A new California program incentivizes people using meth or cocaine with money if they can prove they are clean in an evidence-based system in which participants can earn incrementally more the longer they stay clean. Why? Because California is grappling with substance use disorder “crisis” with deaths from cocaine, meth, and other stimulants soaring in recent years. In 2021 for instance, 65% of drug-related overdose deaths involved stimulants, compared to 22% in 2011. The impulsive nature of stimulant cravings and addiction calls for alternative approaches.

A Medi-Cal initiative called CalAIM provides social and behavioral health services, including addiction treatment to individuals in California . California Healthline reports that CalAIM provides people who use meth and cocaine with an incentive to quit habit-forming drugs that are difficult to kick on your own.

Contingency Management (CM) is a program that provides motivational incentives to treat people who use stimulants like meth or cocaine, and support their path to recovery. It recognizes and reinforces individual positive behavioral change, and requires them to prove it with drug tests showing negative results for stimulants. “CM is the only treatment that has demonstrated robust outcomes for individuals living with stimulant use disorder, including reduction or cessation of drug use and longer retention in treatment,” the program states.

“The Recovery Incentives Program increases access to new evidence-based treatments for Californians living with substance use disorder,” the program’s Fact Sheet states. “Starting in 2023, the program is available to members living with stimulant use disorder in participating counties, in outpatient, intensive outpatient, and Narcotic Treatment Program settings. As part of the program, eligible Medi-Cal members participate in a structured 24-week outpatient program, followed by at least six months of additional recovery support services. Participants meet with a trained contingency management coordinator twice weekly for the first 12 weeks of the program, then weekly for weeks 13 to 24 to complete a drug test. Participants receive a small gift card each time they test negative for stimulants and can earn up to $599 per year in incentives.”

California is the first state in the country to receive federal approval of CM as a benefit in the Medicaid program through the CalAIM 1115 Demonstration. CM also tested other sources of funding.

According to the state Department of Health Care Services, about 2,700 patients from 19 counties have enrolled in the program since April 2023.

Quinn Coburn, 65, who is in the program, told California Healthline, “It’s that little something that’s holding me accountable.”  Coburn received $10 for each clean urine test he provided the first week of the program, and the pay increases in subsequent weeks: $11.50 per test in week two, $13 in week three—up to $26.50 per test.

The program promises as much as $599 a year, and Coburn is proof that it’s doable: As of mid-May, Coburn had completed 20 weeks of clean drug tests and made $521.50.

“The way stimulants work on the brain is different than how opiates or alcohol works on the brain,” said John Duff, lead program director at Common Goals, where Coburn receives treatment. “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.”.

The average recovery rate for people suffering from meth addiction is around 37%, which is about equal to other physically addictive drugs such as cocaine, heroin, and prescription drugs. Cannabis is also being explored as a potential treatment to help reduce stimulant cravings.

Fighting Meth Abuse at the National Level

The fight against meth abuse is also taking place at the national level.

In 2022, President Joe Biden signed legislation designed to address the rising scourge of meth abuse in the United States.

The new law, titled the Methamphetamine Response Act, “requires the government to declare methamphetamine an ‘emerging drug threat’ and to develop a response plan specific to methamphetamine,” according to a press release.

The bill had bipartisan support in the House of Representatives and Senate: its sponsors were Sens. Dianne Feinstein (D-Calif.) and Chuck Grassley (R-Iowa) and Reps. Scott Peters (D-Calif.) and John Curtis (R-Utah).

According to a study from the National Institutes of Health, “overdose deaths involving methamphetamine nearly tripled from 2015 to 2019 among people ages 18-64 in the United States.” That study showed that the “number of people who reported using methamphetamine during this time did not increase as steeply, but the analysis found that populations with methamphetamine use disorder have become more diverse,” suggesting that “increases in higher-risk patterns of methamphetamine use, such as increases in methamphetamine use disorder, frequent use, and use of other drugs at the same time, may be contributing to the rise in overdose deaths.”

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A newly published survey from researchers at Kent State University sought to find out whether “cannabidiol (CBD) use and/or delta-9-tetrahydrocannabinol (THC) use … shows promise to enhance exercise recovery.”

The researchers said that the study “aimed to determine if individuals are using CBD and/or THC as a means of recovery from aerobic and/or resistance exercise, as well as additional modalities that might be used to aid in recovery.”

