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Recovery Incentives Act, confronting Meth & overdose crisis passes

SB 110 authorizes Medi-Cal to fund evidence-based treatment giving those struggling with addiction financial rewards for staying sober

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Photo Credit: County of Los Angeles

SACRAMENTO — Senator Scott Wiener’s (D-San Francisco) legislation, Senate Bill 110, passed both the Assembly and the Senate on concurrence with bipartisan, unanimous votes. It will now head to the Senate for a concurrence vote, and then to Governor Gavin Newsom’s desk, where it can be signed into law.

SB 110 will address the worsening methamphetamine addiction crisis facing in the state. The Recovery Incentives Act legalizes the substance use disorder treatment known as “contingency management,” and authorizes Medi-Cal to cover it. Contingency management has proven to be the most effective method of treatment for methamphetamine addiction, and is frequently used as a treatment program by the Veterans Affairs Administration. This intervention program gives those struggling with substance use disorder financial rewards if they enter substance use treatment programs, stay in the program, and get and remain sober. This positive reinforcement helps people reduce and even fully stop substance use.

In the Biden-Harris administration’s new drug policy platform, increasing access to evidence-based treatment was slated as the number one priority. This includes contingency management. The platform cites the need to end “policy barriers related to contingency management interventions (motivational incentives) for stimulant use disorder” as part of its effort to expand evidence-based treatment.

There is currently no form of Medication-Assisted Treatment (MAT) for meth, unlike with opioids where treatment options such as methadone are available. Contingency management is thus a critical tool in addressing the meth addiction crisis. According to the San Francisco Department of Public Health (SFDPH), since 2008, meth overdose deaths in San Francisco have increased by 500%. Additionally, 50% of psychiatric emergency room admissions at San Francisco General Hospital are now meth-related. These disturbing statistics demonstrate the urgency with which San Francisco and other communities must address this epidemic.

With drug overdose deaths on the rise across the country, the state, and in San Francisco — San Francisco had a record number of overdose deaths in 2020 — effective substance use intervention programs are more important than ever. In San Francisco, according to data collected in 2019, roughly 60% of all overdose deaths were meth-related.

Meth use has spiked all over California and in San Francisco, and worsened through the COVID-19 pandemic. With social isolation, mental health issues like depression, and economic suffering all worse for many than in prior years, meth use has also increased significantly. Since COVID-19 was declared a national emergency on March 12th, The Hill reports that patients across the country “tested positive for methamphetamines at a roughly 20 percent higher rate between March and May than previous samples.”

Stimulant use has also grown rapidly in the LGBTQ and Black communities, which were already deeply impacted by the meth crisis. The LGBTQ community — particularly gay, bi and trans men — have seen a rapid increase in meth use as a party drug taken to enhance sexual experiences. SFDPH also reports that the mortality rate is highest among African American men.

Programs like the San Francisco AIDS Foundation’s PROP (Positive Reinforcement Opportunity Project) program – in which LGBTQ men who used meth are given gift cards for staying sober – are found to be highly effective. According to the San Francisco AIDS Foundation, in one year of the PROP program, 63% of participants stopped using meth entirely and another 19% reduced their use. This approach, coupled with community support meetings, proves time and again to be an effective method of treating meth addiction. Veterans Affairs hospitals throughout the state also use contingency management programs with success. This bill intends to make these programs accessible on a wider scale by authorizing them to be reimbursable by Medi-Cal.

The bill would also require the California Department of Health Care Services (DHCS) to issue guidance on the use of contingency management programs for Medi-Cal patients.

The bill is sponsored by the San Francisco AIDS Foundation, APLA Health, Equality California, the City and County of San Francisco, and the California Association of Alcohol and Drug Program Executives (CAADPE).

“We’re seeing meth overdose deaths skyrocket, and it’s clear that we need creative solutions for our addiction crisis,” said Senator Wiener. “We know that contingency management works; it’s one of the only effective and evidence-based treatments for stimulant addiction. Meth addiction is difficult to kick, and contingency management can help. We have every responsibility to help people succeed in abstaining from drugs that can be harmful to them and everyone in their community. Allowing state Medicaid funds to reimburse contingency management programs is an important step, and it’s something upon which legislators on both sides of the aisle can agree.”

