Senator Wiener Introduces the Recovery Incentives Act to Confront the Growing Meth and Overdose Crisis

SB 110 legalizes and authorizes Medi-Cal to fund evidence-based treatment giving participants struggling with addiction financial rewards for staying sober
January 14, 2021

Sacramento – Senator Scott Wiener (D-San Francisco) has introduced SB 110 to address the worsening methamphetamine addiction crisis facing our state. The Recovery Incentives Act legalizes the substance use disorder treatment known as “contingency management,” and authorizes Medi-Cal to cover it. Contingency management has proven to be the most effective method of treatment for methamphetamine addiction, and is frequently used as a treatment program by the Veterans Affairs Administration. This intervention program gives those struggling with substance use disorder financial rewards if they enter substance use treatment programs, stay in the program, and get and remain sober. This positive reinforcement helps people reduce and even fully stop substance use.

With drug overdose deaths on the rise in San Francisco and across the state — San Francisco had a record number of overdose deaths this year — effective substance use intervention programs are more important than ever. In San Francisco, according to data collected in 2019, roughly 60% of all overdose deaths were meth-related.

There is currently no form of Medication-Assisted Treatment (MAT) for meth, 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 disturbing statistics demonstrate the urgency with which San Francisco and other communities must address this epidemic.

Meth use has spiked all over California and in San Francisco, and is getting worse through the COVID-19 pandemic. With social isolation, mental health issues like depression, and economic suffering all on the rise, meth use has also increased significantly. Since COVID-19 was declared a national emergency on March 12th, The Hill reports that patients across the country “tested positive for methamphetamines at a roughly 20 percent higher rate between March and May than previous samples.”

Stimulant use has also grown rapidly in the LGBTQ and black communities, which were already deeply impacted by the meth crisis. The LGBTQ community — particularly gay, bi and trans men — have seen a rapid increase in meth use as a party drug taken to enhance sexual experiences. 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 – in which LGBTQ men who used meth are 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 again to be an effective method of treating meth addiction. Veterans Affairs hospitals throughout the state also use contingency management programs with success. 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 sponsored by the San Francisco AIDS Foundation, APLA Health, Equality California, the City and County of San Francisco, and the California Association of Alcohol and Drug Program Executives.

“The rise of substance use and overdose deaths in San Francisco and California is a travesty and we must address it with every tool we have,” said Senator Scott Wiener. “Meth addiction is particularly powerful and destructive. Meth harms those caught in its grip, as well as our larger communities who experience public safety issues because of the meth crisis. The Recovery Incentives Act will expand access to contingency management programs, which are the only proven treatment – particularly given the lack of medication-based treatments – for stimulant addiction. This is an evidence-based approach to substance use disorder, and we have a moral obligation to do everything in our power to help those suffering with meth and other addictions.”

"We are making investments to provide long-term solutions for people suffering from addiction in order to increase access to services and substance use treatment beds,” said Mayor London Breed. “Senator Weiner's bill will give us more tools to support our most vulnerable residents by promoting treatment and rehabilitation for those who suffer from methamphetamine addiction so we can make a difference in their lives and the conditions on our streets.”

“Given the current overdose crisis and other factors including the COVID-19 pandemic and homelessness it’s more important than ever that we invest in evidence-based and low threshold services like contingency management,” said Mike Discepola, Vice President of Behavioral Health at the San Francisco AIDS Foundation. “Contingency management services at San Francisco AIDS Foundation have been effective and have reached many at-risk populations in our communities for whom traditional treatment is difficult to access – including communities of color, queer, and gender non-conforming individuals who are generally underserved by our treatment continuums. Our overreliance on traditional models of abstinence-based care have been major barriers to our communities to improve their lives and circumstances. It is beyond time to invest in contingency management and other innovative solutions to assist those we love to address their substance use concerns.”

“The numbers in LA County are staggering – meth-related deaths increased over 900% from 2008 to 2018 and meth is now linked to more deaths than any other drug. LA County is facing a meth crisis, particularly in the LGBTQ community, and we must take aggressive action to get people the treatment they need and save lives,” said Dr. Sean Boileau, Behavioral Health Services Director of APLA Health. “Although we still don’t have an effective medication for meth addiction, contingency management is a proven intervention to help people stay in treatment and stop using drugs. I personally witnessed the effectiveness of contingency management during my work as a psychologist at the Department of Veterans Affairs, which has long supported the use of contingency management to help veterans struggling with drug use. SB 110 is a critical step toward expanding use of contingency management services and addressing California's growing meth crisis. APLA Health applauds Senator Wiener for championing this critical issue.”

“Meth addiction is a major health emergency facing our LGBTQ+ community,” said Rick Zbur, the Executive Director of Equality California. “That’s why we are proud to co-sponsor Senator Wiener’s bill to combat the crisis head on with proven treatment methods. Everyone – especially vulnerable members of our LGBTQ+ community – deserves access to treatment and recovery.”

“CAADPE is proud to join, as a co-sponsor, with Senator Wiener in his effort to address the unique challenges the COVID-19 pandemic presents  for people with substance use disorders,” said Al Senella, President of the California Association of Alcohol and Drug Program Executives.  “In this time of the need for public health safeguards, California should be using all known and effective strategies to address the growing need for substance use disorder services.  Contingency Management programs are proven to help individuals maintain their health and as an effective relapse prevention strategy. CAADPE applauds Sen. Wiener for his leadership in bringing this important substance use disorder treatment strategy to California.”