The Brief

Bernard Groves has spent five years trying to quit methamphetamine.

He lost his job. He lost his car. He nearly lost his apartment. Worse than that, he says, his addiction has hurt his family.

“I went [to lunch] with my auntie and I saw such sadness in her eyes,” Groves said.

The 35-year-old checked himself into several rehab programs in San Diego and San Francisco hoping "to be that Bernard I used to be for the people that I love."

But each time, Groves felt the progress he made in therapy morphed into people talking at him, telling him what to do. Eventually, he would always return to meth.

“My best friend was like, ‘I don't get it, Bernard. You put your mind to something, you've always been able to achieve it. Why can't you get over this meth?’ ” Groves said. “I don't know why. And it feels awful.”

Unlike opioid addiction, there are no FDA-approved medications for the more than 3 million Americans addicted to stimulants like meth and cocaine. Instead, the most effective treatment is low-tech — and more controversial: Give people retail gift cards usually worth less than $30 in exchange for negative drug tests. Research shows that it works, and after more than three decades of resistance, policymakers are finally giving that strategy a chance.

Bernard Groves (left) has been going to contingency management sessions with his counselor Andrew Dertien (right) since June to try to kick his meth addiction.

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‘This isn’t treatment’

Offering people small rewards for not using drugs — known as contingency management — dates back to the 1980s. Patients are tested for drugs regularly over several months. They receive a gift card for every negative result, and payouts grow with each test.

The treatment is based on a well-established concept that positive reinforcement is an effective motivator. Animals pull levers when rewarded with food. Students’ behavior improves by letting them watch TV after class. Compared to traditional counseling, researchers have found people are twice as likely to stop using meth or cocaine if they receive gift cards.

Studies suggest the immediate excitement of getting a gift card after a negative test replaces the dopamine rush people get from using drugs. Scientists hypothesize this activity effectively rewires our brains.

But the approach has failed to catch on in spite of the evidence.

Rick Rawson, a professor emeritus of psychology at UCLA and early proponent of contingency management, says many addiction care providers historically dismissed the treatment as a form of bribery.

“You would hear things like, this isn't treatment, this is just paying people not to use drugs,” Rawson said. “It wasn't a medicine. It wasn't talk therapy. It was this sort of transactional thing.”

Concerns of fraud have also stymied contingency management's growth. Rawson persuaded California health officials to fund a pilot program in 2005. But the work stopped abruptly after federal health officials warned participating clinics that the project ran afoul of rules designed to prevent doctors from luring patients into their offices and then charging Medicaid for care they never provided.

“I'd pretty much given up,” Rawson said after Medicaid shut down the pilot. “I figured this just isn't going to happen.”

Contingency management gets second chance

Outside of the Department of Veterans Affairs, which has offered contingency management since 2011, the treatment lay dormant for nearly a decade. But attitudes began to shift after the synthetic opioid fentanyl fueled a rise in overdose deaths in the U.S., Rawson said.

“People started to recognize that a lot of these people are buying cocaine or methamphetamine and dying of fentanyl overdoses because fentanyl is mixed into the drug supply,” said Rawson.

In the last four years, some states have relied on federal grants or court rulings against opioid manufacturers to fund their contingency management programs. In California — where overdose deaths involving meth have skyrocketed — health officials asked the federal government to allow the state to become the first in the nation to pay for contingency management with Medicaid dollars.

The Biden administration greenlit the plan along with a broader package of non-traditional health care services California is testing called CalAIM. Under the state’s contingency management program, which launched last year, gift cards after each stimulant-free urine test start at $10 and climb up to $26.50. A patient who tests negative every time over six months can earn up to $599, which can be paid out individually or in a lump sum.

It's unclear if that is enough money to persuade people to quit. Most studies show contingency management works best when patients can make upward of $1,000. California picked a lower amount to avoid triggering tax problems for patients or compromising their eligibility for other public benefits like food assistance.

