California Pays Meth Users To Get Sober – KFF Health News

GRASS VALLEY, Calif. — Here in the rugged foothills of California’s Sierra Nevada, the streets aren’t littered with needles and dealers aren’t selling drugs on the corner.

But meth is almost as easy to obtain as hazy IPA or locally grown weed.

Quinn Coburn knows the lifestyle well. He has used meth most of his adult life, and has been in prison five times for dealing Marijuana, Methamphetamine and Heroin, Now 56, Coburn wants to stay sober forever, and he says Medi-Cal, an experimental program through California’s Medicaid program that covers low-income people, is helping.

As part of an innovative approach calledcontingency management“Coburn pees into a cup and gets paid for it – provided the sample is free of stimulants.

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

Through April 2023, 19 counties have enrolled a total of about 2,700 patients, including Coburn, according to the Department of State Health Care Services.

“It’s that little thing that keeps me accountable,” said Coburn, a former construction worker who has tried repeatedly to kick his habit. He is also motivated to stay clean by fighting criminal charges for drug and firearms possession, which he vociferously denies.

Coburn received $10 for each clean urine test in the first week of the program. Participants get a little more money the following weeks: $11.50 per test in the second week, $13 in the third week, and a maximum of $26.50 per test.

they can earn that much $599 per year.By mid-May, Coburn had completed 20 weeks and earned $521.50.

Participants receive at least six months of additional behavioral health treatment after the urine testing ends.

There has been heavy rain in the state money and effort in preventing opioid addiction and fentanyl trafficking, but the use of stimulants is also increasing rapidly in California. According to the state Department of Health Care Services, the rate at which Californians are dying from Doubled from 2019 to 2023,

Although state-of-the-art treatment May work for opioids And as with other drugs, California has prioritized stimulants. To qualify, patients must have moderate to severe stimulant use disorder, which includes symptoms such as strong craving for the drug and prioritizing it over personal health and well-being.

Substance use experts say that incentive programs that reward participants, even in small ways, can have a powerful effect, especially on meth users, and growing body of evidence indicates that they may 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, MD, director of Common Goals, an outpatient drug and alcohol counseling center in Grass Valley. The principal is the program director, where Coburn receives treatment.

“Amphetamine users have a more active reward system in their brains, so getting $10 or $20 at a time is more attractive than sitting in group therapy,” Duff said.

Duff admitted that he was skeptical of the multimillion-dollar price tag for an experimental program. “You’re talking about a lot of money,” he said. “It was a tough sell.”

What convinced him? “People are continuously coming forward. “It is proving to be very effective in getting rid of stimulants.”

According to the Department of Health Care Services, California was the first state to include this approach as a benefit in its Medicaid program, although other states have followed, Including Montana,

Participants in Nevada County will be required to come twice a week to provide a urine sample, once a week for the second half of treatment. Each time the sample is free of stimulants, they are paid via retail gift card – even if the sample tests positive for other types of drugs, including opioids.

Duff said that although participants can take money after each clean test, many prefer to take a lump sum after completing the 24-week program. They can choose gift cards from companies like Walmart, Bath & Body Works, Petco, Subway, and Hotels.com.

Charlie Abernathybettis — Coburn’s substance use disorder counselor, who helps run the program for Nevada County — said not everyone consistently takes clean urine tests, and he created a system to prevent people from fudging their results. Have prepared.

For example, he uses blue toilet cleaner to prevent patients from diluting their urine, and he has removed the spigots on bathroom faucets so patients do not use hot water for the same purpose. .

If participants fail, there will be no consequences. They simply won’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,” Abernethybates said, adding that the ultimate goal is to convert participants into long-term treatment. “Hopefully you’ll feel comfortable here and I can convince you to sign up for outpatient treatment.”

The Abernethybates have taken a tough love approach to addiction therapy that has helped keep Coburn sober and accountable since starting in January. “This time it’s different,” Coburn said, lighting a cigarette on a sunny April afternoon. “Now I have support. I know my life is at stake.

Growing up in the Bay Area, Coburn never felt like he fit in. She was adopted at an early age and dropped out of high school. His irregular home life, he said, pushed him onto a path of hard drug use and crime, including drug manufacturing and selling.

“When I first got cranky, I felt like I was human for the first time. “All my fear about being antisocial just went out of me,” Coburn said of using a street name for meth.

Coburn escaped to the solitude of the mountains, trees, and rivers that define the rural landscape in Grass Valley, but the area was also filled with drugs.

A construction accident in 2012 left him in severe pain and unable to work.

Coburn delved deeply into the drug as both user and creator. “You wouldn’t believe the market for it here – more than you can even imagine,” he said. “This is no excuse, but I had no way to earn a living.”

Financially strapped, he said, he rented a cheap, converted garage from another local drug dealer. Law enforcement officials raided the home in October and officers found a gun and a large amount of fentanyl and heroin. Coburn, who faces up to 30 years in prison, vigorously defends himself, saying the drugs and weapons were not his. “I did the rest. Not this one,” he said.

Coburn is also in an outpatient addiction program and is active in Alcoholics Anonymous, sometimes attending several meetings a day.

Every week, he said, the small payments from the Medi-Cal experiment feel like small victories.

He plans to take his $599 lump sum and give it to his foster parents, with whom he is living while fighting his criminal charges.

“The least I can do for them is stay with them and get better,” Coburn said, crying. “I’m not giving up.”

This article is part of “Faces of Medi-Cal”, a series from California Healthline that explores the impact of the state’s safety-net health program on enrollees.

This article was produced by kff health newswho publishes California HealthlineAn editorially independent service of California Health Care Foundation,