California will pay drug addicts to stay 'clean'

Frustrated by the uncontrolled rise in drug overdose deaths, California's leaders are trying to do something radical: They are proposing that the state pay people to stay "clean." Writes about it NPR.

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The federal government has been doing this with military veterans for years, and research shows it's one of the most effective ways to get people to stop using drugs like cocaine and methamphetamine, stimulants for which no pharmaceuticals are available.

It works like this: people get small rewards or payments for each negative drug test for a specified amount of time. Most people who complete their treatment without a positive test result can earn several hundred dollars. They usually receive money for a gift card.

California Governor Gavin Newsom has asked the federal government to allow tax dollars to be used to pay through Medicaid, a health insurance program for the poor and disabled that reaches nearly 14 million people in California.

Meanwhile, a similar proposal is being passed through the Democratic-controlled California Legislature. It has already been passed by the Senate without objection and is pending in the Assembly.

“I think there's something that everyone will like about this strategy,” said state Sen. Scott Wiener, a San Francisco Democrat and the bill's sponsor. “The most important thing is that we know it works.”

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How much it will cost depends on the number of participants. A program reaching 1000 people can cost up to $ 286, which is a penny in California's total budget of over $ 000 billion.

In San Francisco, one person signed up for a similar program and is now working as a consultant.

In this city, a nonprofit agency runs a small, private, similar program. Tyrone Clifford signed up there, who became addicted to methamphetamine because they promised to pay him for every test negative for 12 weeks.

His first payout was $ 2. This amount increased slightly with each subsequent negative test, for a total of about $ 330.

“I thought I could make money in 12 weeks. “I did this before when my dealer was in jail,” he said. “When I’m done, I’ll have $330 to get high.”

Clifford actually made it through the program without testing positive. But instead of using the money to buy drugs, he bought a laptop computer to go back to school. He says he has been sober from meth for 11 years and now works as a consultant for the San Francisco AIDS Foundation, helping people who have had the same addiction problems as him.

Clifford, 53, said earnings don't matter much. Unlike those struggling with drug addiction, Clifford has always had a job and a home and has never been in great danger. But he said watching his score grow with each negative test motivated him more than any other treatment program.

“When you see those dollars grow, it’s proof that you’re doing it,” he explained.

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According to analysis by the California Health Benefits Review Program, there is “clear and compelling evidence” that treatment helps people avoid using drugs such as methamphetamine and cocaine. However, research shows that the program is only effective in keeping people sober during the program, as the effect does not last longer than six months after treatment ends.

Clifford acknowledged that the program didn't work for everyone, but added that his treatment included extensive group and one-on-one counseling that made him accountable and made him feel like a part of society.

Clifford said he considers the treatment to be successful even if people don't get it without a positive test result.

“At least they’re trying,” he says.

Clifford said that if California began paying benefits through Medicaid, it would mean an explosion of similar programs across the state.

There are no pharmaceuticals to treat addictions to drugs such as methamphetamine and cocaine.

California, like much of the country, has fought the abuse of opioids, including drugs such as pain relievers and heroin. But the number of stimulant overdose deaths in California nearly quadrupled from 2010 to 2019, and the problem has only worsened since then.

Preliminary data for the first nine months of 2020, when much of the state was locked down by the coronavirus, shows that mortality from stimulant overdose has jumped 42% since 2019.

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While there are several pharmaceuticals available for opioids to help people sober up, for stimulants like methamphetamine and cocaine, there is no single drug available, often causing people to rely only on their willpower to break the habit.

“There is a clear gap in treatment services for individuals with stimulant use disorder,” said Jaycee Cooper, director of California's Medicaid program.

Such programs are not widely used because it is unclear if state and federal laws allow you to pay for it with Medicaid money. California has a law that prohibits people from benefiting or receiving kickbacks from treatment programs. Wiener's Law clarifies that the program is legal under state law.

Whether this violates federal law is still in question.

"We don't think that's the case," Wiener said, noting that US President Joe Biden's administration has expressed interest in the treatment.

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