California pays meth users up to $599 a year to get sober

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Here successful nan rugged foothills of California’s Sierra Nevada, nan streets aren’t littered pinch needles, and dealers aren’t hustling narcotics connected nan corner.

But meth is almost arsenic easy to travel by arsenic a hazy IPA aliases locally grown weed.

Quinn Coburn knows nan manner well. He has utilized meth for astir of his big life and has done 5 stints successful jailhouse for dealing marijuana, methamphetamine and heroin. Coburn, 56, wants to get sober for good, and he says an experimental programme done Medi-Cal, nan state’s Medicaid programme for low-income people, is helping.

As portion of an innovative attack called “contingency management,” Coburn provides a urine sample and gets paid for it — arsenic agelong arsenic it is cleanable of stimulants.

In nan coming fiscal year, nan authorities is expected to allocate $61 cardinal to nan experiment, which targets addiction to stimulants specified arsenic meth and cocaine. It is portion of a broader Medi-Cal inaugural called CalAIM, which provides social and behavioral wellness services, including addiction treatment, to immoderate of nan state’s sickest and astir susceptible patients.

Since April 2023, 19 counties person enrolled a full of astir 2,700 patients, including Coburn, according to nan authorities Department of Health Care Services. In Los Angeles County, nationalist wellness officials cited contingency guidance arsenic 1 of nan only effective ways to dainty stimulant usage disorder. Los Angeles has 42 participating providers and has served 1,566 group — some nan astir of immoderate county, nan section said.

A ample cleanable agency interior pinch solid windows and brownish carpeting

Common Goals, a Nevada County nonprofit, has enrolled much than a twelve group successful a California programme that pays Medicaid participants who usage meth, cocaine and different amphetamines to enactment sober.

(Angela Hart / KFF Health News)

“It’s that small thing that’s holding maine accountable,” said Coburn, a erstwhile building worker who has tried many times to footwear his habit. He is motivated to enactment cleanable to conflict criminal charges for possession of narcotics and firearms, which he vociferously denies.

Coburn received $10 for each cleanable urine trial he provided during his first week successful nan program. Participants get a small much arsenic they proceed: $11.50 per trial successful week two, $13 successful week 3 and expanding to $26.50.

They tin gain arsenic overmuch arsenic $599 a year. As of mid-May, Coburn had completed 20 weeks and made $521.50.

Participants person astatine slightest six months of further behavioral wellness curen aft nan urine testing ends.

The authorities has poured important money and effort into curbing opioid addiction and fentanyl trafficking, but nan usage of stimulants is besides exploding. According to nan authorities Department of Health Care Services, nan complaint of Californians dying from specified narcotics doubled from 2019 to 2023.

Although nan cutting-edge curen tin activity for opioids and different drugs, California has prioritized stimulants. To qualify, patients must person mean to terrible stimulant usage disorder, pinch symptoms specified arsenic beardown cravings for nan supplier and prioritizing it complete individual wellness and well-being.

Substance usage experts opportunity inducement programs that reward participants, moreover successful a mini way, tin person a powerful effect peculiarly pinch meth users. A growing assemblage of evidence indicates that specified programs tin lead to semipermanent abstinence.

“The measurement stimulants activity connected nan encephalon is different than really opiates aliases intoxicant activity connected nan brain,” said John Duff, lead programme head astatine Common Goals, an outpatient supplier and intoxicant counseling halfway successful Grass Valley successful Nevada County, wherever Coburn receives treatment. “The reward strategy successful nan encephalon is much activated pinch amphetamine users, truthful getting $10 aliases $20 astatine a clip is much enticing than sitting successful group therapy.”

Duff acknowledged that he was initially skeptical of nan multimillion-dollar value tag for an experimental program.

“You’re talking astir a batch of money,” he said. “It was a difficult sell.”

What convinced him of its effectiveness? “People are showing up, consistently. To get disconnected stimulants, it’s proving to beryllium very effective.”

California was nan first authorities to screen this attack arsenic a use successful its Medicaid program, according to nan Department of Health Care Services. Others, including Montana, person followed.

Participants successful Nevada County must show up doubly a week to supply a urine sample, tapering to erstwhile a week for nan 2nd half of treatment. Every clip nan sample is free of stimulants, they get paid via a unit gift paper — moreover if nan sample tests affirmative for different kinds of drugs, including opioids.

Though participants tin cod nan money aft each cleanable test, galore opt for a lump sum aft completing nan 24-week program, Duff said. They tin take gift cards from Walmart, Bath & Body Works, Petco, Subway, and different companies.

Charlie Abernathybettis — Coburn’s constituent usage upset counselor, who helps tally nan programme for Nevada County — said not everyone consistently produces a cleanable urine test, and he has devised a strategy to extremity group from rigging their results. He uses bluish toilet cleaner to forestall patients from watering down their urine and has dismantled a spigot connected nan bath faucet to support them from utilizing lukewarm h2o for nan aforesaid purpose.

For those who fail, location are nary consequences. They simply don’t get paid that time and tin show up and effort again.

“We aren’t going to alteration behaviour by penalizing group for their addiction,” Abernathybettis said, noting that nan extremity is to modulation participants to semipermanent treatment. “Hopefully you consciousness comfortable here, and I tin person you to motion up for outpatient treatment.”

Abernathybettis has employed a “tough love” attack to addiction therapy that has helped support Coburn sober and accountable since he started successful January.

“It’s different this time,” Coburn said arsenic he lit a cigaret connected a sunny day successful April. “I person support now. I cognize my life is connected nan line.”

Quinn Coburn stands connected a sun-dappled thoroughfare successful Grass Valley.

Coburn says getting paid for cleanable urine tests is nan inducement he needed to footwear his meth habit: “It’s that small thing that’s holding maine accountable.”

(Angela Hart / KFF Health News)

Growing up successful nan Bay Area, Coburn ne'er felt for illustration he fresh in. He was adopted astatine an early property and dropped retired of precocious school. His erratic location life group him connected a people of difficult supplier usage and crime, including manufacturing and trading drugs, he said.

“When I first did crank, it made maine consciousness for illustration I was quality for nan first time,” Coburn said, utilizing a thoroughfare sanction for meth. “All my phobias astir being antisocial near me.”

Coburn escaped to nan solitude of nan mountains, trees and rivers successful Grass Valley, but nan area was besides rife pinch drugs.

Construction accidents successful 2012 near him successful excruciating pain, incapable to work. He fell deeper into nan supplier scene, arsenic some a personification and a manufacturer.

“You wouldn’t judge nan marketplace up present for it — much than you tin moreover imagine,” he said. “It’s not an excuse, but I had nary measurement to make a living.”

Financially strapped, he rented a cheap, converted car shed from different section supplier dealer, he said. Law enforcement officers raided nan location successful October, uncovering a weapon and ample amounts of fentanyl and heroin. Coburn, who faces up to 30 years successful prison, maintains that nan narcotics and weapons were not his. “All nan different ones I did,” he said of nan possession charges. “Not this one.”

Coburn is successful an outpatient addiction programme and is progressive successful Alcoholics Anonymous, sometimes attending aggregate meetings a day. Every week, nan mini payments from nan Medi-Cal research consciousness for illustration mini wins, he said.

He is readying to return his $599 arsenic a lump sum and springiness it to his foster parents, pinch whom he is surviving arsenic he fights his criminal charges.

“It’s nan slightest I tin do for them letting maine enactment pinch them and get better,” Coburn said, choking backmost tears. “I’m not giving up.”

This article was produced by KFF Health News, a nationalist newsroom that produces in-depth publicity astir wellness issues.

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