“Discrimination, stigma and shame are all barriers that prevent too many LGBTQ+ people from receiving the treatment they need to overcome meth use and addition. Enough is enough.” said Equality California Executive Director Rick Chavez Zbur. “I’m grateful that the California Assembly took bold action today to increase access to a proven, evidence-based solution to this crisis. Thanks to Senator Scott Wiener’s visionary leadership, The Recovery Incentives Act will improve and save the lives of countless LGBTQ+ Californians.”

“CSAM, California’s physician specialists in evidence based treatment, is proud to support this important bill which expands the use of contingency management for stimulant use disorder in California,” said CSAM President Dr. Anthony Albanese. “Currently there is no medication proven to treat stimulant use disorder, Contingency management is therefore a critical component of treatment.”

“Contingency management programs are proven to help individuals maintain their health and are an effective relapse prevention strategy, by giving those struggling with substance use disorders positive reinforcement to remain in treatment,” said Al Senella, President, California Association of Alcohol and Drug Program Executives (CAADPE).

“With drug overdose deaths on the rise, effective substance use programs are now more important than ever – especially for the LGBTQ+ community,” said APLA Health Chief Executive Officer Craig E. Thompson. “In Los Angeles County alone, meth-related deaths increased over 900% from 2008 to 2018 and meth is now linked to more deaths than any other drug. SB 110 is a timely and urgent measure that will expand access to highly effective contingency management services and save lives. We applaud Senator Wiener for championing this critical issue and urge Governor Newsom to sign the bill into law as soon as possible.”

“Behind the rise in opioid overdose deaths in California lurks a rise in deaths by stimulant overdose,” stated Vitka Eisen, President and CEO of HealthRIGHT 360. “We must use every available evidence-based intervention in order to address this challenge. Contingency management has a strong body of research supporting its effectiveness in treating methamphetamine addiction. The passage of SB 110 will give us an additional tool that can immediately save lives.”

“With an overdose crisis that gets worse every year, it’s time to invest in programs and services that we know will prevent overdose and improve the health and lives of people who use drugs,” said Kevin Rogers, interim CEO of San Francisco AIDS Foundation. “The success of our PROP program, which takes a harm reduction approach to help people who use stimulants like methamphetamine and cocaine reduce and stop their use, and many other contingency management programs demonstrates the positive impact these programs can have if they are scaled up and replicated. SFAF strongly supports SB 110, and we call on the Governor to sign this important bill into law. Thank you Senator Wiener for your leadership on this effort.”

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California

H.S. students steal Pride flag, defecate on it & post video to TikTok

“It was definitely an act of hate directed at the LGBTQ community and a lot of students felt it, you know, felt that attack very acutely”

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Paso Robles High School via Google Earth

PASO ROBLES, Ca. – Earlier this school year two students walked into a science teacher’s classroom at Paso Robles High School, they proceeded to rip down the LGBTQ+ Pride flag hanging in the room and fled out the door. The theft took place as there was a classes break and as science instructor Evan Holtz took out after them he lost them in the throng of students in the hallway.

Holtz, who is a chemistry teacher, tutor, and swim coach, has been teaching at Paso Robles since 2019. In an interview with the San Luis Obispo Tribune, Holtz told the paper he had displayed the Pride flag to show solidarity with the school’s LGBTQ students, making sure that they knew they were welcome and safe in his classroom.

What happened immediately after the theft has left the high school’s LGBTQ+ students angered and alarmed. First, the Tribune reported, a video surfaced on TikTok of students attempting to flush the rainbow Pride flag down a toilet. Then, the video showed one student defecating on the flag in the toilet, according to those who had seen and heard about the video.

“It was definitely an act of hate directed at the LGBTQ community,” Geoffrey Land, a social sciences teacher told the paper. “And a lot of students felt it, you know, felt that attack very acutely.”

The Paso Robles Joint Unified School District said that administrators at the high school had taken “disciplinary action” after being alerted to the situation and the TikTok video by students. The next action undertaken on October 1st by the school district has left LGBTQ+ students disillusioned and further upset.

District Superintendent Curt Dubost sent a memorandum letter to faculty that read:

The Paso Robles Joint Unified School District has received multiple concerns about certain flag displays in teacher classrooms, including those that are large and distracting and those that alter the American flag.

I want to start by reiterating my statement from last year that rainbow flags mean different things to different people but to many are a symbol of safety, inclusion and equity. All students deserve protection against bullying and harassment. A safe, caring learning environment is essential if students are to achieve their academic potential.

