GRASS VALLEY, Calif. \u2014 Here in the rugged foothills of California\u2019s Sierra Nevada, the streets aren\u2019t littered with needles and dealers aren\u2019t hustling drugs on the corner.<\/p>\n

But meth is almost as easy to come by as a hazy IPA or locally grown weed.<\/p>\n

Quinn Coburn knows the lifestyle well. He has used meth most of his adult life, and has done five stints in jail for dealing marijuana, methamphetamine, and heroin<\/a>. Now 56, Coburn wants to get sober for good, and he says an experimental program through Medi-Cal, California\u2019s Medicaid program, which covers low-income people, is helping.<\/p>\n

As part of an innovative approach called \u201c contingency management<\/a>,\u201d Coburn pees in a cup and gets paid for it \u2014 as long as the sample is clean of stimulants.<\/p>\n

In the coming fiscal year, the state is expected to allocate $61 million to the experiment, which targets addiction to stimulants such as meth and cocaine. It is part of a broader Medi-Cal initiative called CalAIM<\/a>, which provides social and behavioral health services, including addiction treatment, to some of the state\u2019s sickest and most vulnerable patients.<\/p>\n

Since April 2023, 19 counties have enrolled a total of about 2,700 patients, including Coburn, according to the state Department of Health Care Services.<\/p>\n

\u201cIt\u2019s that little something that\u2019s holding me accountable,\u201d said Coburn, a former construction worker who has tried repeatedly to kick his habit. He is also motivated to stay clean to fight criminal charges for possession of drugs and firearms, which he vociferously denies.<\/p>\n

