California counties launch Medicaid-funded programs that give stimulant drug users money in exchange for sobriety
Rachel Schilke
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California is launching a pilot “contingency management” program across counties to provide money to methamphetamine users in exchange for staying sober, the latest method employed by the state to combat rising drug addiction and homelessness.
Twenty-four counties are participating in the Recovery Incentives Program. Under this program, operating under the state’s Department of Health Care Services, participants addicted to stimulants can receive gift cards starting at $10 if they test negative for the drug.
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The testing occurs once or twice a week. The amount on the gift cards will gradually increase to a maximum of $26.50 per test, and the cards are redeemable at Walmart or another retailer. If they test positive, participants will receive nothing.
Participants can earn a maximum of $599 over the course of the program in exchange for testing negative. The $599 maximum was intentional because it falls just below the IRS’s threshold that requires parties to report transactions of $600 or more.
The Recovery Incentives Program received funding from the federal Centers for Medicare & Medicaid Services through a waiver, making California the first in the United States to have a contingency management program under Medicaid.
Brad Shapiro, director of the Opiate Treatment Outpatient Program at Zuckerberg San Francisco General Hospital, believes the “contingency management” program model works because it replaces the desired prize a patient’s brain craves — the drug — with a different type of reward.
“It’s a little bit like winning something,” Shapiro said. “It triggers that reward place in the brain that otherwise they would be turning to the drug for.”
The Recovery Incentives Program in San Francisco opened enrollment on July 17, and it is set to last for six months. The program’s staff hopes to serve about 50 people.
Some have questioned the long-term efficacy of the program, saying it is unclear what will happen once a participant leaves the program and exhausts the financial incentives to stay off drugs.
“Using gift cards as incentives distracts us from tackling the larger, more pervasive issue at hand,” Los Angeles City Councilwoman Traci Park said to Just the News. “These gestures, while well-intentioned, cannot genuinely address the root causes of the crisis we are facing. To achieve lasting and meaningful change, we must proactively address the underlying issues head-on.”
Drugs contribute largely to California’s rising homeless population and crime rates. Among homeless people, amphetamines are by far the most common choice, according to a recent study by the UCSF Benioff Homelessness and Housing Initiative. Some homeless people have reported using stimulants to stay awake out of fear of being attacked if they fell asleep.
Police and district attorneys in California have blamed state laws such as Proposition 47 for the increases, saying it ties law enforcement’s hands and prohibits them from exercising the law.
Proposition 47 downgraded nonviolent drug crimes and possession of drugs such as methamphetamine from felonies to misdemeanors. Law enforcement argues that this law allows repeat offenders to only complete minimal jail time before heading back out on the streets.
Stimulant-related drug deaths accounted for 65% of overall drug-related deaths in California in 2021, which is up 22% since 2011, according to DHCS. No drug treatments or medications exist for helping people addicted to stimulants, as opposed to medicines helping ease addicts off opioids, for example.
However, Shapiro said he has faith in the Recovery Incentives Program, given similar programs have had positive results.
The six-month program mirrors one from the Department of Veterans Affairs that has been in place for over a decade. In that program, which has served over 6,300 veterans, 92% of participating veterans tested negative for their drug tests.
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“It’s actually, in my opinion, really quite criminal that we’ve gone decades knowing this is an effective treatment, and the powers that be have failed to make a pathway for treatment for people,” Shapiro said.
Participating counties in the 24-county program include some of the largest in the state, such as Fresno, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, and San Diego counties. Other counties, such as Santa Clara, hope to launch a similar program within the next few weeks to address their rising drug problems.