The anonymous survey involved 111 participants who “were regularly using cannabis (CBD and/or THC) as well as were currently exercising,” and the questions “pertained to level of cannabis use, methods used for consumption of cannabis, exercise habits, exercise recovery strategies, and demographics.”

“Eighty-five percent of participants reported participating in aerobic training. In addition, 85% of participants also reported regular participation in resistance exercise. Seventy-two percent of participants participated in both aerobic and resistance exercise. Ninety-three percent of participants felt that CBD use assisted them with recovery from exercise, while 87% of participants felt the same regarding THC use,” the researchers said.

“Individuals who habitually use cannabis, CBD or THC, and regularly engage in exercise do feel that cannabis assists them with exercise recovery. More data are necessary to understand the role of cannabis in exercise recovery as well as perceived ergogenic benefits of cannabis by individuals who both regularly participate in exercise and habitually use cannabis,” they wrote in their conclusion. 

Even world class athletes have long dabbled in cannabis, often preferring it to booze because it doesn’t result in a hangover. And as laws surrounding recreational pot use have changed throughout the United States, professional sports leagues have also adjusted their own drug policies. 

NBA legend Kevin Durant said this summer that he personally lobbied league commissioner Adam Silver to do away with the ban on marijuana.

“I actually called him and advocated for him to take marijuana off the banned substance list,” Durant, a star for the Phoenix Suns, said at a conference hosted by CNBC. “I just felt like it was becoming a thing around the country, around the world … the stigma behind it wasn’t as negative as it was before. It doesn’t affect you in any negative way.”

The NBA and its players’ union brokered a new collective bargaining agreement earlier this year that eliminates drug testing for cannabis.

“Marijuana will be removed from the Prohibited Substances List (‘PSL’),” the contract reads. “A team that has reason to believe one of its players is under the influence of marijuana or alcohol while engaged in NBA or team-related activities, or has a dependency issue involving marijuana or alcohol, may refer the player to a required evaluation treatment program.”

One of the greatest scorers to ever play the game, Durant has been open about his own marijuana use. At the CNBC conference, Durant said that Silver likely had an inkling that he had toked up before their meeting.

“Well, he smelled it when I walked in, so I ain’t really have to say much,” Durant said. “He kind of understood where this was going. And I mean, it’s the NBA, man. Everybody does it, to be honest. It’s like wine at this point.”

The researchers at Kent State University said the changing policies and mores surrounding marijuana in the United States prompted them to conduct their survey.

“Over the past decade, cannabis use has become more widespread in the United States, both medically and recreationally. As of 2021, 52.5 million individuals in the US reported use of cannabis in the past year, accounting for 18.7% of the country’s population (Key substance use and mental health indicators in the United States: Results from the 2021 national survey on drug use and health 2021),” they wrote. “Cannabis plants are composed of a variety of cannabinoid compounds, most notably cannabidiol (CBD) and delta-9-tetrahydrocannabidiol (THC), both of which bind endocannabinoid receptors, cannabinoid type 1 (CB1) and cannabinoid type 2 (CB2) (Pagotto et al. 2006). While CBD has a low-binding affinity for CB1 and CB2 receptors, both receptors bind THC. Contrary to THC, CBD does not induce psychotropic effects. It has, however, been demonstrated to acutely stimulate parasympathetic nervous system activation resulting in reduced heart rate, reduced systolic blood pressure, and increased vasodilation . Conversely, THC has been demonstrated to impair cognitive function and up-regulate sympathetic nervous system activity, leading to acute increases in heart rate, systolic blood pressure, and vasoconstriction.”

The researchers noted that both “CBD and THC have the potential to enhance recovery from aerobic and resistance exercise due to analgesic, anti-inflammatory effects as well as the ability to enhance sleep quality.”

“Both compounds have also assisted in acutely reducing subjective feelings of pain intensity in chronic-pain patients, while acute CBD intake has been demonstrated to attenuate muscle damage following resistance exercise in resistance-trained men and women. Survey data in both recreationally active and athletic populations has demonstrated that individuals use cannabis to assist with exercise recovery, pain relief resulting from muscle-soreness, to reduce inflammation, and enhance sleep,” they said.

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The nation’s most wide-ranging drug reform measure secures a spot on the ballot.

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By swapping cannabis for alcohol, patients have been recovering their health since the 1970s.

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