Overdose deaths from stimulants in California nearly quadrupled between 2010 and 2019, and the problem has gotten even worse since. Preliminary data from the first nine months of 2020 — when much of the state was locked down because of the coronavirus— shows stimulant overdose deaths jumped 42% compared to 2019.
California has proposed a radically different approach to fight this growing problem.
The state is advancing legislation that would pay people to get them to stop using drugs like cocaine and methamphetamine, stimulants for which there are no pharmaceutical treatments available.
It works like this: People earn small incentives or payments for every negative drug test over a period of time. Most people who complete the treatment without any positive tests can earn a few hundred dollars. They usually get the money on a gift card.
It’s called “contingency management” and Gov. Gavin Newsom has asked the federal government for permission to use tax dollars to pay for it through Medicaid, the joint state and federal health insurance program for the poor and disabled that covers nearly 14 million people in California.
Meanwhile, a similar proposal is moving through California’s Democratic-controlled Legislature. It’s already passed the Senate with no opposition and is pending in the Assembly, where it has a Republican co-author.
One example of a similar program is the San Francisco AIDS Foundation, a nonprofit agency, which runs a small, privately-funded contingency management program. It’s where Tyrone Clifford, who was addicted to meth, enrolled because they promised to pay him for every negative test over 12 weeks.
His first payment was $2. That increased slightly with each subsequent negative test for a total of about $330.
I like that the payments start small and grow from there. I think if it started with larger payments, many people would enroll in such a program just for the money. But starting at just $2 would seem to attract people who are serious about wanting to kick their drug habit. Then as you move through the program, the higher payments create an incentive to want to finish the program. I am also guessing it becomes harder to stay on the program with each passing week, so the increasing payments may provide just enough incentive to stick with the program.
While the fear is that some people may enroll in the program just for the money and then turn around and use that money to buy drugs, it doesn’t seem like someone could buy a lot of drugs from the money earned. Thus from a cost-benefit standpoint, the program seems to be a winner. If someone only lasts one week, it’s only cost the state $2. The longer a person stays in the program, the more expensive it gets, but it also seems to increase the odds that a person will be able to kick the drug habit. Which could save the state thousands of dollars in more expensive health care costs for these individuals.
There is “clear and convincing evidence” that the treatment works to keep people sober from drugs like methamphetamine and cocaine, according to an analysis by the California Health Benefits Review Program. However, while research shows it is effective in keeping people sober during the program, the effect doesn’t last much beyond six months after treatment concludes.
That’s why, according to Clifford, who has now been drug-free for 11 years, emphasizes that the extensive group and individual counseling sessions that were part of the program were an effective way to keep him accountable and made him feel part of a community.
Clifford would also consider the treatment a success even if people don’t make it without a positive test.
For the simple reason that they are trying something.
I applaud California’s willingness to try such a program, and I hope it provides the desired outcomes…
source: CBS Sacramento
*image from PR Week