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…