A person holds a glass pipe used to smoke meth following the decriminalization of all drugs in downtown Portland, Oregon on January 25, 2024. Since hard drugs were decriminalised in Oregon three years ago, there are no arrests, just the fine and a card with a telephone number where the user can get help. In February 2021, possession and use of all drugs -- including cocaine, heroin, ecstasy and fentanyl -- was decriminalised in the western state. Sale and production remains punishable. (Photo by Patrick T. Fallon / AFP) (Photo by PATRICK T. FALLON/AFP via Getty Images)
Los Angeles, California – As methamphetamine overdoses continue to surge among unhoused residents, Los Angeles County has turned to a treatment strategy that’s gaining national traction—and raising eyebrows. Known as contingency management, the program offers cash-equivalent gift cards to participants who test negative for stimulant use, particularly methamphetamine, during weekly drug screenings. Participants can also earn rewards for reaching other goals, like attending medical appointments or signing up for public benefits.
The concept isn’t new. Contingency management has been studied for more than 30 years and is widely considered the most effective treatment available for stimulant use disorder. But until recently, it was rarely used in public health settings—especially not with unhoused populations. In 2023, California became the first state to receive federal approval to use Medicaid funds for such programs, and L.A. County soon followed suit with a locally funded initiative aimed at reducing overdose deaths and promoting long-term recovery.
The stakes are high. Methamphetamine remains one of the leading causes of overdose death among Los Angeles County’s unhoused population. A 2024 report from the L.A. County Department of Public Health and UC San Francisco found that one in three homeless Californians regularly uses meth. Unlike opioid addiction, which can be treated with medications like methadone or buprenorphine, there are no FDA-approved medications for stimulant use. That leaves service providers with few evidence-based tools—making contingency management all the more critical.
The county’s program operates in partnership with homeless service providers and is currently available at six shelters and drop-in centers, with plans to expand to more locations including MacArthur Park, Harbor City, and Santa Fe Springs. Participants can earn between $10 and $50 per week in Visa gift cards for staying off stimulants, with total potential earnings around $600 over a 13-week cycle. But passing every drug test isn’t required to stay enrolled. If a participant tests positive, they lose that week’s incentive but are encouraged to return and try again—no punishment, no eviction from the program.
That low-barrier, harm-reduction model is key to the program’s design. Service providers say the goal isn’t just sobriety—it’s engagement, stability, and trust. Behavioral health teams, operating from mobile vans equipped as mini-clinics, circulate through shelters and encampments, helping participants stay connected to care even when they relapse.
Critics have dismissed the model as bribery or enabling, but addiction specialists say that view ignores the evidence. A review of dozens of studies found that participants in contingency management programs were 22% more likely to be drug-free six months later compared to those receiving standard treatment. The American Society of Addiction Medicine now recommends contingency management as the standard of care for meth addiction.
While just 30% of participants complete the full cycle, county officials say even short-term engagement can reduce harm and help reconnect people to housing and support. With funding secured for at least another year, Los Angeles County is betting that meeting people where they are—and rewarding progress over perfection—may be the most pragmatic way forward.
