Paid to stay sober; Programs to reward people addicted to drugs for staying clean showing results

SAN FRANCISCO – U.S. cities wanting to pay people with drug addiction to stay sober have scored a major victory by getting more funding for what are known as contingency management programs. 

Health experts say these programs are working and early promising results are allowing for the expansion of these kinds of efforts to battle the fentanyl crisis. California is leading the way, and cities like San Francisco are seeing what the impacts can be. 

When Dana turned 19 years old, she started using heroin, meth, and fentanyl. At 24, she’s a new mom taking her first steps to turn away from addiction.

“He’s definitely giving me a whole new perspective on things and a reason to change,” said Dana, who asked her last name not be used. 

Scenes of fatal overdoses on city sidewalks have become too common. Drug overdose deaths in San Francisco this year are spiking, putting the city on track to far surpass the record number of fatalities of 725 in 2020.

“We are in the midst of this profound public health crisis,” said Dr. Jeffrey Hom, director of population behavioral health with the city’s Department of Public Health.   

Participants like Dana get tested weekly. If they’re clean, they receive gift cards over six months totaling close to $600.

Dr. Hom and the San Francisco Department of Public Health are doubling down on incentives to keep people addicted to drugs clean. 

“It’s been proven in multiple scientific and to be an effective behavioral treatment for substance use disorders, especially stimulant use disorders,” said Hom. 

At the federal level, the VA health system has been funding contingency management programs for about a decade. 

For the first time, California is using Medi-Cal dollars, expanding eligibility statewide and giving people struggling with addiction a second chance. 

“It’s just so much support and resources,” said Dana. “I didn’t know it was out there.” 

“There’s a lot of help in the city and it’s not a one size fits all, but just participate and you never know where the help is gonna come from and where the change is gonna come,” said John Dunham, contingency management supervisor at Zuckerberg San Francisco General Hospital. 

Dunham talks with Dana regularly during visits. He’s seen a dramatic change in the young mother. 

For Dana, it’s a shift she believes others can make too.   

“Just do it. It really comes down to, you know, whether or not you want to change or not because if you don’t want to change, it doesn’t matter what kind of research is out there. It doesn’t matter,” said Dana. 

Staying clean is giving this mom a new path forward and the possibility of more doors opening up for a different kind of life. 

California recently became the first state in the country to receive federal approval for contingency management programs as a benefit of the Medicaid program. 

Health experts say there is no medication for stimulant use disorders. 

San Francisco’s Department of Health says it is already scaling up programs like this across the city so that more individuals have access.   

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