Res 1871-2021

By Council Member Levin Whereas, In October of 2021, New York State Assembly Member Robert C. Carroll introduced legislation (A.8356) and New York State Senator Diane J. Savino introduced a companion bill (S.7485), which would require the Office of Addiction Services and Supports (OASAS) to establish contingency management services for certain persons with substance use disorders; and Whereas, According to the Centers for Disease Control and Prevention (CDC), substance use disorders have contributed to a decreased life expectancy in the United States with the number of drug overdose deaths having quadrupled from 100,000 per year in 1999 to nearly 500,000 deaths per year in 2019; and Whereas, The National Center for Health Statistics reported during the 12-month period from April 2020 to April 2021, more than 100,000 Americans died of overdoses-an increase of almost 30 percent from the 78,000 overdose deaths reported in 2020; and Whereas, According to the Director of the National Institute on Drug Abuse (NIDA) "these are numbers we have never seen before," and the majority of fatalities are occurring among people aged 25 to 55 who are in the prime of life and leave behind families and children; and Whereas, Contingency management is a behavioral therapy approach based upon B.F. Skinner's operant conditioning principles that promotes a method of learning by utilizing positive rewards and negative punishments in order to strengthen healthy behaviors; and Whereas, According to federal agencies such as NIDA and the Substance Abuse and Mental Health Service Administration (SAMHSA), research has proven contingency management to be highly effective in helping individuals abstain from substance misuse and comply with treatment objectives in order to incentivize abstinence from opioids, stimulants and other substances; and Whereas, Contingency management programs include Voucher-Based Reinforcement (VBR) that reward clients with monetary goods and services in exchange for a drug-free urine samples, and similarly, Prize Incentives (PI) programs that allow participants with drug negative urine tests to draw from a bowl for a chance to win a prize between $1.00 and $100.00; and Whereas, Metaanalysis has confirmed that the effect of contingency management is moderated by the size of the rewards, with smaller rewards providing less benefits, and NIDA research studies found contingency management programs have proven especially effective for treating stimulant use disorders, involving substances such as cocaine and methamphetamine, which currently have no proven FDA-approved medication treatments; and Whereas, Despite its proven efficacy, according to the Journal of Health Affairs, one of the biggest barriers to contingency management programs is the argument voiced by some researchers, clinicians and other members of society that include criticisms likening the treatment approach to "bribery" and calling it "unethical to pay people for what they should be doing anyway"; and Whereas, Others contend that it would be unlawful to provide contingency management to patients enrolled in health plans or programs funded by federal or state dollars; however, the Department of Health and Human Services Office of the Inspector General released an advisory opinion in 2008 that took the position that offering contingency management in conjunction with a specific treatment program does not violate anti-kickback statues; and Whereas, According to data collected by the New York City Department of Health and Mental Hygiene (DOHMH) there were 503 deaths due to unintentional drug poisoning or overdose confirmed during the third quarter of 2020 in New York City; and Whereas, Given the recent increase of overdose deaths attributed to the uptick in substance misuse during the ongoing COVID-19 pandemic, and the well-documented devastation that untreated substance use disorders have on society; now, therefore, be it Resolved, That the Council of the City of New York calls upon the New York State Legislature to pass, and the Governor to sign, A.8356/S.7485, which would establish contingency management services for persons with substance use disorders to incentivize abstaining from opioids, stimulants and other substances. CD LS 18185 11/22/21 1