The Biden administration on Wednesday removed a major barrier for health care providers who want to offer contingency management, a form of addiction treatment increasingly used to help reduce the use of stimulants, especially methamphetamine.
Contingency management helps drug users reduce their consumption by providing financial incentives in exchange for reduced substance use. Although it comes in many forms, typical programs may include providing gift cards in exchange for negative urine drug tests. And while it may seem controversial, several studies support its effectiveness, and several US states, including California, Montana, West Virginia, and Washington, already offer it through their Medicaid programs.
However, despite their effectiveness, many federal grants intended to support contingency management are limited to $75 per year, a level that experts and providers say is insufficient to enable behavior change. However, with less than two weeks left in office, the Biden administration announced that grants offered by the Substance Abuse and Mental Health Services Administration can now fund contingency management services up to $750 per year. Payments must be made via vouchers or gift cards, according to the agency’s announcement, and cannot be made in cash.
SAMHSA had previously declined to raise the cap, citing concerns that providing greater financial incentives could violate federal anti-kickback laws.
As the use of stimulants such as meth and cocaine has increased, contingency management has gained increasing support as a crucial part of the national response to the drug crisis. Opioids still kill more people than any other drug other than alcohol, but deaths from stimulants have risen sharply, and an increasing share of overdoses involve opioids in combination with stimulants.
Although opioid addiction is treatable with medications such as methadone and buprenorphine, there is currently no approved drug treatment for stimulant addiction.
Contingency management “is considered a primary and potentially lifesaving intervention for the more than 4 million people who meet diagnostic criteria for stimulant use disorder,” SAMHSA said in a bulletin announcing the change.
The decision marks the end of a yearslong advocacy by contingency management advocates, who argued that providing a paltry $75 per year – roughly $3 per week for a typical six-month distribution period – was ineffective.
Beyond the funding implications, the Biden administration’s move has symbolic weight – it is by far the largest show of support the federal government has ever shown for contingency management, and could change the attitude of private insurers and healthcare providers toward can change the intervention.
Outspoken proponents of contingency management included Westley Clark, a former SAMHSA official; Sarah Wattenberg, since retired from her leadership position at the National Association for Behavioral Healthcare; David Gastfriend, the chief physician at DynamiCare, an emergency management provider; and Keith Humphreys, a former federal drug policy official and Stanford researcher.
“This is a huge advance,” Humphreys said, “because this is the only treatment that works for cocaine and methamphetamine addiction.”
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