We have a duty as a school district to ensure that hate speech and bullying conduct does not create an unsafe campus environment. Students in protected classes are often among the most vulnerable and susceptible to bullying and discrimination.”

Superintendent Dubost then laid out the new district policy: No flags bigger than 2 feet by 2 feet may be displayed in classrooms, and no flags that are “alterations of the American flag” may be displayed in classrooms.

In a follow-up interview with the Tribune Dubost justified his actions telling the paper, “We don’t want to turn it into a politicized issue where a student enters a classroom and looks up, ‘Oh, there’s a rainbow flag here, or there’s a blue lives matter flag here — that determines what the partisanship is of my teacher.’ We think that that’s a real slippery slope. And so we continue to believe that this is a very reasonable compromise solution that allows rainbows, but within reason.”

In an op-ed written by PRHS students on National Coming Out day last week, they expressed their dismay over Dubost’s actions.

October 11 is National Coming Out Day, when lesbian, gay, bisexual, transgender and queer people can celebrate support for LGBTQ equality. But in Paso Robles, where we attend high school, we cannot celebrate. Too often, LGBTQ students feel unwelcome, unsafe and targeted by hate.

After briefly mentioning the theft, video, and the action to ban flags other than a U.S. National flag taken by Superintendent Dubost they added:

Eventually, the school imposed minor discipline upon the offenders, and nearly two weeks later issued a policy statement that includes a ban on rainbow flags larger than 2’ x 2’. As the standard flag size is 3’ x 5’, the school purposefully banned the very flag that was desecrated. What message does this send to students? The flag ban means the school has allowed the haters to win, while LGBTQ students feel punished for wanting to be seen and supported.

The students cited a 2018 oral history project at PRHS which interviewed students in the Paso Robles Joint Unified School District area high schools of Templeton, Atascadero and Paso Robles.

They found that offensive slurs and open hostility directed at LGBTQ+ individuals were commonplace in classrooms. LGBTQ+ students reported not feeling included in their school culture. Students interviewed reported that teachers who wore rainbow colored pins or posted supportive flags or posters in their classroom walls helped create welcoming, safe spaces. Over the years, PRHS has witnessed loss of life, violence and intimidation — all in the name of anti-LGBTQ hate.

In their call to action the students stated that; “Enough is enough. How many more students will be traumatized by systems and people who fail to embrace the beauty and diversity of their students? The school’s response is a collective slap in the face of all LBGTQ students at PRHS. From our perspective, the school’s flag ban means they’re more interested in appeasing the bullies than protecting the safety of the victims of hate.”

There is a community forum event scheduled for Wednesday, October 20 from 6 to 8 p.m. at the PRHS performing arts center. Organized by students, the event, “Coming Out Against Hate,” is an opportunity for students to “share their experiences and visions for a more welcoming, inclusive educational environment,” and it’s the first forum of its kind in Paso Robles, according to a news release sent out about the event.

With the forum, we’re hoping that things change and they stop normalizing hate against us,” a senior told the Tribune, “I’m really proud of the fact that so many people are brave enough to come up against the adversity that is very obvious here. We might get a ton of hate for this. We might get hate-crimed ourselves.

But we can’t let this continue. We have a culture of homophobia here. We literally have no other option than to put ourselves kind of at risk and in danger. Because we can’t let this continue.”

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California

Gender neutral toy section in retail stores bill signed by Newsom

California now becomes the first state to require big box stores and large retailers to set aside areas with a gender neutral section

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Ballinger Family at Mattel's Creatable World dolls event 2019 (Screenshot from YouTube )

SACRAMENTO – A law that designates display of products like toys and childcare items in gender-neutral ways was signed Saturday by Governor Gavin Newsom. California now becomes the first state in the nation to require big box stores and large retailers to set aside areas with “a gender neutral section with a reasonable selection of items regardless of whether they have been traditionally marketed for either girls or for boys.”

AB 1084 is co-authored by Assemblyman Evan Low, who chairs the California Legislative LGBT Caucus, and Assemblywoman Cristina Garcia, who chairs the California Legislative Women’s Caucus.

