Contingency management test to pay drug users in California

California to test contingency management program

Finding a solution to the growing number of methamphetamine-related overdose deaths and associated public health costs has been a major focus of California law in recent months. A bill proposed by State Senator Scott Weiner, Senate Bill 110, suggested that an incentive-based treatment program called contingency management be more widely available. This bill hoped to get Medi-Cal, California’s medical assistance program, to cover this type of treatment.

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

What is contingency management?

Contingency management incorporates incentive payments into drug treatment. Those who attempt to recover from a methamphetamine or cocaine addiction are rewarded with cash or gift cards for remaining abstinent from these substances. Routine drug tests are used to determine whether or not these payments will be granted.

San Francisco resident Billy Lemon shared his experience with contingency management at NPR. Lemon participated in an emergency management program with the San Francisco AIDS Foundation while trying to recover from a methamphetamine addiction. Each week, Lemon has been tested 3 times. When the tests returned negative, Lemon was awarded $ 7. After 12 weeks, Lemon had earned $ 330 which he used to buy a cell phone. Lemon said the program was more than just a way to make money for him, saying he felt like he was being told “good job” for not using methamphetamine. It gave him a sense of self-worth that motivated him to still be sober today, 9 years later.

How effective are paid drug users?

Many people addicted to methamphetamine and other substances begin to use drugs to cope with other aspects of their lives. The highs that come from drug use provide temporary relief. This fleeting relief rewires the addictive reward system in the brain. Drug use becomes immediate reinforcement. Initially, recovering from an addiction is usually the opposite of a reward, as positive results do not come immediately. Those who recover from drug addiction experience the most unpleasant and difficult effects early in the detoxification process. Payments involved in emergency management programs are designed to provide immediate rewards in treatment.

For methamphetamine and cocaine addictions, contingency management is the most effective treatment according to some studies. This is especially true when paired with behavior therapy. At the San Francisco AIDS Foundation, 63% of those who participated in an emergency management program in 2019 have completely stopped using methamphetamine. Since 2011, the federal government has used an emergency management program for veterans struggling with drug use. A study from this veterans program looked at 73,000 drug tests and showed that 92% were negative.

It is believed that by allowing more insurance coverage for emergency management programs, more drug treatment centers will be encouraged to offer it. This would be a huge improvement as there is currently no effective treatment drug for methamphetamine or cocaine addiction. While for opioids, there are 3 drugs approved by the FDA. Those who oppose making emergency management programs more accessible are unsure of paying those who use methamphetamine to stop using drugs. Some view this type of reward as an unethical bribe.

The current state of methamphetamine use

Drug overdose deaths are on the rise across the United States, with 93,000 deaths reported in 2020. Between 2015 and 2019, the number of methamphetamine-related overdose deaths nearly tripled. In California, more people have died from methamphetamine and cocaine overdoses than from fentanyl last year. High-risk use patterns and the popularity of injecting methamphetamine may have contributed to this increase. Injecting methamphetamine has also been linked to the transmission of HIV through needle sharing and decreased inhibitions that can lead to unprotected sexual activity.

According to US News, there has been a 585% increase in methamphetamine-related heart failure in California. When heart failure occurs, the heart becomes too weak to properly pump blood, causing symptoms of fatigue, shortness of breath, and heart palpitations. Because chronic methamphetamine use persistently activates the sympathetic nervous system, heart failure can lead to high blood pressure, increased heart rate, and narrowing and hardening of the heart arteries.

People hospitalized with methamphetamine-related heart failure tend to stay in hospital longer and have more procedures. This translates into higher hospital costs. Methamphetamine-related heart failure hospitalization costs fell from $ 41.5 million in 2008 to $ 390.2 million in 2018. Supporters of emergency management programs believe making them more available could save money in California, despite the payments included in the program. With methamphetamine use leading to more crime, it currently costs $ 81,000 to put a person in a California jail for a year. In comparison, most emergency programs cost $ 6,000 per person each year.

The future of contingency management

Although Newsom has refused to make contingency management programs more accessible, the state will go ahead with the approved pilot program. Newsom’s support for the therapeutic approach shows promise for what will happen after the pilot program ends. The Biden administration also showed its support for contingency management programs when the topic was addressed in the 2021 drug control policy. “Identifying and removing political barriers to contingency management” was among the goals of Biden’s drug policy in 2021. Washington, West Virginia and Montana are also looking to make contingency management more accessible.

About Rhonda Lee

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