An intriguing experiment in drug treatment is quietly unfolding in the Bay Area. The idea? Rewarding methamphetamine users who get clean with gift cards to Burger King, Walmart and other stores.
Drug treatment providers in four Bay Area counties have tried the approach since the first local program started in San Jose a year ago as part of a statewide pilot. About 300 users of meth and other stimulants have participated so far and received a combined $23,500 for passing regularly scheduled drug tests. Hundreds more in the region are expected to give it a shot this year.
Here’s how it works: Participants earn gift card money each time they pass a drug test on a set schedule, once or twice a week. They can stop at any time — but that also means they stop earning rewards.
The idea, though it may seem controversial to some, is rooted in decades of scientific research showing that rewards and encouragement help stimulant users enter recovery more effectively than conventional treatments alone, including therapy. In 2021, a bill to expand access to this form of treatment passed the California Legislature with no opposition in either chamber.
It’s notoriously difficult to treat meth addictions, and relapse rates are very high. But in this tough climate, cash and prizes have been shown to have a lasting benefit.
“This is easily the most effective treatment for people with stimulant use disorder,” said Wesley Saver, policy director for the San Francisco-based drug treatment nonprofit HealthRight 360. “It’s phenomenal.”
The nonprofit started its gift card program a year ago in an office on Tully Road in San Jose. About 50 people have enrolled so far, Saver said. Of those, 13 are working their way through the program, and nine have completed the 24-week course.
The nonprofit Our Common Ground runs a nearly identical program in neighboring San Mateo County. Of the 28 people who enrolled at some point since July, only eight had dropped out early as of mid-February, the nonprofit’s data shows.
Like much of the U.S., California has a meth problem. About 5,170 people fatally overdosed on meth or another stimulant in California during a 12-month period ending in October 2024, narrowly trailing the death rate of fentanyl and other opioids. It’s also very common for people to use opioids and meth at the same time and die from a combination of the two. Overdose rates have recently fallen in the Bay Area.
Compared to fentanyl users, though, meth users have fewer treatment options.
Medications such as buprenorphine are extremely effective at reducing opioid overdose risk and smothering cravings. Currently, California public health experts are trying to improve access in hospitals, prisons and jails. But no such medication exists for people addicted to meth or cocaine.
Jonathan Krawetz was one of the first people in the Bay Area to try the new gift card program. Last year, staff asked him if he wanted to enroll while living at Our Common Ground’s supportive housing facility in Redwood City.
Krawetz, 51, entered recovery from meth and other drugs more than a year ago, he said. The gift card program was a piece of that success. He completed all 24 weeks and earned the maximum payout, which he used to buy his nieces Halloween costumes from Walmart and then birthday gifts from Marshalls.
California became the first state in the U.S. to gain approval from the federal government to pay for the treatment strategy with Medicaid funds. That federal approval lasts through 2026. The state Department of Health Care Services pays for the gift cards and sets strict standards for the programs.
“I want to stay sober,” Krawetz said. “This not only reinforces that but gives me incentive to do it.”
He plans to find a sober residence to call home and continue making pottery at a local studio. It’s impressive progress from just a few years ago when he went from living in a lean-to in a San Jose park to jail. He was beyond help, he said.
“I’m bipolar, and I’m an addict,” Krawetz said. “And when I use drugs, I go homeless. I’m just crazy. I’m not normally like that.”
Chris Morales, operations director at Our Common Ground, said participants are broadly enjoying the program, and it’s a cost-effective way to supplement other conventional treatments.
Untreated meth addictions routinely land users in expensive emergency rooms or jails. In Santa Clara County, where Krawetz was incarcerated for five months, it costs more than $106,000 to jail someone for a year.
“There are far more tax dollars spent on someone actively in addiction,” Morales said.
But because relapse is “more the rule than the exception,” and meth users tend to lead unstable lives, Morales said that success in the gift card program doesn’t necessarily mean that someone completes the 24 weeks of drug testing.
“If it works for some, it’s a good thing,” he said. “The more tools, the merrier.”
One hard measure of success, though, is the number of urine tests that come back clean.
In San Jose, HealthRight 360 staff have conducted 740 drug tests on program participants since February 2024. Of those, 94% showed negative results for meth or other stimulants, according to Saver.
That figure is even higher, 96%, in Alameda County.
Drug treatment providers in 20 other California counties have rolled out gift card programs in the last two years, including in Contra Costa County and San Francisco, as part of a pilot program.
Statewide, about 4,260 stimulant users receiving Medi-Cal benefits enrolled in a gift card program in 2024, according to the state Department of Health Care Services.
At first glance, the data looked so promising that it made him suspicious, said Thomas Freese, a clinical psychologist and director of integrated substance abuse programs at UCLA.
“Is it really as positive as it seems?” he said. “And it seems that it is.”
In the Bay Area, it’s too soon to say if the gift cards will help meth users stay in recovery for long. In 2021, a scientific meta-analysis of the treatment by researchers found that it’s effective for at least a year.