National Council Statement on the Need To Revise Contingency Management Rules

WASHINGTON, D.C. (May 3, 2024) — The National Council for Mental Wellbeing today issued the following statement in response to the decision by the Biden-Harris administration to keep rewards for contingency management (CM) programs at current levels.

The new 2024 State Opioid Response and Tribal Opioid Response Notices of Funding Opportunity, released May 2, miss an opportunity to leverage the potential benefits of CM.

CM represented an effective approach for those with a substance use disorder in more than 100 randomized controlled trials over 50 years. Evidence shows it can double abstinence rates across opioids, stimulants, alcohol, tobacco and nicotine, compared to standard care alone. It is also the only evidence-based treatment for stimulant use disorders, which is significant because overdose deaths from stimulants like cocaine and methamphetamines also is on the rise. The psychostimulant-involved death rate increased 317% from 2013-19.

In addition, the Office of Inspector General with the Department of Health and Human Services issued a favorable advisory opinion in March 2022 regarding CM.

“Data released by the Centers for Disease Control and Prevention in March found that nearly 108,000 people died of an overdose in 2022, with stimulants claiming more lives every year,” National Council President and CEO Chuck Ingoglia said. “The need for more intervention strategies has never been more obvious. Contingency management is an evidence-based approach that leverages positive reinforcement to encourage healthy behaviors, such as abstinence and treatment retention, and it has demonstrated its effectiveness over and over.”

“The overdose crisis is ravaging Black Americans and people who live in rural parts of the U.S.,” National Council Substance Use Lead Philip Rutherford said. “CM programs can help reduce overdose deaths and improve health equity among people in underserved communities. If we care about finding an equitable approach to our nation’s overdose crisis, we must make it easier for people in underserved communities to take advantage of CM programs, because they work.”

“Despite the evidence, CM remains underutilized by addiction treatment providers due to a number of barriers,” Ingoglia said. “Under current government fraud and abuse laws, a reward for participating in a CM program could be considered an illegal kickback. In addition, nonmonetary rewards must not exceed the equivalent of $75 per patient per year. The rules governing CM have prevented more people with a substance use disorder from taking advantage of these programs. The federal government should consider increasing the nonmonetary reward threshold and exempting CM programs from fraud and abuse laws.”