This article was republished with permission from The Lund Report, an independent nonprofit health news organization based in Oregon. Five years after voters approved new funding to expand access to drug treatment and recovery services, state health officials have not put systems in place t o effectively track whether the law is achieving its goals despite having already spent close to $800 million,  auditors say. Instead, questionable oversight by the Oregon Health Authority, multiple revisions to Measure 110 by lawmakers and Oregon’s fragmented behavioral health system, have combined to undermine the public health goals envisioned by voters when they approved the much-debated drug decriminalization law, according to a new report issued by the the Oregon Secretary of State’s audit division.  The report is the final in a series of three to assess the state’s management of Measure 110. Oregon voters approved the law by a hefty margin in 2020 based on promises to significantly expand access to drug and alcohol treatment. Auditors, however, found that Measure 110 is not living up to its promise to measurably help Oregonians with substance use disorders in large part due to a lack of data, among other issues. Without that information, auditors say they can’t tell if Measure 110’s initiatives are actually working as intended to reduce overdose deaths and increase access to treatment for people with substance use disorders. “OHA has not implemented systems to track basic metrics, such as whether the number of treatment providers or services has increased since 2020. Grant reporting lacks standardized controls or verification, meaning it’s difficult to tell what effect, if any, the grant funding had,” the audit report stated. In an unusual move, Oregon Health Authority leadership disagreed with three of the auditors’ six recommendations for improvement, for instance saying the push to establish a baseline to measure progress is not achievable. Oregon Health Authority Director Sejal Hathi rejected auditors’ recommendation that the agency overcome data challenges to retroactively create baseline data to allow progress to be measured on overdoses, using proxy data if necessary. “The period from 2019 to 2023 is not a reliable timeframe for establishing or creating proxy baseline data in behavioral health due to the significant disruptions caused by the COVID 19 pandemic,” she wrote. “This period is further complicated by the launch of multiple initiatives and programs  …  which introduced substantial changes to the behavioral health landscape, precluding the establishment of a defensible proxy Baseline.” Nor did she agree with auditors’ recommendation that the agency create an infrastructure to better integrate Measure 110-funded care other parts of the health care system, saying that doing so is not required by the Measure 110 program, is not funded, and some person-level data sharing with certain types of providers may violate privacy laws. Oregon Secretary of State Tobias Read said there have been positive changes since the previous two audits, but there is still a lot more work to be done before Measure 110 is effective, and that relies on the Oregon State Legislature as well as the state health authority. “The Legislature needs to provide stability when creating policy – we can’t keep changing direction and expect that we’ll get anywhere. And OHA needs to implement these recommendations so that more Oregonians can get into treatment and we can all have safer, healthier communities, Read told The Lund Report via email. “OHA has implemented most of the prior recommendations, like documenting policies and procedures and developing a strategic plan. But we’ve been saying from the beginning that we need better data if we hope to measure whether or not Measure 110 is working.” Challenges date back years ​National survey data indicates that Oregon ranks among the highest among states in rates of reported substance use disorder and use of illicit drugs. In 2023, more than 1,700 Oregonians died from a drug overdose, according to state figures. Among its major policies, Measure 110 created a grant program to fund treatment programs across the state using cannabis tax revenue. Last year, the state awarded $391 million in grants to Measure 110 providers, who under the law are organized into regional networks. About $800 million has been awarded since 2021, auditors say. Lawmakers have amended Measure 110 several times, including a reversal in 2024 that recriminalized small amounts of illegal drugs, resulting in a dramatic increase in arrests for drug possession. Those changes, auditors acknowledge, have made it hard for the health authority to build or evaluate long-term strategies, as have leadership changes and reorganizations within the agency. As a result, “Measure 110 services are still not well integrated into Oregon’s broader behavioral health system, leaving them fragmented and harder to manage,” the report states. The auditors also stated that it was unrealistic to expect results from the Measure 110 programs within four years. “The pattern of annual revisions has undermined confidence in the program’s direction and hindered the development of long-term strategies,” auditors wrote in their report, referring to a series of actions by lawmakers. “Additionally, without action by OHA to address governance, integration, and accountability, the program has little to no chance to fully deliver on its promise to help Oregonians struggling with addiction.” Problems from problematic launch persist