AUDIE CORNISH, HOST:
In the last few years, when it comes to drug addiction in America, the focus has been largely on prescription pain pills and on synthetic opioids; say, fentanyl. But that is not America's only drug problem. In some places, it's not even the biggest.
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JENNY HANSSON: Federal and local police made their biggest meth bust in Oregon history last month.
CORNISH: This week, officials announced a record-breaking meth seizure in Eugene, Ore. - almost 400 pounds worth of methamphetamines worth more than a million dollars. And that story has been playing out in other parts of the country.
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WILLIAM JOY: It's the largest meth seizure ever in North Texas.
UNIDENTIFIED REPORTER: The largest methamphetamine seizure in Polk County history. Today...
SUZIE SUH: The biggest meth bust in U.S. history; nearly $20 million worth of drugs seized in the Inland Empire. But...
CORNISH: All that has happened in the last year in Texas, Florida and California. In San Diego County alone, new data shows last year, 722 people died with meth in their system, a 32% increase over the prior year. Now, weeks ago, the district attorney in San Diego, Summer Stephan, said the county is ground zero for the meth crisis.
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SUMMER STEPHAN: Fentanyl is getting a lot of attention for good reason. It is taking lives. But methamphetamine is still the No. 1 killer, and it is also the No. 1 driver of violence in our community.
CORNISH: CONSIDER THIS - meth is surging in America and hitting some marginalized communities the hardest. Now, one state is on the brink of adopting a bold new plan to fight it by paying people not to use.
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CORNISH: From NPR, I'm Audie Cornish. It's Wednesday, October 6.
It's CONSIDER THIS FROM NPR. Now, a quick heads up - we do mention suicide in today's episode.
Nationwide, meth-related overdoses nearly tripled - that's from 2015 to 2019. Last year in California alone, more people died from overdosing on stimulants like meth than opioids like fentanyl. And throughout the West, 70% of police agencies say meth is their biggest drug problem.
Almost a decade ago, it was Billy Lemon's biggest problem, too. He was living in San Francisco, where he wasn't just using meth, he was selling it across state lines.
BILLY LEMON: I would get bread bowls, and I would hollow them out. I would line the inside of the sourdough with meth and then cover it back up and shrink-wrap the bread and then send loaves of bread with some accoutrements from Fisherman's Wharf so it looked like a care package to people in Boston. And then they would literally send me 15-, $16,000 in 20s or hundreds via FedEx.
CORNISH: But Billy Lemon's addiction wasn't sustainable. He was arrested three times. He did some jail time. And eventually, he stopped selling meth. But he couldn't stop using. And at one point, he tried to take his own life.
LEMON: You know, there was a suicide attempt at Pier 23. It didn't happen that day.
CORNISH: A friend helped him get into a recovery center, and he walked in with nothing but the clothes on his back
LEMON: With zero money; literally zero money.
CORNISH: Not even a cellphone - days earlier, he'd chucked his in a trashcan near a park.
LEMON: Because I was - I had made the conscious decision to shut all those doors completely and open new ones at whatever cost and however hard that was going to be. And it was hard.
CORNISH: It was hard, but Lemon plugged in to the process. Group therapy, opening up, processing his past - he grabbed on to every tool he could to aid in his recovery.
LEMON: And so I was going to do rehab, and I was going to do two 12-step meetings a day, and I was going to do outpatient treatment at the same time.
CORNISH: There was one other thing Lemon tried. He went to the San Francisco AIDS Foundation, where they offered a recovery program that was strikingly simple. If Billy stayed off drugs, they would pay him. Three times a week, he came in, peed in a cup; negative test, seven bucks in his account. Now, paying users to stay off drugs is not a brand-new idea. It's also not without controversy. But for Lemon, it helped.
LEMON: For somebody who had not had any legitimate money without committing felonies, that seemed like a cool thing.
CORNISH: After three months, those payments would add up to $300.
LEMON: And so I was like, yes. Yes, I want that.
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CORNISH: Billy Lemon spoke to reporter April Dembosky of member station KQED, who reports on California's effort to take the program that helped him statewide.
APRIL DEMBOSKY, BYLINE: The treatment is called contingency management, and it incentivizes drug users with money or gift cards to stay off drugs. People can earn up to 3- or $400 over the course of three months. For Lemon, it was about more than just the money. It was about being told, good job.
LEMON: It was the first opportunity where I was like, I have self-worth still. It's buried. This person sees it and is willing to give me $7 just to take care of myself. That was very motivating.
DEMBOSKY: Studies show contingency management works. In the San Francisco program Billy Lemon did, 63% of participants stopped using meth entirely, and another 19% reduced their use. The small payments aim to rewire the brain's reward system so the person seeks the money or gift card to get a dopamine release instead of meth or coke.
LEMON: You're like, oh, oh, oh, I can feel good without the daily use of that substance. Let me try and go one more week. And then all of a sudden, you're at 90 days, and you've actually - you've made a change.
DEMBOSKY: But the treatment is controversial. Critics have scoffed at the idea of paying drug users not to use drugs, calling it unethical or a bribe. Most insurers don't cover it. Neither do state Medicaid programs. The feds generally forbid them from offering financial incentives to patients as a protection against fraud and waste. But a California bill now on the governor's desk would make clear that the state's Medicaid program is allowed to offer contingency management. State Senator Scott Wiener is the author.
SCOTT WIENER: We need to embrace this proven effective approach, make it clearly legal and start reimbursing for it.
