Here in the rugged foothills of California’s Sierra Nevada, the streets aren’t littered with needles and dealers don’t sell drugs on street corners.
But meth is almost as easy to find as a hazy IPA or locally grown weed.
Quinn Coburn knows the lifestyle well. He used methamphetamine for most of his adult life and served five prison sentences for trafficking marijuana, methamphetamine and heroin. Coburn, 56, wants to get sober for good, and he says an experimental program run by Medi-Cal, the state’s Medicaid program for low-income people, is helping him.
As part of an innovative approach called “contingency management“, Coburn provides a urine sample and is paid for it – provided it is free of stimulants.
In the next fiscal year, the state is expected to allocate $61 million for the experiment, which targets addiction to stimulants such as methamphetamine and cocaine. It is part of a larger medical initiative called CalAIM, which provides social and behavioral health services, including substance abuse treatment, to some of the state’s sickest and most vulnerable patients.
Since April 2023, 19 counties have enrolled a total of about 2,700 patients, including Coburn, according to the state Department of Health Services. In Los Angeles County, public health officials have cited emergency management as one of the only effective ways to treat stimulant use disorder. Los Angeles has 42 participating providers and has served 1,566 people, the most of any county, the department said.
Common Goals, a Nevada County nonprofit, has enrolled more than a dozen people in a California program that pays Medicaid participants who use methamphetamine, cocaine and other amphetamines to stay sober .
(Angela Hart/KFF Health News)
“It’s that little something that holds me accountable,” said Coburn, a former construction worker who repeatedly tried to kick his addiction. He is motivated to stay clean to fight criminal charges for drug and gun possession, which he vehemently denies.
Coburn received $10 for each clean urine test he took during his first week in the program. Participants receive a little more over time: $11.50 per test in the second week, $13 in the third week, increasing to $26.50.
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 urine testing is completed.
The state has devoted a lot of money and effort to combating opioid addiction and fentanyl trafficking, but the consumption of stimulants is also exploding. According to the Department of State Health Services, the rate of deaths of Californians from these drugs doubled from 2019 to 2023.
While this cutting-edge treatment may work for opioids and other drugs, California has prioritized stimulants. To qualify, patients must have a moderate to severe stimulant use disorder, with symptoms such as a strong urge to use the drug and prioritizing it over their health and well-being personal.
Addiction experts say incentive programs that reward participants, even in small ways, can have a powerful effect, especially among methamphetamine users. A a growing body of evidence indicates that such programs can lead to long-term abstinence.
“The way stimulants act on the brain is different from the way opiates or alcohol act on the brain,” said John Duff, senior director of the Common Goals Program, an outpatient drug and alcohol counseling center. of alcohol in Grass Valley, Nevada County, where Coburn is receiving treatment. . “The reward system in the brain is more activated in amphetamine users, so receiving $10 or $20 at a time is more appealing than going to group therapy.”
Duff acknowledged that he was initially skeptical about the multimillion-dollar price tag of an experimental program.
“You’re talking about a lot of money,” he said. “It was a hard sell.”
What convinced him of its effectiveness? “People show up regularly. To stop taking stimulants, this is very effective.”
California was the first state to include this approach in its Medicaid program, according to the Department of Health Care Services. Others, including Montana, followed.
Participants in Nevada County must report twice a week to provide a urine sample, then once a week during the second half of treatment. Whenever the sample does not contain stimulants, they are paid via a retail gift card, even if the sample tests positive for other types of drugs, including opioids.
Although participants can collect money after each clean test, many opt for a lump sum after completing the 24-week program, Duff said. They can choose gift cards from Walmart, Bath & Body Works, Petco, Subway, Hotels.com and other companies.
Charlie Abernathybettis – a substance use disorder counselor in Coburn who helps run the program for Nevada County – said not everyone consistently produces a clean urine test and that it designed a system to prevent people from faking their results. He uses blue toilet cleaner to prevent patients from diluting their urine and has taken apart a faucet on the bathroom faucet to prevent them from using hot water for the same purpose.
For those who fail, there are no consequences. They just don’t get paid that day and can show up and try again.
“We’re not going to change behavior by penalizing people for their addiction,” Abernathybettis said, emphasizing that the goal is to transition participants into long-term treatment. “I hope you feel comfortable here and I can convince you to sign up for outpatient treatment.”
Abernathybettis used a “tough love” approach to addiction therapy that has helped Coburn stay sober and responsible since starting in January.
“It’s different this time,” Coburn said as he lit a cigarette on a sunny April afternoon. “I have support now. I know my life is at stake.”
Coburn says getting paid for clean urine tests is the incentive he needed to stop using meth: “It’s that little something that keeps me accountable.” »
(Angela Hart/KFF Health News)
Growing up in the Bay Area, Coburn never felt like he belonged. He was adopted at a young age and dropped out of high school. His erratic home life pushed him toward hard drug use and crime, including manufacturing and selling drugs, he said.
“When I started cranking, I felt like I was human for the first time,” Coburn said, using a street name for meth. “All my phobias about being antisocial left me.”
Coburn fled to the solitude of the mountains, trees and rivers of Grass Valley, but the area also teemed with drugs.
Construction accidents in 2012 left him in excruciating pain, unable to work. He moved deeper into the drug business, both as a user and manufacturer.
“You wouldn’t believe the market here – more than you can imagine,” he said. “It’s not an excuse, but I had no way of making a living.”
Short on cash, he rented a converted garage on the cheap from another local drug dealer, he said. Law enforcement searched the home in October and found a gun and large quantities of fentanyl and heroin. Coburn, who faces up to 30 years in prison, maintains the drugs and weapons did not belong to him. “All the others I did,” he said of the possession charges. “Not this one.”
Coburn participates in an outpatient substance abuse program and is active in Alcoholics Anonymous, sometimes attending several meetings a day. Each week, the small payments in the Medi-Cal experience feel like small victories, he said.
He plans to take his $599 lump sum and give it to his adoptive parents, who he lives with while he fights his criminal charges.
“It’s the least I can do for them, allowing me to stay with them and get better,” Coburn said, holding back tears. “I do not give up.”
This article was produced by KFF Health Newsa national newsroom that produces in-depth journalism on health issues.