Led by California, a few states are testing an experimental program that pays people to stop using hard drugs.
The Golden State was the first to win approval from the Biden administration to cover the sobriety payments, with Medicaid wrapping it into an ambitious health-care initiative spearheaded by Democratic Gov. Gavin Newsom to provide the state’s sickest residents with a broad array of behavioral health and social services. Washington state and Montana have since followed.
California is focusing on stimulants, including cocaine and meth. Participants must pee into a cup regularly, and if the urine is free of stimulants, they get paid with a gift card, starting at $10 for the first test. The longer they abstain, the more they’re paid — up to $599 a year.
Addiction doctors say the treatment, called “contingency management,” can be lifesaving. Lethal overdoses in California from meth, including other psychostimulants, have spiked 129 percent since 2019 and from cocaine 102 percent, according to a KFF Health Newsanalysis of estimates from the Centers for Disease Control and Prevention.
“Contingency management is the gold standard for stimulant use disorder because you can win things for good behavior. But not a lot of places are providing it yet,” said PK Fonsworth, a psychiatric emergency room doctor and addiction psychiatrist in Los Angeles. “A lot of patients I see on amphetamines show up with these extreme highs and lows, manic behavior, and it can turn into a meth-induced psychosis or kill you.”
An intense policy focus on opioids helped reduce overdose deaths slightly from 2022 to 2023, even as use skyrocketed during the coronavirus pandemic. In the meantime, though, two older scourges — methamphetamine and cocaine — emerged as major public health threats.
The number of Americans who died from overdosing on meth jumped a staggering 117 percent from pre-pandemic levels, and cocaine overdose deaths rose about 83 percent, data shows.
The CDC data, released this month, shows that about 36,000 Americans died from methamphetamine in 2023, up from about 17,000 in 2019. Cocaine killed nearly 30,000 people in 2023, up from 16,000 in 2019.
Research shows promise for contingency management. For instance, study participants achieve significant periods of sobriety, agree to long-term addiction treatment and even reduce risky sexual behavior.
The Biden administration is pushing more states to consider the approach, calling it a “proven treatment” that “remains underutilized.”
So far, 19 of California’s 58 counties have enrolled a total of about 2,700 stimulant users.
The biggest take-up is in Los Angeles County, the most populous county in the United States, where public health officials cited contingency management as one of the only effective ways to curb stimulant use.
There are no consequences for failing a drug test. Participants simply don’t get paid that day but can try again later.
Quinn Coburn , a self-described longtime addict, has remained sober on the program in the rural Northern California town of Grass Valley, amassing more than $500 so far.
“It’s that little something that’s holding me accountable,” said Coburn, a former construction worker who said he has tried repeatedly to kick his habit.
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