Low-income Californians with methamphetamine use disorders may soon have expanded access to a well evidenced treatment intervention that offers monetary rewards for a reduction in use.
On January 23, State Senator Scott Wiener introduced Senate Bill 888 that would add contingency management to substance use disorder treatments covered by Medi-Cal, the state health insurance program funded by federal Medicaid. Contingency Management is a behavioral intervention that provides incentives, usually gift cards, for reducing, and eventually abstaining from, drug use.
“This is a science-based approach to treating meth addiction,” Wiener told the San Francisco Chronicle, “and it’s time for California to embrace it.” He represents the Bay Area, which is seeing high rates of methamphetamine use and related deaths. Recently, regional politicians moved to open “sobering centers” in San Francisco and San José to people who use meth.
Research has shown that contingency management produces “significantly more negative samples” of urine tests among people diagnosed with “methamphetamine abuse and dependence,” and study participants “were abstinent for a longer period of time (5 versus 3 weeks),” as a presentation from the Centers for Medicare and Medicaid Services has summarized.
Much of the available research has studied its efficacy among low-income people. However, one 2009 study set out to address “a commonly held belief that contingency management (CM) may be less effective for substance abusers with relatively more economic resources compared to those with relatively few resources.” They found that income had no effect on treatment outcomes.
Contingency management is one of the few well studied treatments for methamphetamine use disorder. Antidepressants, like buproprion and mirtazapine, as well as medications often used for opioid use disorders, like buprenorphine and naltrexone, have been found to help reduce cravings, but do not have the same breadth of research enjoyed by contingency management.
“When it comes to opioids or alcohol, we have other options. But this really stands out for stimulants,” Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation, an organization that administers its own Contingency Management program, told the Chronicle.
Even if the bill passes, Contingency Management still faces hurdles before low-income folks can begin accessing the treatment through their state insurance. The state’s health department would first need to produce a guidance on its implementation, and the state legislature and Governor would need to allocate sufficient funds in the annual budget.
This could pose obstacles for Contingency Management’s successful roll-out. “One drawback of contingency management is the potential for unsustainable treatment incentives because of funding restrictions,” stated the federal Health and Human Services Administration in March 2019.