California Tries Paying Drug Users to Stay Sober

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source: https://www.nytimes.com/2023/08/29/us/california-drug-program-gift-cards.html

Anything is worth a try, right ?

California Tries Paying Drug Users to Stay Sober

Aug. 29, 2023

The state is testing a program, run through Medicaid, that lets methamphetamine users earn gift cards by testing negative.



Dr. Siddarth Puri, left, an addiction psychiatrist, greeting Damion Corral, 45, a participant in contingency
 management, a treatment approach that offers rewards for avoiding drug use at Skid Row.

California began a bold experiment this year: paying people to stay sober.

With overdose deaths on the rise, the state’s Medicaid program recently became the first in the nation to begin offering financial rewards to drug users who abstain from using stimulants like cocaine and methamphetamine. The program is an innovative, science-backed effort with many supporters, but it has raised some eyebrows.

“It’s really a brave choice of California to try this against potential backlash and misunderstanding,” said Catherine Teare, an associate director at the nonprofit California Health Care Foundation, noting that stimulant use is a particularly severe problem among the state’s growing homeless population. “This isn’t going to solve it,” she said, “but I think it’s well worth trying.”

There aren’t any targeted medications to combat addiction to stimulants, as there are for opioids and alcohol, so stimulant addictions are among the hardest to treat. That’s why state officials are banking on this pilot program to fight cocaine and methamphetamine abuse.

Deaths from these kind of stimulants in California quadrupled from 2011 to 2019, according to an analysis by the California Health Care Foundation. Emergency department visits related to amphetamines rose nearly 50 percent in two years, from 2018 to 2020, the analysis found.

“The public health burden of methamphetamine use disorder is enormous,” said Brian Hurley, the medical director for substance abuse prevention and control in the Los Angeles County Department of Public Health. “We’re excited to be able to offer this treatment — we needed this tool for stimulant use disorder.”

Los Angeles County, which has about 20 outpatient treatment centers enrolling patients in the program, is one of two dozen counties, including San Francisco, Alameda and Orange, that are participating in the initiative. According to state officials, 88 percent of California’s Medi-Cal population lives in the participating counties. The program is expected to cost roughly $50 million, most of it paid for with federal funding.

The program, which lasts 24 weeks for participants, employs what’s known as contingency management, essentially a kind of positive reinforcement. The goal is to rewire people’s brains so that they associate not using drugs with good outcomes.

A meta-analysis published in JAMA Psychiatry in 2021 found that 80 percent of studies that tested this approach for stimulant use showed that it reduced drug use. According to the California Department of Health Care Services, contingency management “is the only treatment that has demonstrated robust outcomes for individuals living with stimulant use disorder.”

Here’s how the state program works: After people who have been diagnosed with a stimulant use disorder enroll, they undergo regular urine testing and are paid for each test that comes back negative for stimulants. The reward, which begins at $10 and rises with each consecutive clean test, comes in the form of a gift card for a grocery store or a retail store. If participants stay clean for 24 weeks, they can earn a total of $599. (Any more than that would have to be reported to the I.R.S.)

Participants are also offered therapy, counseling, medication to help manage the use of other drugs and connections to community resources. Those services continue for up to six months after the initial 24 weeks.

After six months, “the hope is that the participant has developed recovery skills,” Hurley told me. “That said, we would like to see this program continue, and we’d understand if patients needed multiple trials of it.”