Methamphetamine, one of top drugs with harshest addictions, has lethal impacts on those who use it: Tearing their skin, not being able to eat, lack of sleep, and having a difficult time finding help.

Clinics are struggling to fight the meth epidemic. According to CalMatters, “The worst part: The clinic workers largely are powerless because unlike with opioid addiction, for which doctors prescribe medications such as methadone, there is no medicine for stimulant use disorder.”

“We live day in and day out watching people suffer in a way that's hard to imagine,” said Dr. Brad Shapiro, medical director of the Opiate Treatment Outpatient Program at Zuckerberg San Francisco General Hospital. “They're just dying in front of us.”

Now, California is trying a new way to stimulant addiction: Paying people with gift cards in reward of remaining sober.

This is what we call “contingency management,” a model that rewards people with financial benefits for every time their drug tests result in negative for stimulants. It has been a success so far in the past through clinical trials, with the U.S. Department of Veteran Affairs using this approach for more than a decade. However, this has not been a precedent in California, with Medicaid not wanting to cover it that prevented expanding funding for its enforcement.

Thankfully, this is changing. With its ongoing expansion, under the help of waivers given by the Center of Medicare & Medicaid Services to cover the costs.

California is the first state in the nation to win approval for a contingency management program under Medicaid.

According to CalMatters, “The Golden State is launching pilot programs in 24 counties, including San Francisco, Sacramento and Los Angeles. Costs for what collectively is called the Recovery Incentives Program will be reimbursed by CalAIM – the state's recent expansion of Medi-Cal services.”

In 2021, 65 percent of drug-related deaths in California involved cocaine, methamphetamine or other stimulants, a 22 percent from 2011.

Stimulants are among a grand coping mechanism for the unhoused community in California, with nearly one-third of people surveyed reported using amphetamines three of more times a week according to the UCSF Benioff Homelessness and Housing Initiative.

As part of the statewide pilot, Zuckerberg San Francisco General Hospital had established a six-month contingency management program that started off serving 50 people, getting tested one to two times a week. When a patient tests negative, they receive a $10 gift card to a retailer, later increasing the dollar amount gradually. If they test positive, they get nothing.

CalMatters mentions how participants can earn a maximum of $599 over the course of the program. This is because any payment or collection of payments over $600 has to be reported to the Internal Revenue Service.

Other programs in counties throughout California, including Fresno and Kern, will follow the same model.

“We're all excited to try it and see if it does help retain people in treatment for longer periods of time so they are more successful,” said Tammy Ramsey, program manager for the Drug Medi-Cal Organized Delivery System in Santa Clara County's behavioral health department. 

Loud For Tomorrow, a Central Valley organization that focuses on local issues and youth empowerment, mentioned about the program, “This is a first step in ensuring our communities receive support and accessible resources while navigating their personal journeys.”

Updates will be posted as the model is rolled out these upcoming months.

More information: California tries contingency management to fight drug use- CalMatters