Oregon Spent $1.5 Billion on Addiction. Only 2.6% Went to Prevention

Oregon spent $1.5 billion on substance use services over two years, but only about 2.6 percent of that total — $39.1 million — went to community-based primary prevention, according to a legislatively mandated report that also found the state does a poor job tracking how its money is used and that most school districts are ignoring a prevention plan required by law.

The findings, produced by the Chicago consulting firm Third Horizon for the Oregon Alcohol and Drug Policy Commission, cover spending between 2023 and 2025 that was spread across eleven state agencies. The vast majority of the money paid for treatment and related services delivered after a disorder had already taken hold.

What the consultant found

Third Horizon's 246-page assessment, ordered by lawmakers through House Bill 3321, drew on state financial records, statewide surveys, interviews with school districts and higher education officials and more than 500 agency documents and contracts.

The headline number is a mismatch. Of the $1.5 billion spent, the consultant verified only $31.2 million as primary prevention — below the $39.1 million that carried a prevention label. Of that verified total, $18.2 million stayed inside state government, and roughly $15 million of that was an estimate for staff time spent enforcing regulations on retail alcohol sales. Only about $13 million reached communities, according to a data snapshot the report provided.

The report notes that every dollar invested in primary prevention returns far more than it costs — a $63 return per dollar, one widely cited estimate puts it — yet Oregon has neither a dedicated, recurring fund for prevention nor an agreed definition of what the work includes.

A mandate without money

Since 1989, state law has required every Oregon public school district to maintain a research-based plan to help vulnerable students avoid addiction later in life. The state, the consultant found, provides no money to do it.

Of Oregon's 197 public school districts, only 65 responded to the questions posed for the report, and only 19 had completed the required plan. The Oregon Department of Education, which is supposed to enforce the mandate, employed a single prevention coordinator and funded a single one-time campaign over the two years studied.

The workforce is thin, too. Nearly half of Oregon's counties had no certified prevention specialist, and most of those who are credentialed work outside rural communities — including eastern Oregon, where the report says the need is acute.

"Schools carry a mandate without money," the report concludes, and services aimed specifically at young people showing early signs of risk are rare, with none receiving state funding. In the consultant's blunt summary, "the youth at highest risk get the least."

Where Oregon stands

The gap matters because Oregon's problem is larger than the national average. Almost 21 percent of residents aged 12 and older meet the criteria for substance use disorder, compared with about 18 percent nationally, and the report notes the state is failing to give vulnerable young people the tools that other states provide.

The assessment builds on a six-month investigation published in 2024 by The Lund Report, the University of Oregon's Catalyst Journalism Project and Oregon Public Broadcasting, which found that most Oregon schools were not using research-based prevention programs despite the state mandate.

"It's pretty stark," said Sen. Lisa Reynolds, a pediatrician who sits on the Alcohol and Drug Policy Commission. "We pat ourselves on the back for allocating this money, and then we're not necessarily following up on what happened … what were the results."

Jon Epstein, a prevention advocate whose 18-year-old son died of an accidental fentanyl overdose in 2020, said the report shows Oregon is underserving families at the front end of the care continuum. "That Oregon is spending only 3 percent of $1.5 billion on primary prevention, of which most of it is actually alcohol age controls … really points to how we are under-serving youth and families by ignoring this part of the continuum of care," he told The Lund Report.

Pam Pearce, a prevention educator and advocate in West Linn, characterized the result as "a serious management and accountability problem." Funding is spread across agencies and purposes, definitions have been inconsistent and dollars are difficult to trace, she said.

What the commission recommends

The Alcohol and Drug Policy Commission is asking the state to set a goal of moving community-based primary prevention from under 3 percent of the total to at least 20 percent over time, without cutting treatment, recovery or harm reduction. It has advanced five proposals: create a dedicated prevention fund from the proceeds of distilled spirits; commit a fixed share of flexible funds to prevention; spend above the federal Substance Use Prevention, Treatment, and Recovery Services block grant minimum, which would amount to about $4.3 million; build a prevention funding formula around youth data; and fund school districts so they can meet their prevention mandate.

What the report does not do

The assessment carries no new appropriation and changes no law. It is advisory, and the commission has no authority to redirect the money on its own. But it gives state legislators a documented baseline for a decision they have so far deferred — and a set of specific proposals that will now compete for attention in a state where treatment spending has long outweighed prevention.