When Billy Lemon was trying to kick his methamphetamine addiction, he went to a drug treatment program at the San Francisco AIDS Foundation three times a week and peed in a cup. If it tested negative for meth, he got paid about $7.
The payments are part of a formal treatment called contingency management, which incentivizes drug users with money or gift cards to stay off drugs. At the end of 12 weeks, after all his drug tests came back clean, Lemon received $330.
“Just to take care of myself. That was very motivating,” Lemon says. “You're like, ‘Oh! I can feel good without the daily use of that substance. Let me try and go one more week.’ And then all of a sudden, you're at 90 days and you've actually made a change, like your brain has actually rewired itself.”
Studies show contingency management is the most effective treatment for meth or cocaine addiction, especially when combined with other behavioral therapy. But paying drug users not to use drugs is controversial. Insurers don’t cover it. State Medicaid programs have stayed away from it because the payments are considered illegal under federal laws.
But as the drug epidemic continues to worsen throughout California and the nation, lawmakers are starting to question those policies and push for changes. State Sen. Scott Wiener, D-San Francisco, introduced a bill this week — Senate Bill 110 — that would allow the state’s Medicaid program to pay for contingency management. He believes this will encourage more drug treatment centers to offer it.