This year, the federal government has increased its investment in opioid use disorder treatment. And with opioid lawsuit settlements pending, more funds appear to be on the way. It’s critical to remember that as this money comes in, our national response must address all forms of addiction.
Co-occurring substance use, or polysubstance use, is now becoming the norm. Meth and cocaine are the most involved non-opioid substances in opioid overdose deaths. In fact, opioid overdose deaths involving stimulants increased by 351% between 2010 and 2018.
The only effective treatment we have for stimulant use disorder is contingency management, which involves offering motivational incentives and tangible rewards for negative drug screens.
How does this work? According to The New York Times,
“Rewarding people for changing a behavior or adopting a new habit is a familiar concept, used by everyone from parents who are trying to get their children to do chores to companies that are trying to get their employees to stop smoking. Research has found it also helps people who are addicted to opioids, but for them, there are other treatments that are equally or more effective. For addiction to stimulants like meth and cocaine, however, contingency management has the best outcomes — especially when combined with therapy that helps people find healthier ways to meet their social and emotional needs than using drugs.”
Despite the evidence base for this behavioral therapy, it is generally not accepted by insurers as a viable treatment option. Treatment facilities which offer contingency management to their patients are unable to bill for it, having to cover the cost themselves. This means that most patients who struggle with polysubstance use are not being offered the full range of effective treatments, particularly if they are addicted to meth or cocaine.
By educating providers and payers about all types of treatment for substance use disorders, we can increase the use of these best practices and also increase access for patients. At the federal level, Shatterproof is championing the Medication Access and Training Expansion (MATE) Act, which is designed to ensure that all DEA-controlled medication prescribers have a baseline knowledge of how to prevent addiction and how to identify, treat, and manage patients who have substance use disorders. Policies like the MATE Act, which focus on addressing all addictions, are a critical step to treating polysubstance use.
While federal agencies like NIDA and NIH are conducting research to find an effective treatment for stimulant use disorder, we must support what works in order to save lives. And that includes contingency management, an effective tool in the toolbox to treat addiction. The reality is that most people struggling with addiction are utilizing multiple substances. At a time when fatal drug overdoses are skyrocketing and include multiple substances, we should be focusing on treating all addictions—not just opioid use disorder—with science and compassion.
Courtney Gallo Hunter is Shatterproof's Vice President of State Policy.