Contingency Management Test To Pay Drug Users In California

California Set To Test Contingency Management Program

Finding a solution to the number of increasing Meth-related overdose deaths and related public health costs has been an important focus for California legislation over the past few months. A bill proposed by state Senator Scott Weiner, Senate Bill 110, suggested that an incentivized treatment program called contingency management be made more widely available. This bill hoped to make it so Medi-Cal, California’s medical assistance program, would cover this type of treatment.

Weiner’s Recovery Incentives Act was passed in both the Assembly and the Senate with bipartisan, unanimous support earlier this month. Despite voicing his support for contingency management programs, California Governor Gavin Newsom vetoed the bill this week. Newsom stated that he is hesitant to pass the bill without knowing the results of the state’s previously approved contingency management pilot program. This pilot program will begin in January, 2022 and will last until March, 2024.

What Is Contingency Management?

Contingency management incorporates incentivized payments into addiction treatment. Those attempting to recover from a Meth or Cocaine addiction are rewarded with money or gift cards when they remain abstinent from these substances. Routine drug tests are used to determine if these payments will be awarded or not.

San Francisco resident, Billy Lemon, told his experience with contingency management to NPR. Lemon participated in a contingency management program with the San Francisco AIDS Foundation while trying to recover from an addiction to Meth. Each week, Lemon was tested 3 times. When the tests yielded a negative result, Lemon was given $7. By the end of 12 weeks, Lemon had earned $330 which he used to purchase a cell phone. Lemon said the program was more than just a way to get money for him, saying that it felt like he was being told “good job” for not using Meth. This gave him a sense of self-worth which has motivated him to still be sober today, 9 years later.

How Effective Is Paying Drug Users?

Many people who are addicted to Meth or other substances begin using drugs to cope with other aspects of their life. The highs that come from drug use provide a temporary relief. This fleeting relief rewires the reward system in the brain which causes an addiction. Drug use becomes an immediate reinforcement. Initially, recovering from substance abuse is typically the opposite of a reward as positive results are not immediate. Those going into recovery for substance abuse experience the most unpleasant and difficult effects early on during the detox process. The payments involved in contingency management programs are designed to provide immediate rewards into treatment.

For Meth and Cocaine addictions, contingency management is the most effective treatment according to some studies. This is particularly true when combined with behavioral therapy. At the San Francisco AIDS Foundation, 63% of those who participated in a 2019 contingency management program completely stopped using Meth. Since 2011, the federal government has been utilizing a contingency management program for veterans who struggle with drug use. A study of this veteran program examined 73,000 drug tests and showed that 92% were negative.

It is thought that in allowing more insurance coverage for contingency management programs, more drug treatment centers will be encouraged to offer it. This would be a huge improvement as there are currently no effective available treatment medications for Meth or Cocaine addictions. Whereas for Opioids there are 3 FDA approved medications. Those opposed to making contingency management programs more accessible are unsure about paying those who use Meth to stop using drugs. Some view this type of reward as an unethical bribe.

The Current State Of Meth Use

Drug overdose deaths are on the rise all over the US with a reported 93,000 occurring in the year 2020. Between the years of 2015 and 2019 the number of Meth related overdose deaths has almost tripled. In California, more individuals died of Meth and Cocaine overdose than from Fentanyl last year. Higher-risk use patterns and the popularity of injecting Meth may have contributed to this increase. Injecting Meth has also been linked to HIV transmission through needle sharing and lowered inhibitions that can lead to unprotected sexual activity.

According to US News, there has been a 585% increase in Meth related heart failures in California. When heart failure occurs the heart becomes too weak to properly pump blood causing symptoms of fatigue, breathlessness, and heart palpitations. Because chronic Meth use persistently activates sympathetic nervous systems, heart failure can lead to high blood pressure, increased heart rate, and heart arteries being narrowed and hardened.

People hospitalized for Meth related heart failure tend to stay in the hospital longer and have more procedures performed. This results in higher hospitalization costs. Meth related heart failure hospitalization costs rose from $41.5 million in 2008 to $390.2 million in 2018. Those in favor of contingency management programs believe making them more available could save California money, despite the payments included in the program. With Meth use leading to more crime, it currently costs $81,000 to put a person in a California jail for one year. In comparison, most contingency programs cost $6,000 per person each year.

The Future Of Contingency Management

Although Newsom has rejected making contingency management programs more accessible, the state will be moving forward with the approved pilot program. Newsom’s support of the treatment approach is promising for what’s to come after the pilot program concludes. The Biden Administration has also shown support for contingency management programs when the topic was addressed in the 2021 Drug Control Policy. “Identify and address policy barriers related to contingency management,” was listed as one of Biden’s 2021 drug policy goals. Washington, West Virginia, and Montana are also looking to make contingency management more accessible.