Here in the rugged foothills of California’s Sierra Nevada, the streets aren’t littered with needles and dealers aren’t hustling drugs on the corner.

But meth is almost as easy to come by as a hazy IPA or locally grown weed.

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. Now 56, Coburn wants to get sober for good, and he says an experimental program through Medi-Cal, California’s Medicaid program, which covers low-income people, is helping.

As part of an innovative approach called “contingency management,” Coburn pees in a cup and gets paid for it — as long as the sample is clean of stimulants.

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, which provides social and behavioral health services, including addiction treatment, to some of the state’s sickest and most vulnerable patients.

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.

“It’s that little something that’s holding me accountable,” 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.

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.

They can earn as much as $599 a year. As of mid-May, Coburn had completed 20 weeks and made $521.50.

Participants receive at least six months of additional behavioral health treatment after the urine testing ends.

The state has poured significant money and effort into curbing opioid addiction and fentanyl trafficking, 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.

Although the cutting-edge treatment can work for opioids 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.

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 indicates they can lead to long-term abstinence.

“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, an outpatient drug and alcohol counseling center in Grass Valley, 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,” Duff said.

Duff acknowledged he was skeptical of the multimillion-dollar price tag for an experimental program. “You’re talking about a lot of money,” he said. “It was a hard sell.”

What convinced him? “People are showing up, consistently. To get off stimulants, it’s proving to be very effective.”

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.

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 — even if the sample is positive for other kinds of drugs, including opioids.

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.

Charlie Abernathybettis — Coburn’s substance use disorder counselor, who helps run the program for Nevada County — said not everyone consistently produces a clean urine test, and he has devised a system to stop people from rigging their results.

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.

If participants fail, there are no consequences. They simply don’t get paid that day, and can show up and try again.

“We aren’t going to change behavior by penalizing people for their addiction,” Abernathybettis said, noting the ultimate goal is to transition participants into long-term treatment. “Hopefully you feel comfortable here and I can convince you to sign up for outpatient treatment.”

Abernathybettis has employed a tough love approach to addiction therapy that has helped keep Coburn sober and accountable since he started in January. “It’s different this time,” Coburn said as he lit a cigarette on a sunny afternoon in April. “I have support now. I know my life is on the line.”

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.

“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 said, using a street name for meth.

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.

Construction accidents in 2012 left him in excruciating pain — and unable to work.

Coburn fell deeper into the drug scene, as both a user and a manufacturer. “You wouldn’t believe the market up here for it — more than you can even imagine,” he said. “It’s not an excuse, but I had no way to make a living.”

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. “All the other ones I did. Not this one,” he said.

Coburn is also in an outpatient addiction program and is active in Alcoholics Anonymous, sometimes attending multiple meetings a day.

Every week, the small payments from the Medi-Cal experiment feel like small wins, he said.

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.

“It’s the least I can do for them letting me stay with them and get better,” Coburn said, choking back tears. “I’m not giving up.”

This article is part of “Faces of Medi-Cal,” a California Healthline series exploring the impact of the state’s safety-net health program on enrollees.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

CNN
 — 

California state Assemblyman Vince Fong will win the special election to succeed former House Speaker Kevin McCarthy in the state’s 20th Congressional District, CNN projects.

Fong’s victory in an all-GOP clash against Tulare County Sheriff Mike Boudreaux will help House Republicans buttress their razor-thin majority on Capitol Hill.

McCarthy, after being deposed as speaker, announced in December that he would resign from his heavily Republican Central Valley seat. He endorsed Fong, a former staffer, as his successor.

Fong will serve out the remainder of McCarthy’s term through January next year. The pair are set for another rematch in November, when they compete for a full two-year term.

The first round of the special election took place in March with all candidates, regardless of party, running on the same ballot. Fong, who also had the support of former President Donald Trump, finished first in that race ahead of Boudreaux and Democrat Marisa Wood. But as he did not take a majority of the vote, the race moved to this month’s face-off between the top two finishers.

The 20th District contest was the first of three House special elections taking place for vacant GOP seats over the next five weeks.

