The opioid epidemic gets the most attention, but the nation’s methamphetamine crisis has also brought an increasing amount of addiction, destruction and death to American cities.
Like the opioid crisis, meth addiction affects politically blue and red states alike, vexing both the Democratic and Republican politicians responsible for addressing it. According to a recent study by drug testing company Millennium Health, deep-red Arkansas has the grim distinction of being the nation’s “meth capital.”
Yet the deadly meth epidemic is also rising in rural and urban areas around California, including San Francisco.
“We know that, as of 2019, a majority of overdose deaths were meth-related, and that most admissions to our psych emergency room at San Francisco General Hospital were meth-related,” said state Sen. Scott Wiener during a press conference last week. “And although we also have big problems with heroin and fentanyl, meth is a significant part of the mix in terms of addiction, overdose and overdose death problems in San Francisco.”
Long-term meth use can trigger psychosis, aggressive behavior and paranoid, delusional thoughts. Wiener wants California to help lead the fight with an innovative but controversial treatment called contingency management. The approach provides financial incentives — some as low as $1 — for meth users to stay clean and get off the highly addictive, dangerous drug.
Doctors can prescribe methadone to heroin users trying to quit the deadly opioid, but no similar treatment exists for meth. That’s why contingency management, which has shown great promise as an effective meth treatment and which the Biden administration has embraced, is so important.
“The treatment is called contingency management, because the rewards are contingent on staying abstinent,” wrote the New York Times in 2020. “A number of clinical trials have found it highly effective in getting people addicted to stimulants like cocaine and methamphetamine to stay in treatment and to stop using the drugs.”
In a contingency management program, a meth user could receive cash vouchers or gift cards as a prize for testing clean, attending counseling or meeting other goals. The Department of Veterans Affairs has used it for over 10 years to help get veterans off drugs like meth and cocaine. In San Francisco, the method has also seen tremendous success.
“At the San Francisco AIDS Foundation, 63% of people who participated in the program in 2019 stopped using meth entirely, and another 19% reduced their use,” reports National Public Radio.
“I got sober with the help of PROP at the San Francisco AIDS Foundation,” said Billy Lemon, executive director of the Castro Country Club, a clean and sober space.
Lemon said his time in a contingency management program called the Positive Reinforcement Opportunity Project, or PROP, helped him kick meth addiction in 2013.
“Those little incremental rewards, for someone who was a stimulant user, is an effective treatment,” Lemon said.
Senate Bill 110, authored by Wiener, would explicitly legalize contingency management programs in California, paving the way for their expansion here. Wiener’s office says the bill is necessary because current law makes it harder for public health officials to use the method.
“Despite the urgency and intensity of the meth crisis, this treatment is not available in most areas of the state, and programs that employ this treatment cannot access state funding through Medi-Cal,” Wiener’s office said in a fact sheet about the bill. “CM is thus functionally prohibited under state law.”
The bill, which would also require Medi-Cal to offer contingency management as an option, passed with unanimous and bipartisan support in both houses of the California State Legislature. Now, it awaits Gov. Gavin Newsom’s signature.
It’s easy to mock the idea of paying people to abstain from negative behaviors like drug abuse and violent crime. When San Francisco recently announced plans to provide cash incentives to individuals deemed “high risk” for violent crime, some critics derided it as “cash for criminals.”
“San Francisco will pay people not to shoot at others,” declared one headline.
Snarky headline writers can make good programs sound silly, but the reality is more complex — and the approach is rooted in evidence. Similar programs in other cities have helped reduce violent crime, even if the method seems counterintuitive to those who prefer a more punitive approach.
In San Francisco, the Dream Keeper Fellowship will provide up to 10 high-risk individuals with financial incentives of up to $500 a month to attend counseling programs, apply for jobs and comply with probation terms. It gives these selected individuals a compelling financial reason to stay on track and turn away from lifestyles that could lead to violence.
Contingency management programs represent investments in the lives of people who, without positive encouragement, might cost taxpayers more in the long run. It costs an estimated $81,000 to lock a person in a California prison for a year, a sum that’s 13.5 times greater than the maximum $6,000 per year in incentives that the Dream Keeper Fellowship will provide.
With drug addiction and violence spiking nationwide, city and state leaders must boldly pursue creative and effective solutions, regardless of what cynics think.
“I am a living, breathing example that if you offer a helping hand, that eventually folks will figure out a way to make it work for you,” said Lemon, who now works to help others beat addiction.
By signing SB 110, Newsom can hopefully create more success stories and make California a leader in solving the meth addiction crisis.