\n\t\t
\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n
\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n
Coburn received $10 for each clean urine test he provided the first week of the program. Participants get a little more money in successive weeks: $11.50 per test in week two, $13 in week three, up to $26.50 per test.<\/p>\n
They can earn as much as $599 a year<\/a>. As of mid-May, Coburn had completed 20 weeks and made $521.50.<\/p>\n
Participants receive at least six months of additional behavioral health treatment after the urine testing ends.<\/p>\n
The state has poured significant money and effort<\/a> into curbing opioid addiction and fentanyl trafficking<\/a>, but the use of stimulants is also exploding in California. According to the state Department of Health Care Services, the rate of Californians dying from them doubled from 2019 to 2023<\/a>.<\/p>\n
Although the cutting-edge treatment can work for opioids<\/a> and other drugs, California has prioritized stimulants. To qualify, patients must have moderate to severe stimulant use disorder, which includes symptoms such as strong cravings for the drug and prioritizing it over personal health and well-being.<\/p>\n
Substance use experts say incentive programs that reward participants, even in a small way, can have a powerful effect with meth users in particular, and a growing body of evidence<\/a> indicates they can lead to long-term abstinence.<\/p>\n
\u201cThe way stimulants work on the brain is different than how opiates or alcohol works on the brain,\u201d said John Duff, lead program director at Common Goals, an outpatient drug and alcohol counseling center in Grass Valley, where Coburn receives treatment.<\/p>\n
\u201cThe reward system in the brain is more activated with amphetamine users, so getting $10 or $20 at a time is more enticing than sitting in group therapy,\u201d Duff said.<\/p>\n
California is paying Medicaid enrollees who use meth, cocaine, and other amphetamines to stay sober. As part of the experiment, participants can earn up to $599 a year for submitting clean urine tests. A Nevada County nonprofit organization called Common Goals has enrolled more than a dozen people since launching its program early this year.(Angela Hart\/KFF Health News)<\/span><\/figcaption><\/figure>\n
Duff acknowledged he was skeptical of the multimillion-dollar price tag for an experimental program. \u201cYou\u2019re talking about a lot of money,\u201d he said. \u201cIt was a hard sell.\u201d<\/p>\n
What convinced him? \u201cPeople are showing up, consistently. To get off stimulants, it\u2019s proving to be very effective.\u201d<\/p>\n
California was the first state to cover this approach as a benefit in its Medicaid program, according to the Department of Health Care Services, though other states have since followed, including Montana<\/a>.<\/p>\n
Participants in Nevada County must show up twice a week to provide a urine sample, tapering to once a week for the second half of treatment. Every time the sample is free of stimulants, they get paid via a retail gift card \u2014 even if the sample is positive for other kinds of drugs, including opioids.<\/p>\n
Though participants can collect the 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 companies such as Walmart, Bath & Body Works, Petco, Subway, and Hotels.com.<\/p>\n
Charlie Abernathybettis \u2014 Coburn\u2019s substance use disorder counselor, who helps run the program for Nevada County \u2014 said not everyone consistently produces a clean urine test, and he has devised a system to stop people from rigging their results.<\/p>\n
For example, he uses blue toilet cleaner to prevent patients from watering down their urine, and has dismantled a spigot on the bathroom faucet to keep them from using warm water for the same purpose.<\/p>\n
If participants fail, there are no consequences. They simply don\u2019t get paid that day, and can show up and try again.<\/p>\n
\u201cWe aren\u2019t going to change behavior by penalizing people for their addiction,\u201d Abernathybettis said, noting the ultimate goal is to transition participants into long-term treatment. \u201cHopefully you feel comfortable here and I can convince you to sign up for outpatient treatment.\u201d<\/p>\n
Abernathybettis has employed a tough love approach to addiction therapy that has helped keep Coburn sober and accountable since he started in January. \u201cIt\u2019s different this time,\u201d Coburn said as he lit a cigarette on a sunny afternoon in April. \u201cI have support now. I know my life is on the line.\u201d<\/p>\n
Growing up in the Bay Area, Coburn never quite felt like he fit in. He was adopted at an early age and dropped out of high school. His erratic home life set him on a course of hard drug use and crime, including manufacturing and selling drugs, he said.<\/p>\n
\u201cWhen I first did crank, it made me feel like I was human for the first time. All my phobias about being antisocial left me,\u201d Coburn said, using a street name for meth.<\/p>\n
Coburn escaped to the solitude of the mountains, trees, and rivers that define the rural landscape in Grass Valley, but the area was also rife with drugs.<\/p>\n
Construction accidents in 2012 left him in excruciating pain \u2014 and unable to work.<\/p>\n
Coburn fell deeper into the drug scene, as both a user and a manufacturer. \u201cYou wouldn\u2019t believe the market up here for it \u2014 more than you can even imagine,\u201d he said. \u201cIt\u2019s not an excuse, but I had no way to make a living.\u201d<\/p>\n
Financially strapped, he rented a cheap, converted garage from another local drug dealer, he said. Law enforcement officers raided the house in October, and authorities found a gun and large amounts of fentanyl and heroin. Coburn, who faces up to 30 years in prison, vigorously defends himself, saying the drugs and weapons were not his. \u201cAll the other ones I did. Not this one,\u201d he said.<\/p>\n
Coburn is also in an outpatient addiction program and is active in Alcoholics Anonymous, sometimes attending multiple meetings a day.<\/p>\n
Every week, the small payments from the Medi-Cal experiment feel like small wins, he said.<\/p>\n
He is planning to take his $599 as a lump sum and give it to his foster parents, with whom he is living as he fights his criminal charges.<\/p>\n
\u201cIt\u2019s the least I can do for them letting me stay with them and get better,\u201d Coburn said, choking back tears. \u201cI\u2019m not giving up.\u201d<\/p>\n
$\"A$
Every week, the small payments from the Medi-Cal experiment feel like small wins, Coburn says.(Angela Hart\/KFF Health News)<\/span><\/figcaption><\/figure>\n
This article is part of \u201cFaces of Medi-Cal<\/a>,\u201d a California Healthline series exploring the impact of the state\u2019s safety-net health program on enrollees.<\/em><\/p>\n
This article was produced by <\/em>KFF Health News<\/em><\/a>, which publishes <\/em>California Healthline<\/em><\/a>, an editorially independent service of the <\/em>California Health Care Foundation<\/em><\/a>.<\/em>\u00a0<\/p>\n
\n
\n\t\t\t\t\t\t\t\t\t\t\tAngela Hart: <\/span>
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t ahart@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t@ahartreports<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n
\n
\n
\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n
\t\t\t\t
\n\t\t\tContact Us\t\t<\/a>
\n\t\t
\n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n