The Brief

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.

California is paying Medicaid enrollees who use meth, cocaine, and other amphetamines to stay sober. As part of the experiment, participants can earn up to $599 a year for submitting clean urine tests. A Nevada County nonprofit organization called Common Goals has enrolled more than a dozen people since launching its program early this year.

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Angela Hart

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KFF Health News

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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.”

Every week, the small payments from the Medi-Cal experiment feel like small wins, Coburn says.

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Angela Hart

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KFF Health News

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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.

The Los Angeles Lakers will unveil a statue of former coach Phil Jackson outside their downtown arena next year.

The Lakers announced the plan Tuesday to honor Jackson, who led the Lakers to five championships and seven NBA Finals appearances during two stints totaling 11 seasons as their head coach.

The statue will be unveiled April 9 before the Lakers’ home game against Minnesota.

After his famed tenure leading Michael Jordan’s Chicago Bulls to six championships, Jackson joined the Lakers in 1999 and immediately began another era of major success for the 17-time NBA champion franchise.

His first three teams in Los Angeles won championships behind the dynamic duo of Kobe Bryant and Shaquille O’Neal, and the Lakers added two more titles in 2009 and 2010 led by Bryant and Pau Gasol. His Lakers also made the NBA Finals in 2004 and 2008.

Jackson set the Lakers franchise record for coaches with 610 victories while leading his teams to the playoffs in every year of his tenure, which ended in 2011.

“Phil Jackson defines championship basketball for a reason,” Lakers governor Jeanie Buss said in a statement. “His masterful approach to coaching brought out the best in some of the greatest athletes to ever play the game. After he accepted my dad’s invitation to join the Lakers, Phil’s unmatched creativity and commitment to excellence restored our championship legacy, bringing five titles and setting a standard of excellence for generations to come. It is a great joy to be able to mark that achievement with the statue he so richly deserves.”

Jackson will be the ninth person associated with the Lakers to be honored with a statue in Star Plaza outside their arena. He joins Magic Johnson, Kareem Abdul-Jabbar, Jerry West, Elgin Baylor, Bryant, O’Neal, broadcaster Chick Hearn and former coach Pat Riley, whose statue was unveiled earlier this year.

Jackson’s 11 championships as a head coach are the most in NBA history. The North Dakota native and former New York Knicks forward is a member of the Basketball Hall of Fame.

Mayor Karen Bass is stepping down from the governing body for the L.A. region’s embattled lead homeless services agency, she told KFI last week.

The decision comes after LAist reported Bass skipped more than half the L.A. Homeless Services Authority Commission meetings held since appointing herself in 2023.

Details on the exit plans

Bass told KFI’s Gary and Shannon she’s leaving the LAHSA Commission, citing time constraints.

“I am going to be stepping down because I just — in terms of time and all,” Bass said in a live radio interview on Friday.

Bass’ office did not respond to interview requests and questions from LAist.

The backstory

LAist reporting found Bass missed 13 of the 21 LAHSA Commission meetings held over a recent year period, well above the four absence-threshold that can trigger potential removal under LAHSA’s bylaws.

Bass’ three-year term on the LAHSA Commission expired June 30, but she still remained on the commission as of Tuesday.

LAist reviewed three years of meeting records and found that Bass was among two sitting commissioners who had four or more absences over a single 12-month period.

L.A.’s mayor appoints half of the board’s members and Bass must appoint her replacement soon.

Paul Rubenstein, LAHSA's chief of staff, told LAist on Tuesday that Bass has not informed the agency that she will step down from the commission. Other members of the commission did not immediately respond to requests for comment.

What’s next?

LAHSA is a joint powers authority between the city and county, created three decades ago to manage the region’s response to homelessness.

The agency has come under scrutiny for alleged mismanagement of taxpayer dollars, including the Trump administration's attempt to suspend LAHSA.

In response to the agency’s documented dysfunction, L.A. County pulled most of its money from the agency and created its own homelessness department.

Bass now appears fed up with LAHSA and eager for the city to follow suit.

“I took the step of being on the commission so that I could learn much more and I could see what we needed to do,” Bass told KFI. “And I came to the conclusion that the city needs to have its own system.”