The value of the gift cards have worked for Bernard Groves. He's been off meth since the first week of July, one of his longest stretches since he started trying to shake the habit.

He's used the gift cards to buy exercise weights at Walmart and food for his pet bird London at Petco. He's also used the money to pick up donuts or a movie night with his mom, sister and grandma.

“Being able to treat my family and do things for them is special,” Groves said. “It brought some joy back in my life.”

He’s surprised at how much pleasure he’s gotten from the program.

“Like, how could you say you're excited to pee in a cup? But I was, every week.”

Groves hopes this approach will help him finally kick his meth use. Recent studies have found people are more likely to stay off stimulants for up to a year after these programs, compared to counseling and 12-step programs.

California’s approach leaves some patients out

Nearly 4,000 people have participated in California’s new program as of September 2024. Researchers at UCLA say at least 75% of urine samples submitted by patients in the program have been negative for stimulants, and clinics say many of their patients have gotten into housing, gone back to work and reconnected with their families.

But California has an estimated 210,000 people on Medicaid who are addicted to meth or cocaine. Medicaid in California generally only covers addiction treatment through specialty addiction clinics, so most people who get their treatment from primary care doctors, community health clinics or hospitals are unable to access contingency management.

Ayesha Appa is an addiction specialist who runs an HIV clinic at San Francisco General Hospital, where most of her patients are homeless, using meth and on Medicaid. She offered contingency management through a private grant until funding ran out in June, and she’s ineligible to offer it through CalAIM.

“It feels both incredibly frustrating and just heartbreaking as a provider,” Appa said, to know a powerful treatment exists that she can’t offer. “It feels like I have a patient living with diabetes, and instead of being able to offer them insulin, all I can do is talk with them about diet and exercise, even though I know there’s a better option out there.”

She thinks often of one patient, a 45-year-old woman, who “desperately wanted to stop using” meth, but who struggled to quit. Appa urged her to visit a CalAIM clinic to get contingency management treatment, but the woman didn’t trust other doctors. Ultimately, the woman overdosed and died.

“What if we could have offered her contingency management in the clinic that she was coming into already?” Appa said. “When I think about her, it's an equal mix of guilt and regret because it truly felt like we could have done more.”

'People get better'

California Medicaid Director Tyler Sadwith believes in the power of this treatment, but has taken a careful approach as the state attempts to scale this work because of the stigma contingency management still has among some health providers and lawmakers.

Sadwith said he appreciates that more people could benefit right now, but starting small gives proponents their best chance of convincing state and federal leaders to extend and expand the program beyond its current end date of 2026.

“We need to prove that this works and that this works well,” Sadwith said. “We feel the importance and the weight of getting this right” as the first state in the nation to cover this sort of treatment under Medicaid.

To make sure programs deliver the treatment effectively and minimize the chance of fraud, California requires clinics go through extra training and inspections, and makes clinicians enter their results into a central database. Clinics also have to dedicate three staffers to the program, a workforce requirement that has forced some providers to delay starting the treatment or not participate at all.

So far, state officials have set aside $5.6 million to help clinics stand up their programs, and Sadwith is eager to reach more patients.

“We want to use this opportunity to prove to the public, to the field, to our federal partners, and to other states that this works,” Sadwith said. “People get better, and there is a role for contingency management in Medicaid.”

At least three other states — Montana, Washington and Delaware — are now running their own programs through Medicaid, and four others are seeking federal approval.

This story comes from the health policy news organization Tradeoffs. Ryan Levi is a reporter/producer for the show, where a version of this story first appeared. Listen to the story here:

Copyright 2024 TRADEOFFS

A Trump administration official on Friday signaled a potential rollback of the racial and ethnic categories approved for the 2030 census and other future federal government forms.

Supporters of those categories fear that any last-minute modifications to the U.S. government's standards for data about race and ethnicity could hurt the accuracy of census data and other future statistics used for redrawing voting districts, enforcing civil rights protections and guiding policymaking.

