Behavioral Providers Brace for Financial Strain As Oregon Decriminalizes Drugs

Jamaica Imani-Nelson, a behavioral health provider in Oregon, worries about what will happen in two months, once Feb. 1 rolls around and Oregonians caught with small amounts of illegal drugs will no longer head to jail.

Her main concern is that a flood of people will be directed to obtain health assessments, then seek free addiction treatment to forgo having to pay a fine. But providers in the state haven’t received any funds to finance those services.

“If we don’t do something fast … once the influx of people come, it’s [going] to be catastrophic,” Imani-Nelson told Behavioral Health Business.

The state voted in November to approve Measure 110, which decriminalizes drugs. It sets up a new system for people caught with small amounts of substances like meth, cocaine and heroin.

While the move has been lauded as a win for people fighting addiction, it creates new challenges — and opportunities — for Oregon behavioral health providers.

Some parts of the new system remain vague, as a soon-to-be-formed council has been tasked with hammering out the nitty-gritty details. But one thing is clear: Those caught with drugs will receive a citation and a $100 fine, which they’ll have the option to waive if they receive a health assessment.

Citation recipients will have 45 days to call a new state helpline for their assessment, which will be conducted by a trained worker. From there, they could be directed to free addiction treatment or other helpful services.

SUD provider impact

Initially, an existing network of substance use disorder (SUD) treatment providers will take in new clients through the program — but they won’t immediately get extra money to do so.

While Imani-Nelson is excited about the opportunity to help more people, she’s nervous about the logistics. She runs Holistic Healing Behavioral Healthcare, a behavioral health services nonprofit in Portland, where she plans to provide no-cost services under the new system.

For the first year of the program, Oregon has allocated $57 million to SUD treatment, peer mentoring and housing services. But that money won’t start flowing until Oct. 1, 2021 at the earliest for the centers designated as treatment hubs. And only in October will a yet-to-be-formed task force release requests for proposals for grants to pay for uninsured treatment and expand services.

Imani-Nelson says her organization won’t turn people away, but there’s only so much pro bono treatment it can afford, especially amid a pandemic that’s decreased its admissions and overall funds.

Helpline logistics

In the program’s initial months, the state’s new helpline will play an important role. However, the Oregon Health Authority has yet to set it up.

The idea is that eventually, after the pandemic passes, existing brick-and-mortar behavioral health providers will take on the role the helpline will play in the program’s initial months. There, people will be able to receive health assessments 365 days per year.

Until then, though, helpline workers will provide health assessments and treatment plans to citation recipients.

Oregon’s current substance abuse helpline creates safety plans for callers, then refers them to providers. But the new helpline will offer a more expansive set of services, according to Lines for Life CEO Dwight Holton, who runs the state’s current line.

The state hasn’t announced whether it’ll use existing line providers for the new project. However, Holton said the new services are an enhanced version of what his company already offers.

The new law mandates some important changes, though. For example, the current helpline uses volunteers. Meanwhile, Measure 110 says certified counselors or other credentialed professionals must provide the behavioral health needs assessment for each client.

“You want to get as close as you can to walking someone into the treatment facility, and we’ve been moving in that direction for a long time now,” Holton told BHB.

Funding fiasco

While behavioral health providers could be the next step in a person’s journey following an assessment, providers will struggle to meet that demand without additional funding.

Heidi Wallace, executive director for Oregon and Washington at the Hazelden Betty Ford Foundation, said treatment capacity in the state is already lacking, especially for the underinsured.

“If you need to detox and you don’t have private insurance, you have to wait in line to get in for that day and may not be able to get in,” Wallace said. “That’s the current system right now.”

Without providers able to meet the heightened demand under the new system, Imani-Nelson predicts there will be more overdoses and higher emergency room utilization.

“It’s kind of like putting the cart before the horse,” she said.

When funding does eventually begin to trickle in, though, behavioral health providers will have the opportunity to expand treatment and provide wraparound services not reimbursed by most payers. Plus, the state is planning to apply for a waiver to have the services covered under Medicaid.

And despite Imani-Nelson’s skepticism that the initial rollout of the new program will be smooth, she and other substance abuse experts say the new law is necessary for equity in the criminal justice system, as addiction disproportionately affects minority populations.

“It’s long overdue, and it’s something that will have benefits into the future,” Richard Harris, the former addiction and mental health director for the state of Oregon, told BHB.  

Still, Harris, who also co-founded and ran the homeless and addiction services nonprofit Central City Concern, says that the new system will take time to build.

“It won’t be as comprehensive assistance as it will be after Oct. 1, because you can’t make all this happen immediately,” he said.

Written by Lisa Gillespie