ARI SHAPIRO, HOST:
As the pandemic has raged, so has the country's drug epidemic. Fatal drug overdoses went up 30% last year. Health officials have been struggling with methamphetamine and cocaine abuse in particular because of the lack of effective treatments for those stimulants.
Well, California is looking to an unusual solution - pay drug users not to use drugs. From member station KQED, reporter April Dembosky explains how the controversial treatment works.
APRIL DEMBOSKY, BYLINE: When Billy Lemon was 42 and trying to kick his methamphetamine addiction, he went to a drug treatment center in San Francisco three times a week and peed in a cup. If it tested negative for meth, he got paid $7.
BILLY LEMON: And for somebody who had not had any legitimate money without committing felonies, that seemed like a cool thing.
DEMBOSKY: The treatment is called contingency management, and it incentivizes drug users with money or gift cards to stay off drugs. People can earn up to 3- or $400 over the course of three months. For Lemon, it was about more than just the money. It was about being told, good job.
LEMON: It was the first opportunity where I was like, I have self-worth still. It's buried. This person sees it and is willing to give me $7 just to take care of myself. That was very motivating.
DEMBOSKY: Studies show contingency management works. In the San Francisco program Billy Lemon did, 63% of participants stopped using meth entirely, and another 19% reduced their use. The small payments aim to rewire the brain's reward system, so the person seeks the money or gift card to get a dopamine release instead of meth or coke.
LEMON: You're like, oh, oh, oh, I can feel good without the daily use of that substance. Let me try and go one more week. And then all of a sudden, you're at 90 days. And you've actually - you've made a change.
DEMBOSKY: But the treatment is controversial. Critics have scoffed at the idea of paying drug users not to use drugs, calling it unethical or a bribe. Most insurers don't cover it - neither do state Medicaid programs. The feds generally forbid them from offering financial incentives to patients as a protection against fraud and waste.
But a California bill, now on the governor's desk, would make clear that the state's Medicaid program is allowed to offer contingency management. State Senator Scott Wiener is the author.
SCOTT WIENER: We need to embrace this proven, effective approach, make it clearly legal and start reimbursing for it.
DEMBOSKY: Wiener was surprised the bill passed with so much bipartisan support.
WIENER: The Republicans love it, which I didn't think they would. But they actually like it because there's an abstinence component to it, right? It's like, we pay you money, and you abstain from using.
DEMBOSKY: The state's Department of Health Care Services, which runs California's Medicaid program, is on board. They've already asked federal regulators for explicit permission to offer contingency management, and the Biden administration appears poised to grant it.
Dr. Kelly Pfeifer is the department's deputy director of behavioral health. She says stimulant abuse is wreaking havoc on California's jails and courts, foster care and hospitals.
KELLY PFEIFER: Which are obviously not only devastating to the person and the family, but very expensive for our health care system.
DEMBOSKY: Pfeifer says the need is urgent. For opioid addiction, there are three FDA-approved medication therapies, including methadone and buprenorphine. For meth and coke, there are none. Making contingency management more widely available would cost California less than $180,000 a year. And Pfeifer says it will make more people willing to seek treatment.
PFEIFER: Because people will see success stories - they'll see friends and family getting treatment and getting help and getting better.
DEMBOSKY: She says five years ago, people were surprised by the idea of treating opioid addiction with other drugs. But now it's routine. And if more states join California and begin offering contingency management, maybe it won't seem so strange to pay drug users not to use.
For NPR News, I'm April Dembosky in San Francisco.
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SHAPIRO: This story comes from NPR's partnership with KQED and Kaiser Health News. Transcript provided by NPR, Copyright NPR.