Those standards were last revised in 2024 during the Biden administration, after Census Bureau research and public discussion.

A White House agency at the time approved, among other changes, new checkboxes for "Middle Eastern or North African" and "Hispanic or Latino" under a reformatted question that asks survey participants: "What is your race and/or ethnicity?" The revisions also require the federal government to stop automatically categorizing people who identify with Middle Eastern or North African groups as white.

But at a Friday meeting of the Council of Professional Associations on Federal Statistics in Washington, D.C., the chief statistician within the White House's Office of Management and Budget revealed that the Trump administration has started a new review of those standards and how the 2024 revisions were approved.

"We're still at the very beginning of a review. And this, again, is not prejudging any particular outcome. I think we just wanted to be able to take a look at the process and decide where we wanted to end up on a number of these questions," said Mark Calabria. "I've certainly heard a wide range of views within the administration. So it's just premature to say where we'll end up."

OMB's press office did not immediately respond to NPR's request for comment.

Calabria's comments mark the first public confirmation that Trump officials are considering the possibility of not using the latest racial and ethnic category changes and other revisions. They come amid the administration's attack on diversity, equity and inclusion programs, a push to stop producing data that could protect the rights of transgender people and threats to the reliability of federal statistics.

In September, OMB said those Biden-era revisions "continue to be in effect" when it announced a six-month extension to the 2029 deadline for federal agencies to follow the new standards when collecting data on race and ethnicity.

Calabria said the delay gave agencies more time to implement the changes "while we review."

The first Trump administration stalled the process for revising the racial and ethnic data standards in time for the 2020 census.

The "Project 2025" policy agenda released by The Heritage Foundation, the conservative, D.C.-based think tank, called for a Republican administration to "thoroughly review any changes" to census race and ethnicity questions because of "concerns among conservatives that the data under Biden Administration proposals could be skewed to bolster progressive political agendas."

Advocates of the changes, however, see the new categories and other revisions as long-needed updates to better reflect people's identities.

"At stake is a more accurate and deeper understanding of the communities that comprise our country," says Meeta Anand, senior director of census and data equity at the Leadership Conference on Civil and Human Rights. "I am not concerned if it's reviewed in an honest attempt to understand what the process was. I am concerned if it's for a predetermined outcome that would be to ignore the entire process that was done in a very transparent manner."

Edited by Benjamin Swasey
Copyright 2025 NPR

A large black bear that was relocated earlier this year after being found under a house in Altadena is up to his old tricks again.

The bear, nicknamed Barry by the neighbors, was found last week under a different Altadena home, and wildlife officials are using a caramel- and cherry-scented lure to entice the roughly 550-pound male bear out of his hiding spot.

So far, they’ve been unsuccessful.

Cort Klopping, information specialist with the California Department of Fish and Wildlife, told LAist the bear seems to be spooked by increased activity around the home, including media crews outside and helicopters overhead.

“It seems as though in this case, this bear has found this poor guy's crawlspace as a comfortable, safe-seeming, warm enclosure for denning purposes,” he said.

He said the space is “somewhere for this bear to kind of hang its hat when it's relaxing.”

How the bear returned

Wildlife officials can tell it’s the same bear who was lured out from under an Altadena house after the Eaton Fire because of the tag number on his ear.

The bear was trapped and relocated about 10 miles away to the Angeles National Forest in January, but Klopping said he’s been back in the Altadena area for around five months.

The male bear after it was removed from under an Altadena home earlier this year.

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The bear spooked a SoCal Gas crew who stopped by for repairs after the Eaton Fire in January.

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The Department of Fish and Wildlife fitted the bear with a temporary GPS collar so officials could keep track of it. The collar came off a couple months later while the animal still was living in the forest.

The bear is believed to have been spotted around the home last Tuesday, Klopping said, and the owner reached out to wildlife officials a few days later for help.

“I’ve seen pictures of this bear, and I’m shocked to be under that house,” homeowner Ken Johnson told LAist media partner CBS LA.

