Senator Wiener Introduces Bill to Confront Meth Crisis Using Contingency Management Intervention

SB 888 will authorize Medi-Cal to fund evidence-based treatment that gives participants with meth addictions cash rewards for staying sober
February 26, 2020

Sacramento – Yesterday, Senator Scott Wiener (D-San Francisco) introduced SB 888 to address the increase in meth usage and overdose deaths. This legislation expands substance use disorder treatment options covered under Medi-Cal, requiring Medi-Cal to pay for contingency management. Contingency management has proven to be the most effective method of treatment for methamphetamine addiction. Contingency management describes the practice of giving those struggling with drug addiction financial rewards if they test clean. There is currently no form of Medication-Assisted Treatment (MAT) for meth use, unlike with opioids where treatment options such as methadone are available. Contingency management is thus a critical tool in addressing the meth addiction crisis. According to the San Francisco Department of Public Health (SFDPH), since 2008, meth overdose deaths in San Francisco have increased by 500%. Additionally, 50% of psychiatric emergency room admissions at San Francisco General Hospital are now meth-related. These unacceptable statistics demonstrate the urgency with which San Francisco must address this epidemic. 

Meth use has spiked all over California and in San Francisco, and is having an outsized impact on the LGBTQ and black communities. Meth use is on the rise in LGBTQ communities, particularly for gay, bi and trans men, as a party drug known to enhance sexual experiences. The SFDPH also reports that the mortality rate is highest among African American men. 

Programs like the San Francisco AIDS Foundation’s PROP (Positive Reinforcement Opportunity Project) program – wherein LGBTQ men who used meth were given gift cards for staying sober – are found to be highly effective. According to the San Francisco AIDS Foundation, in one year of the PROP program, 63% of participants stopped using meth entirely and another 19% reduced their use. This approach, coupled with community support meetings, proves time and time again to be an effective method of treating meth addiction. This bill intends to make these programs accessible on a wider scale by authorizing them to be reimbursable by Medi-Cal. 

The bill would also require the California Department of Health Care Services (DHCS) to issue guidance and training on the use of contingency management programs for Medi-Cal patients. 

The bill is supported by the San Francisco AIDS Foundation and sponsored by the City and County of San Francisco.

Senator Scott Wiener said:

“Meth addiction is a major public health and public safety challenge in San Francisco and in other parts of California. We need to employ every possible tool to help people recover from this powerful addiction. Contingency management is an effective and essential tool in treating meth addiction – particularly given the lack of effective medical interventions – and we must expand access to it. This is a science-based approach to treating meth addiction, and it’s time for California to embrace it.” 

Mayor London Breed said: 

“At a time when drug-related overdoses are increasing in San Francisco, we need to make sure people can access substance use treatment, including innovative approaches like contingency management. In San Francisco, we’re working to improve our entire behavioral health system, while focusing specifically on people experiencing homelessness, in addition to mental illness and addiction. Senator Wiener’s legislation recognizes that we need to change our current system so that our most vulnerable residents can access the necessary interventions to help get these patients on the road to recovery.”

Dr. Grant Colfax, the Director of the San Francisco Department of Public Health, said:

“At the San Francisco Department of Public Health, we are always looking for ways to make it easier for people with substance use disorder to access treatment and low-threshold services. Contingency management is an evidence-based practice that can help people who use methamphetamine and, along with other treatment interventions, could improve health outcomes for San Franciscans.”

Joe Hollander, the CEO of the San Francisco AIDS Foundation, said: 

“Contingency management is one of a few evidence-based interventions that helps reduce the harms associated with meth use. Senator Wiener’s legislation will help more people access substance use treatment and prevent overdoses by ensuring California’s Medi-Cal population has access to this low-threshold service.”