State Lawmakers Move to Expand Effective – But Controversial – Treatment for Meth Addiction

Rick Andrews (right) runs a drug counseling and testing program at the San Francisco AIDS Foundation to help men get their meth use under control.  (Courtesy San Francisco AIDS Foundation)

When Billy Lemon was trying to kick his methamphetamine addiction, he went to a drug treatment program at the San Francisco AIDS Foundation three times a week and peed in a cup. If it tested negative for meth, he got paid about $7.

The payments are part of a formal treatment called contingency management, which incentivizes drug users with money or gift cards to stay off drugs. At the end of 12 weeks, after all his drug tests came back clean, Lemon received $330.

“Just to take care of myself. That was very motivating,” Lemon says. “You're like, ‘Oh! I can feel good without the daily use of that substance. Let me try and go one more week.’ And then all of a sudden, you're at 90 days and you've actually made a change, like your brain has actually rewired itself.”

Studies show contingency management is the most effective treatment for meth or cocaine addiction, especially when combined with other behavioral therapy. But paying drug users not to use drugs is controversial. Insurers don’t cover it. State Medicaid programs have stayed away from it because the payments are considered illegal under federal laws.

But as the drug epidemic continues to worsen throughout California and the nation, lawmakers are starting to question those policies and push for changes. State Sen. Scott Wiener, D-San Francisco, introduced a bill this week — Senate Bill 110 — that would allow the state’s Medicaid program to pay for contingency management. He believes this will encourage more drug treatment centers to offer it.

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“We need to embrace this proven, effective approach to meth addiction, make it clearly legal and start reimbursing for it, so we can address this health epidemic,” he said.

In 2020, three times as many people in San Francisco died from drug overdoses as from COVID-19, according to data from the county medical examiner. Deaths and hospitalizations from methamphetamine have been taxing the city’s public health system for years.

While there are three FDA-approved drug treatments for opioid addiction, none have been found that work for stimulants like meth, leaving treatment providers desperate for more tools.

San Francisco Mayor London Breed in 2019 convened a methamphetamine task force, which issued a list of 17 recommendations to stem use of the drug, including expanding access to contingency management. The programs that currently offer it are supported by city funding or philanthropic donations. San Francisco is a co-sponsor of Wiener’s bill.

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Given the geographic reach of meth addiction across the state, Wiener believes he’ll gather the bipartisan support he needs to pass the bill. The biggest challenge will be financial, he acknowledged. The state’s budget has been decimated by the pandemic, leaving little money for new programs. But Wiener says there is hope for federal money and cooperation.

Until now, the federal government has been reluctant to relax rules that bar public health programs from offering contingency management. When treatment experts recently asked the U.S. Department of Health and Human Services to waive the rules for two years, the agency refused.

"It’s clear the [Trump] administration had minimal interest in looking at evidence or science, on a wide variety of topics,” said Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation, a co-sponsor of the bill.

Thomas believes things will be different under the incoming administration. President-elect Joe Biden has a son who struggled with substance-use disorder, and he has appointed California Attorney General Xavier Becerra, a champion of liberal health policy, to lead the federal HHS.

“So we’re hoping there will be more attention on what actually works,” Thomas said.