The new law addresses what LGBTQ+ advocates have been championing to address more open acceptance of diversity and inclusion of gender models outside of the more rigid ‘traditional’ established societal models that LGBTQ advocacy groups have said are archaic and harmful to healthy development for LGBTQ+ youth.

“I’m incredibly grateful to Gov. Gavin Newsom for signing AB 1084, which will bring California law up to speed with what many retailers have already realized: We need to stop stigmatizing what’s acceptable for certain genders and just let kids be kids. My hope is this bill encourages more businesses across California and the U.S. to avoid reinforcing harmful and outdated stereotypes,” Low said in an emailed statement.

“We need to stop stigmatizing what’s acceptable for certain genders and just let kids be kids,” Low added. “My hope is this bill encourages more businesses across California and the U.S. to avoid reinforcing harmful and outdated stereotypes.”

The California Retailers Association declined to comment on the bill after its passage last month. Formal opposition has come from a number of conservative groups. State Sen. Melissa Melendez, a Republican from Lake Elsinore, voted against the bill, the Associated Press reported, saying she would “recommend we let parents be parents.”

“Unlike the author, I actually have children, five of them to be exact, and I can tell you it is very convenient for parents,” she said. “I don’t think parents need the government to step in and tell them how they should shop for their children.”

The law, which does not include clothes solely applies to toys and “childcare items,” which include hygiene and tooth products. Retail companies with at least 500 employees are affected, however, small businesses are exempt.

In 2015, Minneapolis based Target Corporation with 1,914 stores across the United States, announced it would stop using some gender-based signs in its stores.

While AB1084 requires large department stores to comply, penalties for not doing so would be light. Starting in 2024, prosecutors could seek fines of up to $250 for first offenses and up to $500 for second offenses. Those would be civil, not criminal, penalties. Stores could also end up having to pay for reasonable attorney’s fees and costs.

Related coverage from ABC7 News Los Angeles:

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California

Newsom vetoes Recovery Incentives Act, the meth & overdose crisis bill

So many people across California are dying from meth overdoses, disproportionately LGBTQ people and people of color

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California Governor Gavin Newsom (Photo Credit: Office of the Governor)

SACRAMENTO – California Governor Gavin Newsom announced Friday night that he had vetoed Senator Scott Wiener’s (D-San Francisco) legislation, Senate Bill 110, — which passed with unanimous and bipartisan support in both houses of the California State Legislature — aimed at confronting the growing methamphetamine addiction crisis facing California.

In an text message to the Blade after learning of the governor’s veto, Wiener said;

I’m deeply disappointed that the Governor has chosen to veto SB 110. So many people across California are dying from meth overdoses, disproportionately LGBTQ people and people of color. And they’re dying right now. Time is of the essence. We know from more than a decade of data and experience that contingency management is highly effective in helping people stop using meth. Contingency management is a proven tool, and we don’t need pilot programs to tell us that. SB 110 would have made clear that contingency management is legal and would have allowed its implementation across the state. This veto is a setback in our effort to confront this epidemic.”

The Recovery Incentives Act aimed to legalize the substance use disorder treatment known as “contingency management,” and authorize Medi-Cal to cover it. Contingency management has proven to be the most effective method of treatment for methamphetamine addiction, and is frequently used as a treatment program by the Veterans Affairs Administration.

This intervention program gives those struggling with substance use disorder financial rewards if they enter substance use treatment programs, stay in the program, and get and remain sober. This positive reinforcement helps people reduce and even fully stop substance use.

The meth crisis is devastating the LGBTQ+ community, and every day that we fail to act means more lives lost to this urgent, preventable epidemic. We are deeply disappointed by today’s veto, but we are committed to expanding access to this important program. We look forward to working with Senator Wiener to do so,”  Equality California’s Executive Director-designate Tony Hoang said.

In his veto message the governor noted:

This bill would require Medi-Cal substance use disorder services to include contingency management services as an optional benefit under the Drug Medi-Cal organized delivery system, subject to utilization controls. Given the promise of contingency management as a treatment for stimulant use disorders, the 2021-22 Budget includes funding to support a pilot
contingency management Medi-Cal benefit from January 2022 through March 2024
.

The Department of Health Care Services has sought federal approval for this pilot project and will work expeditiously to implement it once it is authorized. The outcomes and lessons learned from the pilot project should be evaluated before permanently extending the Medi-Cal benefit. As such, this bill is premature, and I am returning it without my signature.

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