San Francisco Promotes Treatment for Stimulant Use Disorder Amid Overdose Epidemic

The rate of overdose deaths in San Francisco remained steady in the first two months of 2024, according to data released Monday from the Office of the Chief Medical Examiner.

The new data shows there were 131 overdose deaths in San Francisco between January and February of this year. That’s compared to 136 overdose deaths over the same period a year ago. There were 811 overdose deaths in San Francisco in all of 2023.

Most of these overdoses involved fentanyl, an opioid about 50 times stronger than heroin. But many people who die from an overdose in the city are combining substances with fentanyl, like methamphetamine or cocaine.

In response, city health officials say they are expanding opportunities for contingency management, a positive-reinforcement-based model that’s primarily used for adjusting methamphetamine and cocaine use.

“Recovering from stimulants improves an individual’s health and reduces their overall risk of overdose,” Christy Soran, deputy medical director of substance use services for the Department of Public Health, told reporters on Tuesday.

Unlike opioid addiction or alcoholism, there are no government-approved medications for stimulant-use disorder. Contingency management offers another option. People participating typically attend weekly or regular meetings with a group and counselor, and they take a drug test for the substance they are targeting. If the test is negative, a small stipend, such as a gift card, is offered.

Veterans Affairs has used contingency management for decades. A 2018 study found that, on average, VA patients attended more than half of their counseling sessions, and 91% of participants tested negative for the targeted substance.

San Francisco’s embrace of contingency management is not new. But its expansion comes alongside statewide efforts to grow access to the model.

In 2021, California became the first state to cover contingency management through Medi-Cal.

The state has also allocated $58.5 million to pilot contingency management programs in nearly two dozen other California counties. In those programs, each patient receives a maximum of $599 over six months, after which they are referred for follow-up recovery programs and services.

Locally, the San Francisco Department of Public Health provides contingency management at the Citywide Clinic’s Stimulant Treatment Outpatient Program, the Office-Based Buprenorphine Induction Clinic and Project HOUDINI LINK. The San Francisco AIDS Foundation and others also provide similar programs.

Meanwhile, San Francisco has been working to increase opioid addiction treatments like buprenorphine or methadone medications as overdose deaths have remained at epidemic levels.

“These medications, specifically buprenorphine and methadone, each reduce a person’s risk of dying by approximately 50%,” Hillary Kunins, director of Behavioral Health and Mental Health SF for the San Francisco Department of Public Health, said on Tuesday to reporters. “I really cannot understate the effectiveness of these medications. They save lives, and they are within every person’s reach.”

Buprenorphine is available across the San Francisco Health Network, including in primary care and hospital settings.

“We want everyone to know, even though addiction is a chronic illness, recovery is possible,” Kunins said. “There is a way out of addiction and into a healthier life.”