Oregon Health Authority: Funding and Delivery of Measure 110 Substance Use Disorder Services Shows Progress, but Significant Risks Remain

Report 2023-39

Oregon State Capital Building

Why this audit is important

The OAC awarded more than $260 million to BHRN providers through December 2023, and expects to award another $150 million through June 2025.

M110 services can help narrow large gaps in Oregon’s substance use services.

As of 2021, Oregon continued to rank high nationally in rates of substance use disorders and low in access to treatment.

Fentanyl use has exploded since 2019, before M110 took effect, increasing the urgency to expand effective treatment services.

The number of fentanyl pills seized in Oregon and Idaho’s high-intensity drug trafficking areas rose from 690 in 2018 to 3,020,802 in 2022.

What we found

  1. M110’s Oversight and Accountability Council (OAC) approved BHRN grants for services required by statute, helping expand community-based services. Despite challenges, providers are delivering accessible services to highly vulnerable people.
  2. The OAC prioritized cultural competence among grantees. This focus is likely to improve service access statewide and help address inequities in substance use treatment and outcomes.
  3. BHRN providers have increased spending and clients served over time, but the first year of reporting showed limited spending and services amid difficulty hiring staff and other challenges, raising risks that some of Oregon’s 42 networks may not provide all required services.
  4. It is not clear how many providers of culturally specific services were funded to help serve populations most affected by the war on drugs, an important measure. The grant process also needs improvement to better attract community-based applicants.
  5. OHA publishes BHRN spending and clients served, but additional reporting on staffing, services, and capital expenditures would help the program better demonstrate impact.
  6. OHA is developing a new system for collecting more detailed behavioral health service data, but it remains uncertain if the agency will have adequate data to demonstrate M110’s effectiveness.

What we recommend

We made six recommendations to the OHA and the OAC to improve the program. OHA agreed with all of our recommendations, and its response can be found at the end of the report. The OAC plans to discuss the review at an upcoming public meeting and prepare a written response, which we plan to attach to this report after review.

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