Santa Clara County will pay drug addicts to get clean

SAN JOSE, Calif. - Santa Clara County is trying a unique way to intervene in drug addiction by doling out gift cards.

A pilot program is launching in the next few weeks for those addicted to methamphetamine and other stimulant drugs. Participants will be given gift cards for each negative drug test they take over a 24-week period. They will receive nothing if they test positive.

Although the program cannot mandate participants get treatment, the aim is to motivate them to seek help. Throughout the year, 70% of 120 drug deaths in the county have included meth, according to the Santa Clara County Office of the Medical Examiner-Coroner.

Tammy Ramsey, program manager for the Drug Medi-Cal Organized Delivery System in Santa Clara County, said the pilot is specifically targeting those using stimulant drugs because people addicted to them don't often have accessible avenues for medication-assisted treatment like those with opioid addictions.

"That's why the state is trying this pilot (program) with this positive reinforcement, to see if that helps anybody," Ramsey told San Jose Spotlight.

The pilot program comes as Santa Clara County continues to struggle with its ongoing mental health and substance use crisis. Local officials declared a mental health emergency at the start of last year, citing a record increase in suicides and drug overdoses, an inadequate number of beds in treatments facilities and the overuse of prisons for those in need of treatment.

The county is one of 24 launching a pilot program in the state, dubbed the Recovery Incentives Program. The program is getting started in other regions grappling with the same critical issues including San Francisco, Sacramento and Los Angeles.

The pilot program will be completed through two community-based providers in Santa Clara County that focus on behavioral health support: HealthRIGHT 360 and Momentum for Health. The program hopes to serve about 90 MediCal recipients throughout the county.

Participants can earn up to $599 through the program--if the amount exceeded $600 it would have to be reported to the IRS. Participants will receive gift cards from $10 up to $26.50, which they can use at a variety of stores, including Walmart, Nike, Home Depot, among others.

This approach to addressing drug addiction is based on the idea of "contingency management," which is when people are financially rewarded each time they test negative for stimulant drugs. Programs have shown positive results in both clinical trials and the U.S. Department of Veterans Affairs. The VA began using contingency management in 2011 and has treated more than 6,300 veterans. Those participants attended about half of their appointments and their tests came back negative 92% of the time for the targeted drug, according to CalMatters.

"The money is a positive reinforcement to hopefully keep them (continuing to get a) negative drug test," Ramsey said. "Only time will tell."

Edward Cohen, a social work professor at San Jose State University, said while there might be concerns around incentivizing those with drug addictions by using financial compensation, the contingency model works. Out of 22 studies examining impact on stimulant addiction using this approach, 82% reported a significant increase in a participant's ability to stay clean, according to a 2021 study.

"Spending (money in a) way to incentivize people to participate in treatment seems to be working," Cohen told San Jose Spotlight. "The idea that they're using the money to instead continue their addiction--first of all, it's not enough money to do that. But it's just enough to encourage people to stay involved (with this program)."

The program costs are being covered through reimbursements by CalAIM, which is California's expansion of Medi-Cal services.

Cohen said the model has proven successful, and he is curious if Santa Clara County's pilot program will produce similar results.

"I would imagine that a program that uses both the combination of the monetary incentives, as well as other ways to give positive reinforcement for people's progress would be pretty highly effective," Cohen said.