California Needs To Pay Folks With Habit To Keep Sober : NPR


State Sen. Scott Wiener tabled a bill in California to pay drug addicts to stay sober. People would make small payments for each negative drug test over a period of time. Rich Pedroncelli / AP Hide caption

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Rich Pedroncelli / AP

State Sen. Scott Wiener tabled a bill in California to pay drug addicts to stay sober. People would make small payments for each negative drug test over a period of time.

Rich Pedroncelli / AP

SACRAMENTO, Calif .– Frustrated with the runaway spike in drug overdose deaths, California leaders are trying something radical: They want the state to be the first to pay people to stay sober.

The federal government has been doing this for years with military veterans, and research shows that this is one of the most effective ways to get people to stop using drugs like cocaine and methamphetamine, stimulants for which there are no pharmaceutical treatments.

Here’s how it works: For every negative drug test, people receive small incentives or payments over a period of time. Most people who complete treatment without testing positive can make a few hundred dollars. They usually get the money on a gift card.

It’s called “Emergency Management,” and Governor Gavin Newsom has asked the federal government for permission to use tax dollars to pay it through Medicaid, the joint state and federal health insurance program for the poor and the disabled that covers nearly 14 million people in California.

Meanwhile, a similar proposal is going through the Democrat-controlled California legislature. It has already passed the Senate unanimously and is pending in the Assembly, where it has a Republican co-author.

“I think there is a lot about this strategy that anyone could enjoy,” said Senator Scott Wiener, a San Francisco Democrat and author of the bill. “The most important thing is that it works.”

How much it would cost depends on how many people are attending. A program that covers 1,000 people could cost up to $ 286,000, which is a small amount in California’s total operating budget of more than $ 262 billion.

In San Francisco, a man signed up for a similar program and is now a consultant

The San Francisco AIDS Foundation, a nonprofit, operates a small, privately funded emergency management program. There the meth addict Tyrone Clifford enrolled because they had promised him to pay him for every negative test over 12 weeks.

His first payment was $ 2. That increased slightly with each subsequent negative test to a total of about $ 330.

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

Clifford made it through the program without a positive test. But instead of using the money to buy more drugs, he bought a laptop so he could go back to school. He says he hasn’t used methamphetamine in 11 years and now works as a consultant with the San Francisco AIDS Foundation to help people who have had the same addiction problems as him.

Clifford, 53, said it didn’t matter much to make the money. Unlike some who struggle with drug addiction, Clifford always had a job and a house, and was never in danger of losing them. But, he said, watching his account grow with each negative test, he said it motivated him more than any other treatment program.

“You watch these dollar values ​​rise, there is evidence that I am,” he said. “There is no way anyone gets rich with this program.”

According to an analysis by the California Health Benefits Review Program, there is “clear and compelling evidence” that the treatment helps keep people sober from drugs like methamphetamine and cocaine. Although research shows it is effective at keeping people sober during the program, the effects don’t last much longer than six months after completing treatment.

Clifford acknowledged the program didn’t work for everyone, but added that his treatment included extensive group and individual counseling sessions that held him accountable and made him feel part of a community.

Clifford said he thought the treatment would be a success, even if people fail without a positive test.

“You’re trying something,” he said.

If California starts paying for emergency management treatments through Medicaid, Clifford believes it would mean an explosion of similar programs across the state.

There are no pharmaceutical treatments for stimulants like methamphetamine and cocaine

California, like most of the country, is grappling with opioid abuse, including drugs like prescription pain relievers and heroin. But deaths from overdose from stimulant overdose in California nearly quadrupled between 2010 and 2019, and the problem has only got worse since then.

Preliminary data from the first nine months of 2020 – when much of the state was in lockdown due to the coronavirus – shows deaths from stimulant overdoses increased 42% compared to 2019.

While opioids have several pharmaceutical treatments available to help people sober up, there are none for stimulants like methamphetamine and cocaine, which often leaves people to their willpower to give up the habit.

“There is a clear gap in treatment services for those with stimulant use disorder,” said Jaycee Cooper, director of California’s Medicaid program. “At this point (emergency management), the only thing people point out that was effective.”

Emergency management isn’t widespread because it’s not clear whether state and federal laws allow Medicaid funds to pay for it. California has a law prohibiting people from benefiting from treatment programs or receiving “kickbacks”. The Vienna law would make it clear that emergency management is legal under state law.

Whether it violates federal law is still questionable.

“We do not believe that this is the case,” said Wiener, noting that the Biden government had signaled its interest in the treatment.

Wiener’s bill would require California’s Medicaid program to pay for treatment, while Newsom’s plan would allow counties to choose whether to participate.