The next is on June 11 in Ohio’s 6th Congressional District. Voters there will decide on a successor to former Rep. Bill Johnson, who resigned to become the president of Youngstown State University. Then, on June 25, Colorado’s 4th District will hold a special election to succeed former Rep. Ken Buck, a hard-line conservative who clashed with his own party at times. Following his resignation announcement in March, Buck told CNN in March that Congress had “devolved into this bickering and nonsense and not really doing the job for the American people.”

California housing regulators are demanding that cities statewide develop meticulous plans to add 2.5 million affordable and market-rate homes by the end of the decade — but some local officials say the process sets them up for failure.

Frustrated mayors and city councilmembers say the new planning requirements are needlessly confusing and that regulators have been slow to review the plans that have been submitted. They argue the convoluted process is leaving some cities vulnerable to unfair penalties for failing to get state approval.

Auditors will now examine whether the state is doing enough to help local governments satisfy the requirements and plan for many more homes than ever before.

“We do have an affordable housing crisis, and the vast majority of cities are doing their best effort to help, but there has been inconsistent guidance,” said state Sen. Steve Glazer, a Democrat from Orinda. He’s pushed for some new housing laws and programs but he has received mixed reviews from housing advocates.

In a letter to the Joint Legislative Audit Committee, which approved the audit last week, Glazer wrote the complaints he’s received from cities — which he declined to identify because they have not all received approval for their proposals — point to “structural problems” in how the state reviews the every-eight-year plans, dubbed “housing elements.”

While the audit will not be legally binding, he hopes it can “reveal the sources of these problems and how to cure them for current and future review processes.”

A 2022 audit of how the state sets goals for the number of homes different regions are expected to approve found errors in the process, which may have led regulators to underestimate the housing need in some areas and overestimate it in others. While the state completed some of the audit’s recommendations for calculating future housing goals, the review did not force any legislative reforms.

Ahead of the new audit, Glazer raised concerns that cities still waiting to get approval are now subject to penalties such as losing state funding, less time to complete mandatory zoning reforms and the dreaded “builder’s remedy,” which could force local officials to accept massive housing projects.

More than a year after California cities and counties were supposed to finalize their plans, many have yet to get state approval. Most are smaller cities that haven’t received much scrutiny on past plans.

Pleasanton Vice Mayor Julie Testa, a vocal critic of the state’s push to build, said 32 Bay Area jurisdictions without compliant plans are evidence of serious flaws in the review process. Testa said that before Pleasanton received approval last summer, it was sometimes difficult to get a timely response from reviewers. She said local planners were often left guessing how to meet the housing element requirements.

“It is absolutely a moving target,” Testa said.

Meanwhile, housing advocates said that as recent laws made the planning process more stringent, state and regional officials alerted cities about the new requirements while offering additional training and other resources.

“Many cities ignored it and just thought they were going to do the same thing they’ve always done,” said Mathew Reed, director of policy with the Silicon Valley pro-housing group SV@Home. He said a backlog of half-baked housing element drafts for regulators to review likely contributed to delayed review times.

For its part, the Department of Housing and Community Development said in a statement that it’s proud of its work to “ensure that communities plan for their fair share of housing.” It took credit for an increase in homebuilding in recent years, though high interest rates and other economic factors have since stalled new construction.

Every eight years since 1969, the department has required cities and counties to submit housing plans that describe how to accommodate a specific number of single-family homes, condos and apartments across a range of affordability levels. But during recent cycles, most jurisdictions haven’t come close to hitting their low- and middle-income housing goals.

To help reverse that trend, the state is now asking local officials to do much more meticulous planning to meet their latest housing targets, which in some cases are double that of the previous cycle. That includes proving sites identified for future homes have a realistic chance of development and providing specifics on programs to streamline the local permitting process.

In 2021, the state also created its Housing Accountability Unit to crack down on local officials skirting state housing laws and flouting the planning process. Last year, the unit and the state attorney general sued Huntington Beach for failing to develop a housing element. In March, a judge stripped the city of some of its authority to block new housing projects.

The newly approved audit is set to begin this fall, but it’s unclear when it could be finalized. A high-profile audit of the state’s homelessness spending released last month took more than a year to complete.