DEMBOSKY: Wiener was surprised the bill passed with so much bipartisan support.
WIENER: The Republicans love it, which I didn't think they would. But they actually like it because there's an abstinence component to it, right? It's like, we pay you money, and you abstain from using.
DEMBOSKY: The state's Department of Health Care Services, which runs California's Medicaid program, is on board. They've already asked federal regulators for explicit permission to offer contingency management. And the Biden administration appears poised to grant it. Dr. Kelly Pfeifer is the department's deputy director of behavioral health. She says stimulant abuse is wreaking havoc on California's jails and courts, foster care and hospitals.
KELLY PFEIFER: Which are obviously not only devastating to the person and the family but very expensive for our health care system.
DEMBOSKY: Pfeifer says the need is urgent. For opioid addiction, there are three FDA-approved medication therapies, including methadone and buprenorphine. For meth and coke, there are none. And Pfeifer says making contingency management more widely available, it will make more people willing to seek treatment.
PFEIFER: Because people will see success stories. They'll see friends and family getting treatment and getting help and getting better.
DEMBOSKY: For Billy Lemon, contingency management was just what he needed to jump-start his recovery, to stay the course in rehab. When he got his $300, he bought himself a cellphone.
LEMON: Because up until then, "Breaking Bad-style" is burner phones, right? My number was never the same.
DEMBOSKY: Now, nine years later, he's still sober, and the number he got with the phone paid for with contingency management money is still his number.
LEMON: It's a nice reminder of what making good decisions for yourself can turn into.
DEMBOSKY: Five years ago, people were surprised by the idea of treating opioid addiction with other drugs, but now it's routine. And if more states join California and begin offering contingency management, maybe it won't seem so strange to pay drug users not to use.
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CORNISH: April Dembosky covers health care for NPR member station KQED in San Francisco. That story came to us from NPR's partnership with KQED and Kaiser Health News. Now, the surge in meth can be traced back almost a decade, and over that time, studies show that certain communities have been hit harder than others - in particular, some Native American and Black communities.
NPR's addiction correspondent Brian Mann has this look at what kind of help people in those communities say they need.
BRIAN MANN, BYLINE: This summer, Winnie White Tail surveyed a new group of tribal members entering the inpatient treatment clinic she runs for the Arapaho and Cheyenne community in Clinton, Okla. White Tail, herself a Cheyenne tribal member, says half were struggling with methamphetamine addiction.
WINNIE WHITE TAIL: I believe it's deeply entrenched across the community, not just in Native communities. It's readily available. It's easy to get.
MANN: A new study published in the journal JAMA Psychiatry finds high-risk use of methamphetamines has surged in recent years. One of the study's lead authors is Dr. Nora Volkow, who heads the National Institute on Drug Abuse. Volkow says Native American and Alaska Native communities are being hit especially hard.
NORA VOLKOW: The difference is gigantic. So this is a group that actually has had the greatest negative impact from the use of methamphetamine.
MANN: Volkow's study found methamphetamine use has surged in nearly every demographic. Far more women are using methamphetamines. There has been a nearly tenfold increase among Black Americans. She says it now appears roughly one-fifth of drug overdose deaths in the U.S. involve methamphetamines.
VOLKOW: And so this is huge, and it's basically almost equivalent in terms of the increase in overdose deaths that we're seeing for fentanyl and other synthetic opioids. So the magnitude of the problem is equivalent in terms of mortality.
MANN: Dr. Stephen Taylor has led an effort by the American Society of Addiction Medicine to improve addiction care for people of color. He says this study makes it clear - America's public health response needs to expand fast beyond the opioid crisis where he believes too much of the focus was on white communities.
STEPHEN TAYLOR: The prototypical people who have been suffering from opioid addiction and dying from overdoses involving opioids have been white people in smaller towns and rural communities.
MANN: Taylor says even before this study was published, drug counselors and researchers working in urban areas and Black, Hispanic and Native American communities knew methamphetamines were making dangerous inroads.
TAYLOR: Those communities have been confronting a massive increase in addictions to and overdose deaths from methamphetamine for a long time.
MANN: The Biden administration has asked Congress for another $10.7 billion to expand drug treatment programs, but reducing the harm caused by methamphetamines won't be easy. The drug is cheap and widely available and increasingly contaminated with fentanyl. There are no approved medical treatments for methamphetamine addiction as there are for opioids. Researchers say this data shows more high-quality treatment and counseling services are desperately needed, especially programs that work within local cultures. Winnie White Tail says that's what her programs do for the Arapaho and Cheyenne tribes, using community mentoring and traditional tribal practices along with Western drug treatment approaches.
WHITE TAIL: Oh, I'm hopeful every day. And I think the younger we can reach our young people, we can begin to turn this corner because a lot of our issues are around low self-esteem, poverty, depression.
MANN: There is a final grim warning in this new study. Researchers say their assessment of the devastating harm caused by methamphetamines may not reflect the full scope of the crisis. That's because they weren't able to survey people living in homeless camps and on the streets around the U.S., where high-risk drug use is known to be widespread.
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CORNISH: NPR's addiction correspondent Brian Mann. I want to offer special thanks to Brian for his help editing this episode and to April Dembosky at KQED for the story you heard earlier about Billy Lemon in San Francisco.
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CORNISH: It's CONSIDER THIS FROM NPR. I'm Audie Cornish.
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