Officials said they were hopeful the bear would move along on its own. They encouraged the homeowner to set up a camera on the crawlspace and line the area with ammonia soaked-rags or a motion-activated wildlife sprinkler system to deter the bear from returning, Klopping said.

“These are all actions that would not harm the bear, not harm people, but they would make it less comfortable for the bear to be there,” he said.

But the bear stayed put.

“Right now, it seems like it's stressed,” Klopping said. “It seems like it's scared, and therefore, it's not really wanting to leave the security of where it is at the moment.”

The hope ahead

A pair of wildlife officials stopped by the home Thursday to set up the sweet-smelling lure and camera so the department can keep an eye on the bear’s activity remotely.

Barry didn’t take the bait immediately, Klopping said, but officials are hopeful the animal will feel more comfortable leaving the crawlspace once activity around the home dies down a bit.

Klopping also is warning people in the area to secure access points on their property so the bear just doesn’t move in there next.

“If I were in that neighborhood, I would be doing everything in my power to make sure that my crawlspaces would not be accessible,” he said, including covering it with something stronger than the wire mesh the bear got through before.

Bears also are extremely food motivated, and Klopping said they can smell your leftover chicken in trash cans on the curb from 5 miles away.

He encouraged residents to be mindful of trash that could be an easy meal for wildlife, as well as pet food and hummingbird feeders, which Klopping said biologists have seen bears drink “like a soda.”

You can find tips on how to handle a bear in your backyard here and resources from the California Department of Fish and Wildlife here.

There’s a new way you can track pollution in your neighborhood.

The SoCal Clean Manufacturing Coalition, a climate advocacy group, has released a map with the locations of more than 1,800 fossil fuel-burning industrial boilers across Los Angeles, Orange, San Bernardino and Riverside counties. Many are at universities and hospitals, as well as some apartment complexes like the Park La Brea apartments in the Miracle Mile.

The map is part of an effort to push the South Coast Air Quality Management District, which regulates our air quality, to pass rules to require these large boilers to be phased out.

Why do these boilers matter?

Industrial boilers aren’t exactly the poster child of pollution, but they do play a role in Southern California. Boilers come in different sizes, and although there are electric types, many still burn fossil fuels to generate hot water, steam and, as a byproduct, nitrogen oxide.

South Coast AQMD says that makes it a source of pollutants. Nitrogen oxide contributors are not only a problem for smog and respiratory issues but also for the agency’s effort to meet federal air quality standards.

That’s why last year the agency approved new requirements for certain buildings to use zero-emission water heaters and boilers when they need replacement.

Teresa Cheng,  California director for Industrious Labs, a coalition member focused on creating cleaner industries, says these rules were for smaller “baby boilers” and that the coalition wants to see that applied to larger ones, which are covered under the agency’s 1146 and 1146.1 rule.

The push has caused concern in the gas industry. The California Fuels and Convenience Alliance, which represents small fuel retailers and industry suppliers, says boilers are essential in a wide range of manufacturing facilities that need high heat, like food processing, fuel production and more.

“CFCA is deeply concerned that requiring industrial facilities to abandon gas-fired boilers at the end of their useful life before the market is technologically or economically ready will still have severe consequences for manufacturers, workers and consumers,” the alliance said in a statement.

The organization says many facilities already have invested in “ultra-low” nitrogen oxide technology and that requiring a switch to zero-emissions equipment could destabilize the industry because of costs.

See the map

The map includes the number of boilers in each place, including how many aging units, and their permitted heating capacity. (That metric essentially correlates with how much pollution it can release.)

Cheng says the map is being shared to make the “invisible visible” so residents can know what’s around them. Most boilers are in communities that already deal with environmental pollution problems.

Boilers are even close to K-12 schools, like Glendale’s Herbert Hoover High School, which has its own.

“ These boilers have a very long lifeline,” she said. “If the air district doesn't pass zero-emissions rules for these boilers, we actually risk locking in decades more of pollution.”