Success of Oregon’s Drug Decriminalization Effort Depends on Provider Diversity, Finances

The state of Oregon is in the middle of a massive transformation in how it handles people caught with small amounts of illegal drugs like heroin, meth or cocaine. Instead of being arrested, people will have the option to get free treatment.

The rule change could inspire other states to follow suit, opening the door for substance use disorder (SUD) providers nationwide to expand their services.

However, those providers must be culturally diverse for the new program to be successful. Additionally, some industry experts worry the increased demand could spell trouble for the already overburdened behavioral health industry.

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Ballot Measure 110 — which decriminalizes drugs in Oregon — passed in November and will take effect Feb. 1.

The new law will make addiction treatment — along with services such as housing — free through funding from legal marijuana sales and savings from the criminal justice system. It also changes the punishment for drug possession.

People caught with drugs will no longer face arrest and jail time; Instead, the measure decreases the penalty to a $100 fine, which is waived if the fine recipient agrees to take a health assessment by phone, or eventually in person.

Cultural competencies

In addition to the principle that drug addiction should be treated as a disease and funded as such, racial inequality was another impetus for the measure.

In recent years, Oregonians of color have been disproportionately arrested for controlled substance possession. But the new measure is expected to reduce the gap between Black and white arrests by 95%, according to the Oregon Criminal Justice Commission.

Because Black people are overrepresented when it comes to drug arrests, health assessments and treatments conducted under the new program should be specially tailored to that population, according to Jamaica Imani-Nelson, the executive director of the Portland-based behavioral health services nonprofit Holistic Healing Behavioral Healthcare. But that could be easier said than done.

“We’re underrepresented in treatment programming, and that’s problematic,” Imani-Nelson, who is Black, told Behavioral Health Business.

Her organization intends to apply for grants to provide treatment to people coming in through the program. But she believes the workers conducting health assessments — which will initially be done through a state-wide hotline and then later at physical hub locations — also need to be culturally specific.

“For marginalized populations, what I see happening is that they’re going to call, and they’re going to be able to distinguish that that person doesn’t look like them or sound like them, and they’re not going to be sold on this thing,” Imani-Nelson said.

Companies like Consejo Sano, a patient engagement platform solutions provider, could help the state get ahead of problems like that, COO Vikram Bakhru told BHB. 

Consejo Sano mainly works with health plans and providers on a white-label basis to connect with culturally diverse and lower income patients. As Measure 110 takes effect, Bakhru sees potential opportunities to do similar work with partners in Oregon. 

“If you think about the population being served, culturally relevant engagement and communication is a key part of the equation,” Bakhru said. “We’ve got to build trust with individuals in their time of need.”

The company does not currently have any partnerships in Oregon, but that could soon change. Consejo Sano hires navigators and other staff to mirror the race and ethnicity of the population it’s serving — and could easily do the same to meet the needs of this program in Oregon, according to Bakhru.

“It’s having the right person coordinate with you to make you feel connected and cared for — someone available by text to ask questions or connect with peer support — that can ultimately then [help you] avoid maybe falling off the bandwagon,” Bakhru said.

The new system will allow providers to better serve populations that currently have problems accessing treatment, according to Richard Harris, the former addiction and mental health director for the state of Oregon. He used undoccumented workers as an example.

“Farm workers are not eligible for Medicaid unless they’re documented, and they also have addiction issues just like everybody else,” Harris said. “And there’s [currently] no way for them to get services.”

But under this program, health care coverage is less of an issue. Grants and other funding will help finance free services for drug users, meaning behavioral health providers will be paid to help people they might not otherwise be able to afford to treat.

“There’s absolutely no reason for places … to not significantly add capacity to their already existing health care programs,” Harris said.

Financial concerns

Still, some providers in the state worry about the logistics of expanding services: Grants usually provide funding for a short-term timeframe — so whether behavioral health providers will feel comfortable relying on that funding stream remains unclear.

“You hear of programs all the time that get a grant, and were able to provide this and it was working, and then the grant money ran out,” Heidi Wallace, executive director for Oregon and Washington at the Hazelden Betty Ford Foundation, told BHB. “It’s devastating.”

Behavioral providers will have the opportunity to express their needs and concerns to a soon-to-be-formed council and the legislature, Wallace said.

Additionally, there’s talk of eventually transitioning certain program services from being grant-funded to being paid for by the Medicaid program, as well as of applying with the Centers for Medicare & Medicaid Services (CMS) to allow people not currently eligible for Medicaid to be included.

“Once you get these services started, then you’ve expanded the capacity in the treatment system,” Harris said. “It’s actually a good transitional funding mechanism. By that time, services [and potentially new populations] become Medicaid eligible and capacities will be enlarged enough that you can then really make use of the added Medicaid match.”

Written by Lisa Gillespie

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