GRASS VALLEY, Calif. — Right here within the rugged foothills of California’s Sierra Nevada, the streets aren’t plagued by needles and sellers aren’t hustling medication on the nook.
However meth is nearly as straightforward to return by as a hazy IPA or regionally grown weed.
Quinn Coburn is aware of the approach to life nicely. He has used meth most of his grownup life, and has carried out 5 stints in jail for dealing marijuana, methamphetamine, and heroin. Now 56, Coburn desires to get sober for good, and he says an experimental program by Medi-Cal, California’s Medicaid program, which covers low-income folks, helps.
As a part of an modern method referred to as “contingency management,” Coburn pees in a cup and will get paid for it — so long as the pattern is clear of stimulants.
Within the coming fiscal 12 months, the state is predicted to allocate $61 million to the experiment, which targets dependancy to stimulants reminiscent of meth and cocaine. It’s a part of a broader Medi-Cal initiative referred to as CalAIM, which supplies social and behavioral well being providers, together with dependancy remedy, to among the state’s sickest and most weak sufferers.
Since April 2023, 19 counties have enrolled a complete of about 2,700 sufferers, together with Coburn, in keeping with the state Division of Well being Care Providers.
“It’s that little something that’s holding me accountable,” mentioned Coburn, a former building employee who has tried repeatedly to kick his behavior. He’s additionally motivated to remain clear to combat felony fees for possession of medicine and firearms, which he vociferously denies.
Coburn obtained $10 for every clear urine check he offered the primary week of this system. Members get slightly more cash in successive weeks: $11.50 per check in week two, $13 in week three, as much as $26.50 per check.
They’ll earn as a lot as $599 a 12 months. As of mid-Could, Coburn had accomplished 20 weeks and made $521.50.
Members obtain not less than six months of extra behavioral well being remedy after the urine testing ends.
The state has poured vital cash and energy into curbing opioid dependancy and fentanyl trafficking, however using stimulants can also be exploding in California. In response to the state Division of Well being Care Providers, the speed of Californians dying from them doubled from 2019 to 2023.
Though the cutting-edge remedy can work for opioids and different medication, California has prioritized stimulants. To qualify, sufferers should have reasonable to extreme stimulant use dysfunction, which incorporates signs reminiscent of sturdy cravings for the drug and prioritizing it over private well being and well-being.
Substance use specialists say incentive packages that reward members, even in a small manner, can have a robust impact with meth customers specifically, and a rising physique of proof signifies they will result in long-term abstinence.
“The way stimulants work on the brain is different than how opiates or alcohol works on the brain,” mentioned John Duff, lead program director at Frequent Targets, an outpatient drug and alcohol counseling middle in Grass Valley, the place Coburn receives remedy.
“The 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,” Duff mentioned.
Duff acknowledged he was skeptical of the multimillion-dollar price ticket for an experimental program. “You’re talking about a lot of money,” he mentioned. “It was a hard sell.”
What satisfied him? “People are showing up, consistently. To get off stimulants, it’s proving to be very effective.”
California was the primary state to cowl this method as a profit in its Medicaid program, in keeping with the Division of Well being Care Providers, although different states have since adopted, together with Montana.
Members in Nevada County should present up twice every week to offer a urine pattern, tapering to as soon as every week for the second half of remedy. Each time the pattern is freed from stimulants, they receives a commission by way of a retail present card — even when the pattern is constructive for different kinds of medicine, together with opioids.
Although members can gather the cash after every clear check, many go for a lump sum after finishing the 24-week program, Duff mentioned. They’ll select present playing cards from corporations reminiscent of Walmart, Tub & Physique Works, Petco, Subway, and Accommodations.com.
Charlie Abernathybettis — Coburn’s substance use dysfunction counselor, who helps run this system for Nevada County — mentioned not everybody persistently produces a clear urine check, and he has devised a system to cease folks from rigging their outcomes.
For instance, he makes use of blue rest room cleaner to stop sufferers from watering down their urine, and has dismantled a spigot on the toilet faucet to maintain them from utilizing heat water for a similar objective.
If members fail, there aren’t any penalties. They merely don’t receives a commission that day, and may present up and take a look at once more.
“We aren’t going to change behavior by penalizing people for their addiction,” Abernathybettis mentioned, noting the last word aim is to transition members into long-term remedy. “Hopefully you feel comfortable here and I can convince you to sign up for outpatient treatment.”
Abernathybettis has employed a tricky love method to dependancy remedy that has helped maintain Coburn sober and accountable since he began in January. “It’s different this time,” Coburn mentioned as he lit a cigarette on a sunny afternoon in April. “I have support now. I know my life is on the line.”
Rising up within the Bay Space, Coburn by no means fairly felt like he slot in. He was adopted at an early age and dropped out of highschool. His erratic residence life set him on a course of arduous drug use and crime, together with manufacturing and promoting medication, he mentioned.
“When I first did crank, it made me feel like I was human for the first time. All my phobias about being antisocial left me,” Coburn mentioned, utilizing a avenue title for meth.
Coburn escaped to the solitude of the mountains, bushes, and rivers that outline the agricultural panorama in Grass Valley, however the space was additionally rife with medication.
Building accidents in 2012 left him in excruciating ache — and unable to work.
Coburn fell deeper into the drug scene, as each a consumer and a producer. “You wouldn’t believe the market up here for it — more than you can even imagine,” he mentioned. “It’s not an excuse, but I had no way to make a living.”
Financially strapped, he rented an affordable, transformed storage from one other native drug seller, he mentioned. Regulation enforcement officers raided the home in October, and authorities discovered a gun and enormous quantities of fentanyl and heroin. Coburn, who faces as much as 30 years in jail, vigorously defends himself, saying the medication and weapons weren’t his. “All the other ones I did. Not this one,” he mentioned.
Coburn can also be in an outpatient dependancy program and is energetic in Alcoholics Nameless, generally attending a number of conferences a day.
Each week, the small funds from the Medi-Cal experiment really feel like small wins, he mentioned.
He’s planning to take his $599 as a lump sum and provides it to his foster mother and father, with whom he’s dwelling as he fights his felony fees.
“It’s the least I can do for them letting me stay with them and get better,” Coburn mentioned, choking again tears. “I’m not giving up.”
This text is a part of “Faces of Medi-Cal,” a California Healthline sequence exploring the influence of the state’s safety-net well being program on enrollees.
This text was produced by KFF Well being Information, which publishes California Healthline, an editorially unbiased service of the California Well being Care Basis.
