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California pays meth users to get clean

This story was originally published by KFF Health News.

Here, in the rugged foothills of California's Sierra Nevada, the streets aren't littered with syringes, and drug dealers don't sell them on corners.

But meth is almost as easy to get as a cloudy IPA or locally grown weed.

Quinn Coburn knows that lifestyle well. He has used meth for most of his adult life and has been to prison five times for dealing marijuana, methamphetamine and heroin. Now 56, Coburn wants to get clean for good and says an experimental program run by Medi-Cal, California's Medicaid program that supports low-income people, is helping him do that.

As part of an innovative approach called “contingency management,” Coburn pees into a cup and gets paid for it – as long as the sample does not contain stimulants.

In the coming fiscal year, the state is expected to allocate $61 million to the experiment, which targets addiction to stimulants such as meth and cocaine. It is part of a broader Medi-Cal initiative called CalAIM, which provides social and behavioral health services, including addiction treatment, to some of the state's most serious and vulnerable patients.

Since April 2023, 19 counties, including Coburn, have admitted a total of about 2,700 patients, according to the state Department of Health.

“It's that little something that keeps me accountable,” says Coburn, a former construction worker who has repeatedly tried to kick his addiction. He is also motivated to stay clean to fight criminal drug and gun charges that he vociferously denies.

Coburn received $10 for each clean urine test he performed during the first week of the program. In subsequent weeks, participants receive slightly more money: $11.50 per test in the second week, $13 in the third week, up to $26.50 per test.

They can earn up to $599 a year. In mid-May, Coburn had completed 20 weeks and earned $521.50.

Participants will receive additional behavioral therapy for at least six months after completion of the urine test.

The state has invested a lot of money and effort into curbing opioid addiction and fentanyl trafficking, but stimulant use is also exploding in California. According to the state Department of Health, the number of Californians dying from them has doubled from 2019 to 2023.

Although the cutting-edge treatment can work for opioids and other drugs, California has prioritized stimulants. To be eligible, patients must have a moderate to severe stimulant use disorder, which includes symptoms such as intense cravings for the drug and prioritizing it over personal health and well-being.

Substance use experts say incentive programs that reward participants, even in small ways, can have a powerful effect, especially on meth users. And there is growing evidence that they can lead to long-term abstinence.

“The way stimulants work on the brain is different than the way opiates or alcohol work on the brain,” said John Duff, senior program director at Common Goals, an outpatient drug and alcohol treatment center in Grass Valley where Coburn is being treated.

“In amphetamine users, the reward system in the brain is more activated, so getting $10 or $20 at a time is more tempting than participating in group therapy,” Duff said.

California is paying Medicaid beneficiaries who use meth, cocaine and other amphetamines money to stay sober. As part of the experiment, participants can earn up to $599 a year if they submit clean urine tests. A Nevada County nonprofit called Common Goals has enrolled more than a dozen people since launching its program earlier this year. (Photo by Angela Hart/KFF Health News)

Duff admitted he was skeptical about the multimillion-dollar price tag for an experimental program. “That's a lot of money,” he said. “It was a hard sell.”

What convinced him? “People come regularly. It's proving to be very effective in getting off stimulants.”

According to the Department of Health Care Services, California was the first state to cover this approach as a benefit in its Medicaid program, but other states, including Montana, have since followed suit.

Participants in Nevada County must show up twice weekly to provide a urine sample. In the second half of the treatment phase, this is reduced to once weekly. Each time the sample is free of stimulants, they are paid via a gift card – even if the sample is positive for other drugs, including opioids.

Although participants can collect the money after each test, many opt for a lump sum payment after completing the 24-week program, Duff said. They can choose gift cards from companies such as Walmart, Bath & Body Works, Petco, Subway and Hotels.com.

Charlie Abernathybettis, Coburn's substance abuse disorder counselor who co-directs the program for Nevada County, said not all patients always get clean results on a urine test, and he has developed a system to prevent people from tampering with their results.

For example, he uses blue toilet cleaner to prevent patients from diluting their urine and has dismantled a faucet in the bathroom to prevent them from using warm water for the same purpose.

If participants fail, there are no consequences. They simply don't get paid that day and can come back and try again.

“We're not going to change behavior by punishing people for their addiction,” Abernathybettis said, noting that the ultimate goal is to transition participants into long-term treatment. “Hopefully you feel comfortable here and I can convince you to enroll in outpatient treatment.”

Abernathybettis takes a tough approach to addiction treatment that has helped Coburn stay sober and responsible since starting therapy in January. “This time is different,” Coburn said as he lit a cigarette on a sunny April afternoon. “I have support now. I know my life is on the line.”

Growing up in the Bay Area, Coburn never felt like he fit in. He was adopted at a young age and dropped out of high school. His unsettled home life led him down a path of hard drug use and crime, including manufacturing and selling drugs, he said.

“The first time I took crank, I felt like a human being for the first time. All my phobias of being antisocial disappeared,” Coburn said, using a street name for meth.

Coburn sought refuge in the solitude of the mountains, trees and rivers that dot Grass Valley's rural landscape, but the area was also teeming with drugs.

After construction accidents in 2012, he suffered from terrible pain and was unable to work.

Coburn got deeper and deeper into the drug scene, both as a user and as a producer. “You wouldn't believe how big the market is here – bigger than you can imagine,” he said. “That's no excuse, but I had no way to make a living.”

Short on cash, he rented a cheap, converted garage from another local drug dealer, he said. Law enforcement officers searched the house in October and found a gun and large quantities of fentanyl and heroin. Coburn, who faces up to 30 years in prison, is defending himself vigorously, saying the drugs and guns were not his. “All the others I made. Not this one,” he said.

Coburn also participates in an outpatient addiction program and is active in Alcoholics Anonymous, where he sometimes attends several meetings a day.

Each week, the small payments from the Medi-Cal experiment felt like small victories, he said.

He plans to give the $599 as a lump sum payment to his foster parents, with whom he is living while he fights the charges.

“It's the least I can do for them, to let me stay and get better,” Coburn said, fighting back tears. “I'm not giving up.”

Each week, the small payments from the Medi-Cal experiment feel like small victories, Coburn says. (Photo by Angela Hart / KFF Health News)

This article is part of “Faces of Medi-Cal,” a series from California Healthline that examines the impact of the state’s social safety net on those insured.

This article was created by KFF Health Newswhich published California Healthlinean editorially independent service of California Health Foundation.

Anna Harden

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