Some drug treatment clinics offer patients prizes if they test negative for illegal drug use. “Some of us need something to motivate us — even if it’s a small thing — to live a better life,” a Pennsylvania man in treatment tells the New York Times. It is called contingency management, because the rewards are contingent on staying abstinent. Some clinical trials have found it highly effective in getting people addicted to stimulants like cocaine and methamphetamine to stay in treatment and to stop using the drugs. Outside the research arena and the Department of Veterans Affairs, it is nearly impossible to find programs that offer such treatment even as overdose deaths involving meth have soared. There were more than 16,500 such deaths last year, more than twice as many as in 2016.
Early data suggest that overdoses have increased even more during the coronavirus pandemic, which has forced treatment programs to move online. One of the biggest obstacles to contingency management is a moral objection to the idea of rewarding someone for staying off drugs. That is one reason publicly funded programs like Medicaid do not cover the treatment. Some treatment providers are wary of giving prizes patients could sell or trade for drugs. Greg Delaney, a pastor and the outreach coordinator at Woodhaven, a residential treatment center in Ohio, said, “Until you’re at the point where you can say, ‘I can make a good decision with this $50,’ it’s counterproductive.” Congress has told states that they could spend federal “opioid response” grants on treatment for stimulant addiction. The agency that distributes the grants allows only $75 per patient per year to be spent on contingency management — far less than what research has found effective.