Pay people to stop using drugs: How California’s plan will work

Some incentives to get Americans vaccinated have included free event tickets, gift cards, donuts, and cash. Now there’s a push in Sacramento to apply that strategy to drug abuse. The idea is to pay addicts not to use illegal drugs.

Governor Gavin Newsom has asked the federal government for permission to use Medicaid dollars for the program. Bills are currently in the state legislature that would fund this effort too.

The author of one of those bills is State Senator Scott Weiner, who represents San Francisco and parts of San Mateo County. He says the strategies would be spearheaded by community organizations and health care clinics that work with meth users. These programs would run for three to four months and cost $300 to $400, he explains.

To show how the program would work, Wiener tells the story of a recovery leader in San Francisco: “He was addicted to meth. He would go to the program every Saturday and urinate in a cup. … If the test came back negative, they would give him $7. That was enough of an incentive for him to keep trying and keep coming back, even though it's not a ton of money.”

Bethany Raiff, psychology professor at Rowan University in New Jersey, says incentive-based substance-use intervention is one of the most effective, non-pharmacological treatments to date.

“When we compare people who just get those same incentives, but it's not tied to abstinence in any way, they continue to use, even though they're highly motivated. They're checking in with people. A lot of those variables are the same. We still see that the contingency — the contingent cash — or whatever the incentive is, is what makes the difference,” she says.

She adds that these treatments work best among people who already want to quit.

“The problem with addiction and with any substance is that it doesn't feel good to stop … at least in the immediate sense. And so these incentives provide some immediate something to help kind of push you over and make it worth your while to remain abstinent.”

Although the program isn’t solely dedicated to meth users, Wiener says people who use meth and other stimulants are a major priority.

“We have a huge meth problem and opioids get a lot of the attention — which is important, the opioid crisis is a nightmare — but meth is surging, and it is so destructive and deadly,” Wiener says. “It is a massive public health and public safety problem.”