Misled or misunderstood? Breaking down what Measure 110 pays for and what it doesn't

PORTLAND, Ore. — Many Oregon voters may have misunderstood or been misled about what the funding from the state’s landmark drug decriminalization law, Measure 110, would cover, a KATU investigation has found.

Oregon became the first state in the nation to decriminalize small amounts of hard drugs in 2020 – with voters sending a clear message that they wanted to move away from the traditional model of criminalizing drug use and move towards a system that treated addiction like healthcare.

The verdict was clear – 58 percent of voters approved the ballot measure; police would no longer make arrests and instead issue tickets for small amounts of hard drugs. Millions of dollars from marijuana sales would create the Drug Treatment and Recovery Services Fund to help people battling addiction.

During the campaign, voters were told Measure 110 would provide millions of dollars for Oregon’s treatment and recovery systems.

However, the law actually doesn’t fund services like drug detox or residential treatment for people on insurance. Oregon’s Medicaid expansion program, the Oregon Health Plan, insures almost everyone without private insurance.

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One ad from the campaign said Measure 110 “replaces criminalization with treatment” and “funds treatments using existing marijuana dollars.” Another said, “110 expands access to life-saving drug treatment.”

We spent a half-hour in downtown Portland showing people the ad - where it says Measure “110 expands access to life-saving drug treatment” – and asked people what they associated with the phrase, “drug treatment.”

Half answered it this way:

“I think of like a treatment center, like an inpatient kind of thing,” one respondent said.

“Things like drug rehabilitation programs and things like that.”

“A place where people can go to get [off] of drugs I would say.”

“I guess a drug treatment center would be almost like a hospital you would think because people need the medication and the medical care to get off these hard drugs.”

However, Measure 110 dollars don’t directly pay for those services - things like inpatient treatment or detox – for people who have insurance.

The director of one residential treatment facility said most of its clients are on the Oregon Health Plan, and the reimbursement the facility receives from the federal government for Medicaid services is low – making it difficult if not nearly impossible to expand and then cover the treatment provided in a bigger facility.

Measure 110 funding does not supplement the federal funding that treatment providers receive through Medicaid to provide that care.

“They told the voters that it was going to pay for treatment with the understanding [...] that the traditional understanding of 'treatment' was residential treatment and detox,” said Mike Marshall, the director and founder of Oregon Recovers – an advocacy group for people in recovery.

Instead, the program pays mostly for services for people already in recovery or waiting for treatment.

It covers housing support, job training, peer support and mentoring, harm reduction (basically making using drugs less dangerous), and low-barrier treatment (such as medication to help someone battling opioid addiction.)

So far, the state has approved roughly $300 million in grants for those services.

“Do you think voters were misled in 2020?” KATU asked Marshall.

“I know voters were misled. Go look at the TV ads. It said it was going to pay for treatment,” Marshall said.

So, why does Measure 110 not pay for things like inpatient treatment for all who need it?

That was never the plan according to Haven Wheelock, one of the chief petitioners to get Measure 110 on the ballot.

“The idea with Measure 110 was to not replace things that were billable by Medicaid,” Wheelock said. “I think for many people when they think about what treatment is, they think about things like inpatient treatment, outpatient treatment, these things that are billable by Medicaid, right? I think it's a new way of thinking about treatment to include things like harm reduction services that we provide here, to include things like peer support, employment support, housing support.”

Wheelock said Measure 110 programs add to services already covered by Medicaid. However, those Medicaid-funded programs aren’t meeting the state’s needs.

A 2022 study by OHSU found Oregon has a 35% shortage in outpatient treatment facilities, a 60% shortage for inpatient treatment, and a 27% shortage for residential detox facilities. Oregon is at, or near, the bottom of the US for access to treatment.

“I genuinely don't think that they were misled,” Tera Hurst said.

Hurst is the executive director of Oregon Health Justice Recovery Alliance, a statewide advocacy group focused on fully implementing Measure 110.

“If there are voters who are now surprised that detox and residential treatment are not funded by Measure 110, what is your message to them as one of the chief supporters of the measure back in 2020?" KATU asked Hurst.

“I would say that, ultimately, detox sobering centers and detox can be covered in Measure 110. What the council chose to fund is also different,” Hurst said, pointing to the Oversight and Accountability Group that ultimately decided where Measure 110 money went. “It's a system. I can't say it enough. It's a system that we have to fund. You can't have just one without the other, and we need all of it. We can't pick and choose at this point; we're in a crisis.”

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Hurst said Measure 110 funds life-saving services that get people ready for treatment or help them continue their recovery after treatment. She pointed to housing support for people coming out of treatment who can leave treatment centers and create an open bed for someone else to get in treatment.

But, remember those ads: “110 expands access to life-saving drug treatment.”

“Could [the ads] not say Measure 110 will pay for harm reduction; it will pay for housing, peer support specialists; it will pay for employment training; it will pay for low barrier treatment; it will not pay for this. Is that not really the place of a campaign?" KATU asked Hurst.

“I don't think it is. I think that the campaign did make it clear that it was peer support, housing, low-barrier treatment, outpatient services, and supported employment, which we would say are all part of the treatment continuum, and you can't have a continuum without multiple things in it,” Hurst said.