The Biden administration on Wednesday eliminated a major barrier for health providers seeking to offer contingency management, a form of addiction treatment increasingly used to help reduce the use of stimulants, particularly methamphetamine.
Contingency management helps drug users curb their consumption by providing financial incentives in exchange for reduced substance use. While it exists in many forms, typical programs may include providing gift cards in exchange for negative urine drug tests. And while it may appear controversial, several studies support its effectiveness, and several states across the U.S., including California, Montana, West Virginia, and Washington already include the offering via their Medicaid programs.
Despite its effectiveness, however, many federal grants meant to support contingency management have been capped at $75 per year, a level that experts and providers say is insufficient to facilitate a behavioral change. With under two weeks left in power, however, 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 annually. 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 larger financial incentives could violate federal anti-kickback laws.
As the use of stimulants like meth and cocaine has increased, contingency management has gained support as a critical component of the nation’s drug crisis response. Opioids still kill more people than any drug besides alcohol, but deaths attributed to stimulants have climbed sharply, and an increasing share of overdoses involve opioids in combination with stimulants.
While opioid addiction is treatable using medications like methadone and buprenorphine, there is not currently an approved medication treatment for stimulant addiction.
Contingency management “is considered a primary and potentially life-saving intervention for the over 4 million people who meet diagnostic criteria for a stimulant use disorder,” SAMHSA said in a bulletin announcing the change.
The decision marks the end of a yearslong advocacy effort from contingency management proponents who argued that providing a meager $75 per year — roughly $3 per week for a typical distribution period of six months — was ineffective.
Beyond the funding implications, the Biden administration’s move carries symbolic weight — it is, by far, the largest show of support the federal government has ever displayed for contingency management, and could shift private insurers’ and health providers’ attitudes toward the intervention.
Among others, vocal contingency management proponents 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 medical officer at DynamiCare, a contingency 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 addiction to cocaine and methamphetamine.”
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