EDITORIAL: Improve on much needed meth-treatment option

Aug. 17—Editor's note: The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team. As part of this project, editorial writer Alex Fryer has been examining issues related to behavioral health and substance use disorders.

As part of the Legislature's $88.5 million investment in substance abuse treatment, providers across Washington were tasked with offering a new approach for methamphetamine users.

It's called contingency management. Unlike other treatment options that use pharmaceuticals to wean people off opioids, contingency management offers small cash rewards to go clean.

Despite promising pilot projects over the years, widespread use of contingency management was essentially banned by the federal government, over fears of Medicaid fraud if doctors paid patients to be treated. After pleas from desperate advocates, the rules changed in the waning days of the Trump administration.

A program in Walla Walla has been offering contingency management for several months, and the early results show both its promise and limitations. The Legislature should continue to track these early efforts to see how best to roll out this strategy even further.

Meth is a notoriously difficult drug to treat. Unlike heroin, for which there are medications such as methadone or Suboxone, there is no widely prescribed drug to help users kick stimulants like meth.

Everett Maroon runs treatment and case management programs in southeast Washington that include needle-exchanges and Suboxone. Last March, he began enrolling people in a contingency management program called "Recovery Rewards." Most were locals, more men than women. "Meth was not the first thing that went wrong in their lives," he said. "Once meth got in the picture, all the other problems got worse."

For eight weeks, people would come in every few days and take a urinalysis. If the results showed no drugs, the person would be awarded a $10 gift certificate to Target or Safeway. The amounts gradually increased to $24. If the enrollee failed two drug tests, they were out of the program.

Of the 30-40 people who expressed an initial interest, eight followed through. Two completed the program — one completely kicked meth, the other relapsed and wants to try again.

An important caveat: The population served by the program was not initially seeking treatment. They entered through the syringe exchange and other offerings intended to reduce the harm from chronic drug use. The mindset of overcoming a substance use disorder had not necessarily set in.

Studies show that even relatively small dollar amounts can provide a needed incentive for meth users to stay engaged and eventually find success.

Maroon said the program could be improved by allowing participants more second chances if they fail, extending it to 12 weeks, and offering the urinalysis and gift cards in a visiting mobile van, so people don't have to travel vast distances to participate.

Word-of-mouth is growing, and interest is increasing, he said. "Even a few dozen improvements are helping out families, communities and our workforce," said Maroon.

Contingency management offers hope to people with stimulant use disorder. While these programs need assessment and adjustment, the Legislature was right to fund them. Now, lessons learned must be put into practice to meet the tremendous need for viable meth-treatment options.

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