A record number of people have lost their lives to drug overdoses during the pandemic. There are pharmaceutical treatments available for opioids to help someone get sober, but there aren't any for stimulants like meth or cocaine.
Now, California could become the first state to address this through "contingency management." That's where people can earn small incentives for every negative drug test over a period of time.
The federal government already does this with veterans, but it hasn't been widely used because it's not clear if state and federal law lets Medicaid money pay for it. California is now asking for permission to do this.
For years, the San Francisco AIDS Foundation has been running a small privately funded contingency management program called PROP, or the Positive Reinforcement Opportunity Project.
“I think it gives them self-esteem, it gives them hope, it gives them some advocacy for themselves and the fact that they can kind of show up and make changes. And I see when they see the amount increasing, it does increase motivation,” said Rick Andrews, Associate Director of Contingency Management at the Stonewall Project.
Participants have to attend three times a week for 12 weeks. Each time they have a negative urine test for meth or cocaine, they can earn gift cards and certificates. The first payment is $2. They can earn up to $330 dollars through the program.
“These aren't huge amounts of money either, so I think it's just sometimes, it's even psychological,” said Andrews.
He has seen people use the money they earn for things like buying food, paying their phone bill, or buying a computer. He says people who have gone through PROP have gone on to stay sober for years and get housing and jobs.
An analysis by the California Health Benefits Review Program found there is clear evidence the incentives work to keep people sober, but the effect doesn't last much beyond six months after the treatment ends.
Andrews with PROP agrees it doesn't work for everyone, but he says it can be successful in conjunction with other support systems.
“Part of the power of PROP here at Stonewall is that there's a whole counseling program here that people can get more intensive support, because after 12 weeks, what happens? I mean, do people go back to, you know, their lifestyles or certain things maybe that, that maybe weren't working for them, previously?” said Andrews.
He says the cost for a contingency management program is relatively low compared to what rehab and hospitalizations cost.