Paying Meth Users Not to Use Is California’s Strategy to Make Them Stop

Fatal drug overdoses, including from meth, have soared. California is preparing to roll out a controversial but proven treatment for meth addiction that involves paying users small sums not to use.

As the pandemic has raged, so has the country’s drug epidemic. Fatal drug overdoses went up 30% last year. Health officials have been struggling with methamphetamine and cocaine abuse in particular because of the lack of effective treatments for those stimulants.

California is looking for an unusual solution – pay drug users not to use drugs. From member station KQED, reporter April Dembosky explains how the controversial treatment works.

Billy Lemon, a user who sought rehabilitation to kick his methamphetamine addiction went to a drug treatment program at the San Francisco AIDS Foundation three times a week and peed in a cup. If it tested negative for meth, he got paid about $7.

“For somebody who had not had any legitimate money – without committing felonies – that seemed like a cool thing,” says Lemon, who was arrested three times for selling meth before starting recovery.

The payments were part of a formal addiction treatment called contingency management, which incentivizes drug users with money or gift cards to stay off drugs. At the end of 12 weeks, after all his drug tests came back negative for meth, Lemon received $330. But for him, it was about more than just the money. It was being told, good job.

According to Lemon, “It was the first opportunity where I was like, I have self-worth, still. It’s buried. This person sees it and is willing to give me seven dollars, just to take care of me. That was very motivating.”

The soaring cases of overdoses and public health costs related to meth and cocaine in California are the main reasons state officials are desperate for more effective treatment options and are pursuing legislation and appealing to federal regulators to make contingency management more widely available. Washington, Montana, and West Virginia are also exploring similar strategies.

How does Contingency Management help?

Research shows contingency management is the most effective treatment for meth or cocaine addiction, especially when combined with other behavioral therapy. At the San Francisco AIDS Foundation, 63% of people who participated in the program in 2019 stopped using meth entirely, and another 19% reduced their use.

The Department of Veterans Affairs has relied on the therapy to treat 5,600 vets over the last 10 years. Of the 73,000 urine samples collected in the VA program, 92% tested negative for drugs, according to Dominick DePhilippis, a clinical psychologist at the Philadelphia Center for Substance Addiction Treatment & Education who helped launch the VA’s program.

“Patients often come to treatment ambivalent about change. Why? Because substance use is so seductive. It provides powerful, immediate reinforcement,” DePhilippis says. “Whereas recovery, its immediate consequences, are often unpleasant: withdrawal symptoms, a clear-eyed view of the devastated landscape that is one’s life.”

Contingency management embraces this challenge head-on, he adds, by offering immediate rewards and reinforcement for abstinence. The small payments or prizes aim to rewire the brain’s reward system, so the person seeks the money or gift card to get a dopamine release, instead of meth or coke.

“You’re like, ‘Oh! Oh! I can feel good without the daily use of that substance. Let me try and go one more week,'” says Lemon. “And then all of a sudden, you’re at 90 days and you’ve actually made a change.”

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What California Plans?

As the drug epidemic continues to worsen throughout California and the nation, with overdoses from stimulants like meth tripling in recent years, state officials are questioning those policies and pushing for changes. Critics are softening their stance.

A bill now on the governor’s desk – SB 110 – would allow the state’s Medicaid program to pay for contingency management services, with the goal of encouraging more drug treatment centers to offer it.

“We need to embrace this proven, effective approach to meth addiction, make it clearly legal and start reimbursing for it, so we can address this health epidemic,” says state Sen. Scott Wiener (D-San Francisco), who sponsored the bill.

Wiener says he was surprised to see the bill pass the California legislature with near-unanimous, bipartisan support.

“The Republicans love it,” he says. “I didn’t think they would, but they actually like it because there’s an abstinence component to it: we pay you money and you abstain from using.”

The state’s Department of Health Care Services, which runs California’s Medicaid program, is also on board. Department leaders have already asked federal regulators for explicit permission to offer contingency management through a statewide pilot project, and the feds appear poised to grant it.

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