SF’s Scott Wiener Wants to Fund Financial Rewards for Meth Addicts who Stop Using Drugs

SF’s Scott Wiener Wants to Fund Financial Rewards for Meth Addicts who Stop Using Drugs - (SF Chronicle - Feb 26)

SACRAMENTO — Facing a growing methamphetamine epidemic with few known treatments, a San Francisco state legislator wants to make public funding available for programs that provide financial incentives to participants to stop using drugs.

Democratic Sen. Scott Wiener introduced SB888, which would expand the substance abuse treatment options that qualify for Medi-Cal, the state’s health care program for the poor, to include contingency management. These programs use vouchers or small cash prizes to motivate people to stay off drugs.

“We need to employ every possible tool to help people recover from this powerful addiction,” Wiener said in a statement.

Meth use is skyrocketing nationally, particularly in Western states. In 2018, nearly 12,700 people died from overdoses involving stimulants with addiction potential, which includes methamphetamine, according to the National Center for Health Statistics. That is almost four times as many deaths as five years before.

San Francisco has been hit hard. Meth is now involved in a fifth of drug arrests in the city and is tied to about half of visits to the psychiatric emergency room. Overdoses surged during the past decade to 126 in 2018, with mortality rates highest among African American men.

Wiener said meth is having an outsized impact on the lesbian, gay, bisexual and transgender community because it is used as a party drug to enhance sexual experiences.

But there are few options available for treatment. Unlike with opioids, there are no federally approved medications for meth addiction. The National Institute on Drug Abuse recognizes contingency management as an effective strategy, and it has been embraced by the U.S. Department of Veterans Affairs.

“When it comes to opioids or alcohol, we have other options. But this really stands out for stimulants,” said Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation.

Her organization runs the Positive Reinforcement Opportunity Project, which aims to help members of the LGBT community stop using meth. The 12-week program offers counseling and has participants take observed urine tests three times each week.

For each negative test, participants earn rewards. They can finish the treatment with up to $330 in gift certificates.

Thomas said the idea is to reinforce positive behavior and that many participants go on to more intensive residential rehabilitation. Out of 126 people who participated in the program last year, 63% stopped taking meth and another 19% reduced their drug use, she said.

Billy Lemon went through the program almost seven years ago as he was trying to kick a meth habit that had taken over his life.

“I just got caught up in a world that I was not prepared for and was not able to gently remove myself from that world, and it snowballed year after year,” he said. “I just knew that I was going to die.”

Lemon said the mix of counseling and financial incentives gave him space to figure out for himself that he wanted to get clean, rather than trying to manage his drug use. Although he could talk in group therapy sessions about his struggles, the rewards for clean drug tests felt like validation for the effort he was putting in.

“It released some of the stigma from being a drug addict,” Lemon said.

Completing the treatment pushed Lemon to go through a 12-step program. He’s now executive director of the Castro Country Club, a nonprofit that runs a sober community space for LGBT people recovering from addiction. He said he would like contingency management programs to be more widely available, in part because they can be a financial lifeline for people who are trying to quit using meth while homeless.

But Wiener said clinics have been discouraged from adopting the model because of a state law meant to crack down on fraudulent rehab facilities that pay people to enroll so they can collect the insurance payments. His bill would clarify that contingency management is not considered an illegal kickback and make it eligible for Medi-Cal reimbursement so providers could expand treatment without relying on private funds.

“This is a science-based approach to treating meth addiction,” Wiener said, “and it’s time for California to embrace it.”