SALEM — The manager Oregon hired in August 2021 to run its Measure 110 drug decriminalization program went on extended medical leave a year later and resigned in July with a blistering letter that accused the Oregon Heath Authority of failing to ensure the program had adequate resources to move quickly enough.

Angela Carter’s letter, first made public last week by The Lund Report, comes as public scrutiny of the program has increased and as lawmakers have sought to address Measure 110′s shaky implementation.

The ballot measure sought to improve treatment options for people addicted to drugs and deemphasize criminal penalties. But its adoption coincided with the rise of the fentanyl epidemic and overdoses across Oregon.

That has produced intense criticism of the program, with skeptics faulting the state for eliminating criminal penalties before establishing alternate pathways to encourage people to seek treatment for addictions.

If the department had staffed the program appropriately, Carter said Oregon would have had treatment options available much sooner to help combat rising addiction rates.

“That would have resulted in community organizations doing their work, receiving their funding in a timely manner,” Carter told The Oregonian/OregonLive.

In a statement Monday, Aug. 14, health authority officials noted that Carter has not held an active role in Oregon’s Measure 110 program since going on leave in August 2022. A department staffer named Jessica Carroll has been running the program on an interim basis since then. Carter, who also filed a workplace civil rights complaint against the health authority in January, resigned July 17.

The agency said the 42 addiction treatment centers established under Measure 110 — known as Behavioral Health Resource Networks — have been operating during the period Carter, a naturopath, was on leave.

“OHA appreciates Dr. Carter’s hard work and dedication to the Measure 110 program and wishes Dr. Carter well going forward,” the agency said.

The health agency’s Measure 110 program administered about $270 million in grants to community organizations for the treatment centers. A separate oversight and accountability council chooses where the money will go.

Treatment providers have raised many of the same issues Carter did in the resignation letter, according to Tera Hurst, director of the Health Justice Recovery Alliance, an advocacy group focused on the implementation of Measure 110. Hurst said House Bill 2513, which passed the Legislature in June, begins to address those issues.

The bill gives the health authority more responsibility in overseeing grants and simplifying who people should call for services, and more flexibility in funding staff and support for the ballot measure.

“We strongly urge OHA to take action to ensure continued implementation of the program, including swift and thoughtful hiring of a new director,” Hurst said in a statement.

A January audit by the Oregon Secretary of State concluded that the Oregon Health Authority hadn’t properly established roles and responsibilities for implementing Measure 110 and failed to provide support for successful implementation of the program.

Carter also faults the agency for the way it has rolled out Measure 110. They said the health authority delayed adding staff for months and then ultimately hired temporary employees working out of state through the consulting firm Deloitte.

“I am deeply disappointed and honestly horrified that the OHA is working in direct opposition to its mission to serve our communities in Oregon through intentional destructive management of such a crucial program,” Carter wrote in an email to The Oregonian/OregonLive.

Carter said they went on medical leave because months of overwork had caused carpal tunnel syndrome in both hands and herniated discs in their neck and back, making it impossible to continue running the Measure 110 program.

Before going to work for the state, Carter worked as a naturopath and was co-founder and former director of the Equi Institute, a Portland organization that works to enrich the health of transgender, queer, intersex and gender-diverse communities. They have also worked in psilocybin training and research.

Carter said they are several years into substance abuse recovery themselves but had no experience leading a treatment program before the health authority hired them at an annual salary of $103,000 in 2021.

Carter identifies as queer and transgender. In January, they filed a complaint with the Oregon Bureau of Labor & Industries that claimed health authority personnel did not accommodate their physical disabilities and retaliated against them based on their gender identity. The complaint is pending.

Carter’s license to practice naturopathy lapsed at the end of 2022.

This year, the Oregon Board of Naturopathic Medicine sanctioned them for leaving about 700 unsigned patient charts when they left the Equi Institute in 2019, and for not following guidance around drug interactions and opioid prescriptions for a patient treated over two years beginning in 2017.

Carter reinstated their license to practice naturopathy in July and will complete 36 months of probation and 12 hours of continuing education related to pain management, prescription guidance and charting practices.

While Carter had no experience leading a governmental department before their hiring by the state, they said they believe strongly in Measure 110′s drug decriminalization work but blamed the health authority for failing to adapt to the ballot measure’s demands.

“I’ve built a lot of things. I understand how to organize them into systems that work well,” Carter said, “but the OHA is a somewhat rigid body and does not allow for a lot of innovation that is necessary for a novel health program like Measure 110.”