The audit drew on Measure 110 operations from 2021 to the present, and includes several notable findings: – Set up to fail: Measure 110’s initial rollout set the program up to fail, according to the auditors, who said state health officials did not manage the program properly from the start, failed to engage with other entities, including law enforcement or the courts, and struggled to secure adequate program resources. Moreover, authority over the programs was divided between health officials and a newly-created volunteer council that approved and managed grants — a process rife with bias and procedural errors, according to past audits. Staff turnover among state health officials and multiple legislative changes further complicated the program’s initial phase, and continue to undermine the program’s effectiveness, according to the auditors.  – Services aren’t integrated into the broader behavioral health system. In reworking Measure 110, lawmakers have created a fragmented program that suffers from a lack of coordination between state and county health officials, law enforcement and treatment providers, according to the audit. Nor are its services integrated with the Oregon Health Plan, the state’s version of Medicaid — a disconnect auditors say makes the people it serves more vulnerable to losing care. In 2024, the health authority dissolved its Health Systems Division and spun off separate Medicaid and Behavioral Health divisions, a move the auditors say led to more splintered operations and weakened oversight. – Inconsistent deflection options for offenders: Auditors also singled out the inconsistent patchwork of deflection programs across the state, a program — created by lawmakers as a collaboration between local law enforcement agencies and behavioral health programs as a result of Measure 110 — which was intended to connect people with substance use disorders with treatment in lieu of arrest or prosecution. There is no state standard for these programs, the audit notes, and participation is optional. Not all counties have a deflection program, and the services offered vary widely, the auditors said, creating a confusing patchwork for law enforcement officials and irregular services for the people in need. – Flawed data and unclear goals: Data deficiencies have been a theme of the M110’s audits since they began in 2023, and at the time auditors called it the “the biggest risk to the program.” The health authority has not collected sufficient information to determine the number of people served through Measure 110 programs or the outcome, according to state auditors. Notably, the state lacks the baseline data on service access and the number of providers from before Measure 110’s launch, and without it, state health officials can’t determine if access to care has increased — a basic metric required by the state legislature. Nor can the state determine the effectiveness of its services or identify gaps in care, particularly for marginalized populations, according to the auditors’ report. Demographic information, such as race, ethnicity, age, and gender among patients was often incomplete or inconsistent. As a result, according to the auditors, grants have not prioritized communities of color who are most affected by the war on drugs — a priority of Measure 110 — resulting in inequitable access to behavioral health services.  “Prior audit recommendations called for data to evaluate program performance. OHA began new data collection efforts in October 2025, but it is unclear when complete and reliable data will be available to assess program effectiveness.” The auditors found other problems as well, not all of them new to this review. Two previous audits in 2023 also called out ill-defined strategy, inadequate data and wasted resources. “Two years after our recommendations were agreed upon by agency leadership, gaps remain unresolved and continue to undermine the will of Oregon voters to provide adequate services to people suffering from substance use disorder,” auditors wrote in their latest report. Mixed response to audit recommendations ​The auditors made six recommendations for state health officials, including three focused on operations and management, which state health officials have accepted, and three focused on data collection — which they did not. The auditors want the health authority to develop a roadmap for improvement with timelines, assigned accountability, and key measures for better program integration, evaluation, and outreach. They also call on the state to focus on “culturally responsive services” when making grants for behavioral health providers. And to make Measure 110-funded providers begin collecting more reliable, standardized data across the network. In response to the audit, Hathi, the agency director, wrote in support of those recommendations and noted work underway to address management needs and accountability issues. But she disagreed with recommendations to create baseline information to set future performance targets and measure progress, including whether the rates of overdoses have decreased, and whether patient treatment has increased. STORY TIP OR IDEA? Send an email to Salem Reporter’s news team: [email protected]. A MOMENT MORE, PLEASE– If you found this story useful, consider subscribing to Salem Reporter if you don’t already. Work such as this, done by local professionals, depends on community support from subscribers. Please take a moment and sign up now – easy and secure: SUBSCRIBE. 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