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Some of Portland’s largest providers of substance abuse disorder treatment are furious at the way tens of millions of dollars in new funding are being allocated in Multnomah County.
There’s a lot of cash at stake: $59 million of new funding from Measure 110 for Multnomah County providers alone.
Oregon voters approved the measure two years ago to decriminalize the personal use of most hard drugs—including heroin, methamphetamine, cocaine and opioids—while also diverting most of the tax revenues from recreational cannabis to fund new treatment for substance use disorder.
Decriminalization officially went into effect in February 2021 and, unofficially, even earlier in some counties. Meanwhile, the Oregon Health Authority has struggled to get treatment dollars out the door.
While money sits unused, Oregonians are dying of overdoses at ever higher rates. Earlier this month, the state reported that drug overdose deaths had more than doubled, from 496 in 2019 to 1,072 in 2021. During that time, fentanyl overdoses rose from 71 to 509, an increase of more than 600%.
The 21-member Oversight and Accountability Council mandated by the measure is still wading through an approval process that is cumbersome, unwieldy and, critics say, rife with subjectivity and decisions that aren’t in patients’ best interests.
The council is charged with distributing $265 million over the next two years. It is also, by design, different from public bodies that have sway over large amounts of taxpayer cash: Its members are mostly people in recovery who work in the treatment field. That means they bring a lot of lived experience, but limited budgetary and management skills.
That shortcoming features prominently in a June 29 letter from eight senior officials, including representatives of Multnomah County, the city of Portland, Cascadia Behavioral Healthcare, and LifeWorks NW, to the OAC and OHA brass.
“We are writing to formally ask OHA for a review and redetermination of the grant decisions in Multnomah County,” the letter reads, “and, in parallel, to request an opportunity to discuss the procedural and substantive problems that occurred.”
Co-chairs of the OAC did not respond to requests for comment on critics’ concerns. Tim Heider, a spokesman for OHA, which is responsible for implementing the measure, says his agency also will not comment on specific criticisms.
After receiving the critics’ letter, however, OHA sent members of the council a three-page letter reminding them they must avoid biases and conflicts of interest and follow the criteria the health authority established for evaluating submissions.
“In addition to questions about fairness, inconsistencies in the OAC’s decision-making can result in delays and disruptions to funding decisions,” the letter reads.
Here’s what critics are upset about:
Critics say the funding allocations are inconsistent.
In their letter, the critics allude to a decision-making process that they say can seem arbitrary and heavily influenced by personal experience rather than the information that providers submitted in their applications. “We recognize each of the 21 OAC members have important life experiences, professional expertise and extensive relationships in Oregon,” the letter says. “While this background helps them in understanding client and sector needs, it has also meant they carry certain biases in how they interpret the intended priorities of the fund.”
The OAC subcommittee insisted, for instance, that some applicants hire peer mentors, even if their proposal didn’t call for them. And Mary Monnat, CEO of LifeWorks NW, expressed surprise that her nonprofit’s application for funding in Washington County was approved while an identical application for Multnomah County was rejected.
Critics say the funding decisions ignore the coexistence of substance abuse and mental illness.
One controversial decision the subcommittee made was not to fund organizations that proposed to treat people with dual diagnoses of substance abuse and mental illness.
Critics blasted that decision as at odds with the reality that many people suffer from both.
“This narrow interpretation of the fund and its intended uses contradicts the [OHA] Request for Grant Application and Rules,” the letter says.
Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance, has monitored the OAC’s deliberations, which occur at weekly Zoom meetings.
She acknowledges panel members expressed opposition to funding dual diagnosis programs, because reimbursement for mental health services is higher than the rate for some substance use disorder programs and they wanted to level the playing field.
But Hurst blames OHA staff for not stepping in to correct them.
“There are people on the OAC who work in addiction who feel that mental health gets reimbursement at a higher level and so they should only fund substance abuse disorder programs,” Hurst says. “But OHA staff should have weighed in and said, ‘You can fund this.’”
Critics say the system will be chaotic.
One of the elements included in Multnomah County’s proposal was a common entry point for anybody seeking help from any of the dozens of treatment providers in the county. Julie Dodge, interim director of the county’s behavioral health system, says her agency’s proposal was rejected out of hand.
“The subcommittee’s discussion of our proposal was about two minutes long,” Dodge says. “They said, ‘They already have plenty of money, and the salaries they are proposing are excessive.’”
OAC members also rejected a proposal to replace the downtown sobering center formerly run by Central City Concern and the Portland Police Bureau.
Advocates for replacing that center believe a new, more comprehensive facility could sharply reduce the relatively high number of people in crisis who require a disproportionate share of resources from public safety agencies and hospital emergency rooms.
One of those advocates, Multnomah County Commissioner Sharon Meieran, an emergency room physician, says she’s disappointed the panel missed a chance to create a vital triage center for some of the neediest people on the county’s streets.
“People are cycling through ERs, jails and the street because there’s nowhere else to go,” Meieran says. “Unless we do something different, that cycle will never be broken.”
Dodge says she hopes the OAC will take the criticisms by her and others to heart. “I’m worried that people won’t be able to find the services they need,” she adds. “Creating access was the whole point of Measure 110.”