Can you pay someone to stop using meth? Proposed California legislation would boost drug treatment option


As overdose deaths soar all through California, proposed state laws would legalize a program that encourages folks to curb their methamphetamine use with incentives like present playing cards and money.

The method, referred to as contingency administration, is a controversial however efficient apply. Researchers have discovered it helps folks management their substance use, notably for methamphetamine. It’s yet one more method that San Francisco officers hope they will use to handle the lethal drug epidemic that killed roughly two people a day within the metropolis final 12 months.

“There’s an growing urgency round making certain now we have the entire instruments obtainable to handle overdoses and substance use dysfunction,” mentioned Laura Thomas, director of Hurt Discount Coverage on the San Francisco AIDS Basis, which is supporting state laws sponsored by Sen. Scott Wiener, D-San Francisco, to legalize the apply and permit Medi-Cal — the state’s insurance coverage for low-income folks — to pay for it.

“We all know there are extra folks on the market who need and deserve these companies,” Thomas added.

Methamphetamine use has spiked dramatically in San Francisco over the previous few years, and the pandemic has exacerbated the issue. In keeping with the San Francisco Division of Public Well being, meth overdose deaths have elevated by 500% since 2008. In the meantime, in keeping with metropolis statistics, 50% of psychiatric emergency room admissions at San Francisco General Hospital are related to meth.

Contingency administration is commonly used for meth dependancy as a result of no treatment exists to assist wean customers off the stimulant. Those that use opioids like heroin and fentanyl can use FDA-approved medicines, resembling buprenorphine or methadone, to handle their addictions.

The best way contingency administration works is easy: Somebody fighting substance use voluntarily pees in a cup a minimum of as soon as per week. If no medicine are detected of their system, they get a small reward like a number of {dollars} added into an account or a present card. They don’t get a reward if medicine are detected. However they’re usually inspired to attempt once more.

Critics of the apply are in opposition to the concept of primarily paying folks to not use medicine, and say the state ought to concentrate on growing different choices like drug therapy and supportive housing. However those that help it say it’s a cheaper, and lower-barrier possibility for individuals who could not have had success with conventional rehab packages.

Although researchers — like those at the National Institute of Health — say contingency administration is an efficient manner to assist folks keep sober, it’s underutilized in California as a result of Medi-Cal doesn’t reimburse those that provide it. That’s as a result of the therapy exists in a authorized grey space in California, the place there’s no regulation that explicitly authorizes or bans it. The incentives may also be thought-about kickbacks under federal law.

Nevertheless, organizations just like the SF AIDS Basis are capable of provide contingency administration packages due to native funding. The Division of Veterans Affairs additionally gives contingency administration throughout its well being care system across the nation.

Wiener’s invoice, The Restoration Incentives Act, which was launched final week, would legalize the apply in California and authorize Medi-Cal to cowl it.

“If we’re critical about tackling meth dependancy, we have to use each obtainable software,” Wiener mentioned. “Individuals are dying, it’s destroying folks’s lives. It’s impacting our well being care system. And specifically, it’s having huge impacts within the LGBTQ group.”

Contingency administration labored for Billy Lemon, who enrolled within the SF AIDS Basis contingency administration program when he was in rehab for his meth dependancy a number of years in the past.

Each time he examined damaging, he mentioned he received a small little rush that he needed to maintain experiencing. By the top of the 12-week program, he mentioned he examined damaging each time and saved about $300. He mentioned this system seemingly labored for him as a result of he was capable of couple it with the help he received from his rehab program.

“You’re increase these actually small wins that may appear actually inconsequential,” Lemon mentioned. “However for somebody who has thrown their life apart and making an attempt to make a change it was actually useful.”

Contingency administration is only when paired with different companies — like rehab, treatment administration, remedy and housing. However San Francisco’s networks of drug treatment services are understaffed and overwhelmed, notably because the pandemic has disrupted companies like drop-in facilities and in-person help teams.

If the regulation passes, Lauren Kahn, a spokeswoman for HealthRIGHT 360 — town’s largest supplier of drug therapy companies — mentioned the nonprofit would “completely provide the service.”

Whereas fentanyl — a lethal opioid that may be 50 to 100 occasions stronger than morphine — was the primary driver behind the document overdose deaths in 2020, the skyrocketing use of meth has additionally wreaked havoc on San Francisco’s streets.

According to a 2019 report by town’s Meth Activity drive, meth is contributing to “violent encounters, property harm, thefts and dangerous waste.” It may well additionally result in psychosis in some customers, which has in flip exacerbated town’s psychological well being disaster.

Isaac Jackson mentioned he tried contingency administration a few years in the past, and it helped him keep sober from meth for a few month. However, he mentioned, it was onerous to finally keep away from the drug as a result of he additionally struggles with melancholy.

Whereas Jackson nonetheless makes use of meth usually, he mentioned he’s capable of preserve his use below management as a result of he stays busy with tasks — like working the City Survivors Union, which advocates for drug customers. He additionally has secure housing.

“I feel it might be an efficient program whether it is a part of a variety of issues supplied to folks,” he mentioned. “Folks have completely different pathways.”

If the laws passes, it might assist develop San Francisco’s drug therapy choices. Town has been gradual so as to add new dependancy therapy packages and develop current ones.

For instance, a meth sobering center that was speculated to open final 12 months was placed on maintain amid the pandemic. Metropolis leaders have additionally lengthy referred to as for a protected consumption website, however that effort is stalled till the state passes laws — which Wiener has also proposed — authorizing it.

In the meantime, town is seing a document variety of deadly overdoses.

Thomas Wolf, a recovering drug person, has blended emotions about contingency administration. He worries that if it isn’t coupled with complete rehab, remedy and different companies, folks will use the cash earned in this system to purchase extra medicine.

However, he mentioned, given the gravity of the disaster, officers ought to attempt all the things.

“I’m of the assumption that we have to attempt something and all the things at this level, together with protected consumption websites,” he mentioned. “At this level, we’d like the kitchen sink.”

Trisha Thadani is a San Francisco Chronicle employees author. Electronic mail: Twitter: @TrishaThadani


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