SACRAMENTO — Frustrated by a spike in drug overdose deaths spiraling out of control, California leaders are trying something radical: They want the state to be the first to pay people to stay sober.
The federal government has been doing this with military veterans for years and research shows it is one of the most effective ways to get people to stop using drugs like cocaine and methamphetamine, stimulants for which no drug treatment is available. .
It works like this: People earn small incentives or payments for each negative drug test over time. Most people who complete treatment without anyone testing positive can earn a few hundred dollars. They usually get money on gift cards.
This is called “contingency management” and Governor Gavin Newsom has asked the federal government for permission to use tax dollars to pay for it through Medicaid, the United States and federal health insurance program for the poor and disabled that includes California. covers about 14 million people. .
Meanwhile, a similar proposal is moving through California’s Democratic-controlled Legislature. It has already passed the Senate without opposition and is pending in the Assembly, where it has a Republican co-author.
“I think this strategy has a lot for everyone to like,” said State Sen. Scott Wiener, a Democrat from San Francisco and the bill’s author. “Most importantly, it works.”
How much it will cost depends on how many people participate. A program covering 1,000 people can cost up to $286,000, a small fraction of California’s total operating budget of more than $262 billion.
The San Francisco AIDS Foundation, a non-profit agency, runs a small, privately funded contingency management program. This is where meth addict Tyrone Clifford enrolled because he promised to pay him for every negative test in 12 weeks.
His first payment was $2. This increased slightly for a total of $330 with each subsequent negative test.
“I thought, I can do 12 weeks. I have done this before when my dealer was in jail,” he said. “I will have Rs 330 more when I am done.”
Clifford made it through the program without testing positive. But instead of using this money to buy more drugs, he bought a laptop computer so he could go back to school. He says he hasn’t used methamphetamine in 11 years and now works as a counselor at the San Francisco AIDS Foundation, helping people who have had similar addiction problems.
Clifford, 53, said making money doesn’t matter much. Unlike some who struggled with drug addiction, Clifford always had a job and a house and was never in danger of being lost. But he said seeing his account grow with each negative test inspired him more than any other treatment program.
“You see the value of the dollar go up, there’s evidence that I’m doing it,” he said. “In no way is anyone getting rich from this program.”
According to an analysis by the California Health Benefits Review Program, there is “clear and convincing evidence” that the treatment works to keep people sober from drugs such as methamphetamine and cocaine. However, while research shows that it is effective at keeping people calm during the program, the effect does not last as long as six months after treatment ends.
Clifford acknowledged that the program doesn’t work for everyone, but her treatment includes extensive group and individual counseling sessions that hold her accountable and make her feel part of a community.
Clifford said he considers the treatment successful, even if people don’t make it without testing positive.
“They are trying something,” he said.
If California starts paying for contingency management treatment through Medicaid, Clifford said he thinks it will mean an explosion of similar programs across the state.
California, like much of the country, is grappling with opioid abuse, including prescription pain relievers and drugs such as heroin. But deaths from stimulants in California nearly quadrupled between 2010 and 2019, and the problem has gotten worse since then.
Preliminary data from the first nine months of 2020 – when much of the state was locked down due to the coronavirus – showed stimulant overdose deaths increased by 42% compared to 2019.
While opioids have many pharmaceutical treatments available to help people calm down, there are none for stimulants like methamphetamine and cocaine, often leaving people up to their will to quit the habit.
“There’s an obvious kind of hole with respect to treatment services for individuals who have stimulant use disorder,” said Jesse Cooper, director of California’s Medicaid program. “At this point[contingency management]is the only thing people are pointing out that has been effective.”
Contingency management is not widely used because it is not clear whether state and federal laws allow Medicaid money to pay for it. California has a law that prohibits people from receiving or receiving “kickbacks” from treatment programs. Wiener’s law would clarify that contingency management is legal under state law.
Whether it violates federal law is still a question.
“We don’t think it does,” Weiner said, noting that the Biden administration has signaled its interest in the treatment.
Weiner’s bill would require California’s Medicaid program to cover the treatment while Newsom’s plan would let counties choose whether to participate.