intractable issues. Measure 110, as you said, the money is just getting out the door right now. The services still need to get set up and we’ll be moving.
This is five times more money than we have put into these types of services before, as a state. There will be transformational changes from it, but we do have to give it time. This isn’t something that’s going to happen overnight. It’s not a quick fix. It took us 50 years to get to this place by the War on Drugs. We’re gonna need time to really make sure that we can move from a failed approach to addiction to one that’s really based in health and science and best practices.
Miller: One of the big arguments that I remember against Measure 110, including by some people who are themselves in recovery, was that the threat of prosecution in the old model was the only way for some people to actually get into treatment. The carrot wasn’t enough, so the stick for some people was actually helpful. How do you get people to actually take advantage of these new services or options that are increasingly going to be available if they don’t have to use them?
Hurst: If that was true, we wouldn’t be in this situation. We’ve tried to incarcerate our way out of this crisis for more than 50 years, as I said, and more people are addicted than ever before, and more people are incarcerated than ever before. And so what we were doing simply wasn’t working.
A lot of evidence shows forcing people into treatment usually doesn’t work. And it also shows that the risk of dying immediately after being discharged from compulsory care is really high, especially for younger clients.
We really need to move to a model where services are evidence-based, they’re voluntary and they’re accessible. Most people will access services if they’re available, they trust the community and the providers.
Miller: Finally, and briefly, the people that voters empowered to make the decisions about which service providers should get grants ... have lived experience with addiction, many of them. But most of them don’t have experience in budgeting and awarding grants and this big state bureaucracy that’s giving out millions and millions of dollars. Is this the right system, in your mind, for deciding who should get this money?
Hurst: Yes. I think that the folks that serve on the council are people with lived experience and their role in this is really to ensure that the services that are most effective on the ground are being funded. It’s also with the intent of the measure to make sure that they were housed in an agency that has all the contracting procurement and budgetary and financial experience. For multiple reasons, they were not able to get the support that they needed in order to really go through this process.
Prior to 110, thousands of Oregonians wanted help and couldn’t get it. And now thousands of people who want help can get help. And that’s a direct result of this law. And that’s because of the council being able to identify these core services.
There are some tweaks that need to be made along the way. That’s why we’re an advocacy organization committed to ensuring that it will be implemented as the voters intended. But it can’t be that can’t be done if we cut it short.