US government lets digital health company pay drug users to stay clean

A new legal opinion from the White House is allowing a company to pay people with drug addictions for staying clean, The Washington Post reported March 11. 

The harm-reduction technique — known as "contingency management" — provides repeated small payments for meeting recovery goals. Research has found the technique can significantly help people stay sober.  

The government previously limited such management. However, at the request of a company that has been conducting research on the effectiveness of payments to drug users, people addicted to alcohol and smokers, the government is allowing contingency management, as explained in an advisory posted March 2 by HHS' Office of Inspector General.

The ruling lets Boston-based DynamiCare Health, a digital health company, pay clients up to $599, a sharp increase from the $75 limit previously allowed — an amount some experts said was too low to be effective. The higher total is the most one can receive without being taxed.

In DynamiCare trials, clients had to carry saliva-based drug test kits at all times and undergo random tests. Management is phone-based, with tests conducted in front of the phone camera and watched by company personnel, according to David Gastfriend, MD, addiction specialist and chief medical officer and co-founder for DynamiCare. Starting with small rewards for achievements such as making it to a meeting, incentives escalate for finding a job or enrolling in a vocational program, Dr. Gastfriend said. The debit card that receives funds blocks spending at liquor stores, casinos and bars, and can't be converted to cash.  

DynamiCare won't face criminal or civil penalties for its payment plan, Robert DeConti, an HHS assistant inspector general for legal affairs, told the Post. The decision applies only to DynamiCare — others who want to offer similar inducements must receive their own OIG advisory.

Last April, President Joe Biden's administration said it would prioritize eliminating barriers to contingency management. The technique is considered particularly valuable for treating stimulant addiction, such as methamphetamine and cocaine, since there are no proven medications. In 2020, the overdose death rate from stimulants such as methamphetamine jumped 50 percent from 2019, according to the National Center for Health Statistics

HHS is allowing California to launch a $58.5 million contingency management test for people with stimulant use disorder in July, using Medicaid funds. When Kelly Pfeifer, MD, deputy director for behavioral health at the California Department of Health Care Services, was asked why taxpayer dollars should go to people who use illegal drugs, she said: "The data is robust, unequivocal. There's nothing else that works to move people toward recovery."

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