Why California wants to pay drug users to stay sober
The state could be the 1st to adopt a ‘contingency management program’ — and it has bipartisan support
California may become the first state in the U.S. to pay drug users to stay sober.
It may seem like a radical idea, but it's not a new one. It's called "contingency management," and it's a system the federal government has used for years with military veterans.
Under the system, people earn small amounts of money for every negative drug test over a period of time. The payments can come in the form of cash or gift cards.
Proponents of the plan say it's a great tool for treating addiction to stimulants like cocaine and methamphetamine, for which there are no pharmaceutical treatments available.
"Meth is a big problem, not just in San Francisco, throughout the country, and we're not doing enough to address it," Scott Wiener, a Democratic California state senator, told As It Happens guest host Peter Armstrong.
"We have to use every tool at our disposal and be creative around meth. And these financial incentives, contingency management, is one of those tools."
California Gov. Gavin Newsom has asked the U.S. government for permission to use federal tax dollars to pay for a one-time contingency management pilot program in California.
Wiener, meanwhile, has sponsored a bill that would require California's Medicaid program to cover the cost of the treatment in the long term, while setting parameters for how the plan would operate.
Does it work?
There are real-life examples of the program helping people get sober, though the concept does have its limitations.
Tyrone Clifford, 53, who was addicted to meth, participated in a 12-week, privately-funded contingency management program through the non-profit San Francisco AIDS Foundation. His first payment was $2 US. That increased slightly with each subsequent negative test for a total of about $330.
"I thought, I can do 12 weeks. I've done that before when my dealer was in jail," he told The Associated Press. "When I'm done I'll have 330 bucks to get high with."
But instead of using the 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 had the same addiction problems he did.
"It's not a huge amount of money. But if you think about it, just in our own psychology as human beings, there are little incentives that we look forward to," Wiener said.
"People say: OK, if I can just get through three workouts a week, then I'm going to reward myself with a piece of cake at the end of the week. And you look forward to that piece of cake all week. And it's just a piece of cake. It's not a big deal. But we look forward to it. And so it does work."
According to an analysis by the California Health Benefits Review Program, there is "clear and convincing evidence" that contingency management helps people stay sober from stimulants for the duration of the program.
I don't care if you are in a Donald Trump right-wing conservative district or a place like San Francisco or Berkeley — we all have these problems.- Calif. Sen. Scott Wiener
But the effect doesn't last much beyond six months after treatment concludes.
That's why Wiener says wraparound programs are key.
"This is not a silver bullet," he said. "I know people who have been sober from meth for a long time, but they're still involved in recovery programs, they still have a recovery community around them, and they still have to keep working."
"So I think it's a good tool for a lot of people in terms of helping them get sober and stay sober for a while. But then they're going to have to employ other strategies to continue that for the long run," he said.
How much does it cost?
Wiener estimates the program would cost between $300 to $400 US per participant over the course of a few months. A program covering 1,000 people could cost as much as $286,000 US.
"You compare that to someone having to go to the emergency room or getting arrested and being processed through jail or someone overdosing, those situations are dramatically more expensive," he said.
It's not clear if state and federal law allow Medicaid money to pay for contingency management. California has a law prohibiting people from profiting or receiving "kickbacks" from treatment programs, but Wiener's bill would clarify contingency management is legal under state law.
The bill has already passed the Senate with no opposition and is pending in the Assembly, where it has a Republican co-author.
"What I've learned in my work around mental health and addiction treatment in the legislature is it's one of those issues that really isn't very partisan, where, you know, some of my strongest support for aggressive mental health treatment bills comes from Republicans," Wiener said.
"I don't care if you are in a Donald Trump right-wing conservative district or a place like San Francisco or Berkeley — we all have these problems and everyone knows people in their community, in their family, in their friendship circles who are suffering."
Written by Sheena Goodyear with files from The Associated Press. Interview with Scott Wiener produced by Katie Geleff.
