Senator Wiener’s Recovery Incentives Act, Confronting the Growing Meth and Overdose Crisis, Passes Assembly Health Committee

July 14, 2021

SACRAMENTO – Senator Scott Wiener’s (D-San Francisco) legislation, Senate Bill 110, passed the Assembly Health Committee with a unanimous, bipartisan vote. It will now head to the Assembly Appropriations Committee. This legislation will 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.

In the Biden-Harris administration’s new drug policy platform, increasing access to evidence-based treatment was slated as the number one priority. This includes contingency management. The platform cites the need to end “policy barriers related to contingency management interventions (motivational incentives) for stimulant use disorder” as part of its effort to expand evidence-based treatment.

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. 

With drug overdose deaths on the rise across the country, the state, and in San Francisco — San Francisco had a record number of overdose deaths in 2020 — 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. 

Meth use has spiked all over California and in San Francisco, and worsened through the COVID-19 pandemic. With social isolation, mental health issues like depression, and economic suffering all worse for many than in prior years, 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 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 (CAADPE).

“Meth addiction is pernicious; it’s both very difficult to live with and to kick,” said Senator Wiener. “We’re seeing cities and towns across California ravaged by the meth crisis, and we need a new approach. Every community is impacted by substance use, particularly meth use – including the LGBTQ community, who sadly faces a meth crisis of its own. We must invest in evidence-based treatments for meth addiction and all substance use disorders.”

“With drug overdose deaths on the rise, effective substance use programs are now more important than ever – especially for the LGBTQ+ community,” said APLA Health Chief Executive Officer Craig E. Thompson. “In Los Angeles County alone, meth-related deaths increased over 900% from 2008 to 2018 and meth is now linked to more deaths than any other drug. SB 110 is a timely and urgent measure that will expand access to highly effective contingency management services and save lives.”

"Meth use and addiction has been a longstanding crisis in the LGBTQ+ community due to stigma, shame and marginalization — and we ought to be doing everything in our power to get folks the support and treatment they need,” said Equality California Executive Director Rick Chavez Zbur. “The Recovery Incentives Act will address this worsening crisis by increasing access to evidence-based, lifesaving meth addiction treatment. We are grateful to Senator Wiener for his leadership and to the members of the Assembly Health Committee who advanced this crucial legislation today." 

 “San Francisco AIDS Foundation strongly supports SB 110 because we know harm reduction-based contingency management programs are effective based on our own experience administering PROP for many years,” said Laura Thomas, Director of Harm Reduction Policy at San Francisco AIDS Foundation. Contingency management is an evidence-based treatment that meets people where they are at and should be recognized as a critical service to support people who use drugs. It is important for Medi-Cal to offer reimbursement to organizations who offer this service. It saves lives and addresses substance use from a perspective rooted in public health science.”

"Contingency Management programs are proven to help individuals maintain their health and are an effective relapse prevention strategy, by giving those struggling with substance use disorders positive reinforcement to remain in treatment,” said Al Senella, President of the CAADPE and CEO Tarzana Treatment Centers. “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." 

“At a time when substance use, including the use of methamphetamine, is on the rise and we are grappling with an overdose crisis, we have seen some policymakers try to take a dangerous step away from evidence-based treatment. We applaud Senator Scott Wiener for listening to science and following evidence-based substance use treatment practices with contingency management programs. We know that contingency management works and can help alleviate the meth crisis throughout California,” stated Dr. Vitka Eisen, President and CEO of HealthRIGHT 360. “We are excited to support SB 110, and look forward to contingency management becoming another important tool to address substance use disorder and improve the lives of people that need the most help.”