California’s government leaders want the state to pay for people to stay sober in an aggressive effort to control the rise in drug overdose deaths.
Gov. Gavin Newsom has asked the United States government for permission to pay for this “contingency management” through Medicaid by using federal tax dollars.
A similar proposal, Senate Bill 110, recently passed the state Senate and would not only make it legal to use Medicaid money to pay for contingency management, but it also asks for federal funding assistance to manage these programs through Medicaid. Gov. Newsom's plan would work alongside SB110 and let individual counties choose if they want to participate in a contingency management program or not.
“I think there is a lot in this strategy for everyone to like," said state Sen. Scott Wiener, a Democrat from San Francisco and author of SB 110. “Most important of all, it works.”
Under the proposal, people would earn small incentives or payments for every negative drug test over a period of time, reported the Associated Press. Those who complete the treatment without any positive tests can earn a few hundred dollars.
It’s estimated that a contingency management program covering 1,000 people could cost the state as much as $286,000.
Some privately funded programs have already seen success using an incentive program to deter drug use.
The AIDS Foundation nonprofit organization in San Francisco has a privately funded contingency management program that offers small payments to those who test negative in drug tests over a period of time. Tyrone Clifford is a 53-year-old former meth addict who participated in the program. His first payment was $2 and increased with each subsequent negative test until he totaled $330 over 12 weeks.
“You watch those dollar values go up, there is proof right there that I am doing this,” Clifford said. “By no means is anyone getting rich off this program.”
Clifford made it through the program without a positive drug test. He used the money to buy a laptop and go back to school. Clifford said he has not used meth in over a decade. He now works as a counselor at the San Francisco AIDS Foundation.
Clifford noted that programs that pay addicts to incentivize staying clean may not work for everybody. In his case, counseling groups also helped him stay accountable.
Overdose deaths from opioid abuse quadrupled in California between 2010 and 2019. Preliminary data from the first nine months of 2020 shows that stimulant overdose deaths jumped 42 percent compared to 2019, according to the Associated Press.
“There is a clear kind of hole in regards to treatment services for individuals who have a stimulant use disorder,” said Jaycee Cooper, director of California's Medicaid program. “At this point (contingency management) is the only thing people are pointing to that has been effective.”
Fentanyl overdose deaths in Los Angeles County tripled between 2018 and 2020, and the overdose rate for people experiencing homelessness increased more than 33 percent in the first six months of 2020, according to an L.A. City Council resolution, which was approved by the council in June in support of Senate Bill 57 -- also introduced by Weiner. It would legalize sites where people can use drugs in the presence of medical personnel in an effort to reduce overdoses.
"The drastic increase of deaths among people experiencing homelessness in Los Angeles signifies an emergency that requires urgent solutions," said Councilwoman Nithya Raman, who introduced the resolution. "SB 57 will not only help lower the number of people dying each day from overdosing, but it will also help us get more people into services and treatment."