The overdose epidemic in California has changed significantly in the last decade. While opioid overdose deaths dominate headlines, an increasing number of people in California are dying from stimulant overdoses, most commonly methamphetamine and cocaine. In 2020, the number of Californians who died from stimulants eclipsed those who died of an opioid overdose.

There are currently no Food and Drug Administration–approved medications to address stimulant use disorder, but contingency management is a proven, effective nonmedication approach. In contingency management, providers give patients positive rewards (including small amounts of cash) to reinforce their reduction of substance use.

Starting in summer 2023, California will become the first state in the nation to cover contingency management as a Medicaid benefit under CalAIM (California Advancing and Innovating Medi-Cal). Several counties participating in the Drug Medi-Cal Organized Delivery System will be part of Phase I of the contingency management pilot. San Francisco launched its contingency management program in July 2023; other counties are expected to follow soon.