When William Lester Jr. He decided to get to the 12-week program to solve drug use, he said that he weighed only 68 pounds. Seattle, Wash. The resident has used heroin for 35 years, and recently also methamphetamine.
He knew that something had to change when he was admitted to the hospital due to kidney failure.
“I wasn't ready to stop for years until one day I said,” I finished, I can't do it anymore, “said Lester, who lives in a supporting apartment in Seattle.
He considers his employee to be placed on the path of the emergency management program – which rewards abstinence from stimulants such as methamphetamine or cocaine, with gift cards.
Gift cards twice a week
The program that works in the United States, including California, Montana and Washington, asks participants to give a urine sample and perform a quick test to see if they use drugs or not in the last few days.
The patient receives a prize for every negative test. In Washington and Plymouth Housing in Seattle, where Lester lives, this award has the form of gift cards.
“It's a bit unusual because it works that it is a procedure in which a person enters and usually has a really positive, fun interaction with the clinicist,” said Michael McDonnell, a professor at the Faculty of Community and Behavioral Health in Elson S. Floyd College of Medicine on Washington State University.
“If he shows that the person has not used (stimulants) in the last few days, they have a really great celebration and give this person a gift card,” explained McDonnell.
For each negative urine sample, which happens twice a week, the patient receives a 12 USD gift card. And the amount gradually increases with each negative test. Participants can receive a maximum of USD 599 per calendar year.
If the patient will positively check the medication, he will not be thrown out of the program. Instead, their gift card amount decreases and must build in a queue.
Gift cards can be used to buy groceries, clothes and even electronics.
Emergency management has decades of evidence confirming his success According to McDonnell, to help people stop or reduce stimulating drugs.
The program is managed from clinics, except for Seattle, where it operates outside Plymouth Housing, a constant supporting non-profit organization for people struggling with long-term homelessness. There, 40 people have been following the program for over a year.
In Plymouth, the goal is to transfer the program to people instead of going to the outpatient clinic.
According to Aaliyah Bains, a manager of the behavioral health program at Plymouth Housing, it is big.
“It was not easy to simply remove from clinical scenery and push into housing,” he recalls. But it works.
“In fact, we have higher participation indicators and higher completion rates than in clinical conditions,” said Bains, referring to preliminary data.
Another difference is that in Plymouth he is an employee supporting a peer who comes to a resident unit, which means that he is seen by someone who has experienced addiction himself.
“I was in AA, in many such things, but you see, I can't refer to anyone who was not where I was,” said Lester, adding that he was a support employee in his housing unit who got him to join the program .
Participation in this was not always easy. Lester says he thought he could cheat the system, but he was surprised that he could stick to him.
“I stopped (using drugs) thanks to the program.”
Along with the growing discussion on involuntary drug treatment in Canada, Julia Wong from CBC goes to Washington to learn about Ricky's law and challenges related to forcing people to rehabilitation.
A approach based on evidence
Most evidence for emergency management comes from decades of veterans' research.
The US Veteran Department has implemented the program in 2011. But attitudes – such as watching prizes as bribes – slowed down its use for the general public.
Things changed when the overdose epidemic became a crisis of public health.
California was the first state that included emergency management within Medicaid and “in order to assess the effectiveness of large -scale treatment”, according to the California Health Department.
In 2021, the states of Montana and Washington began to use the program on a large scale to use stimulants.
In Washington, 24 clinics offer a 12-week program. According to McDonnell, preliminary results show that out of over 200 participants about 70 percent and a reduction in their use of stimulants was observed.
Information in the morning – Fredericton14:40Meth clinical examination
This is the largest clinical trial in the world about the use of methamphetamine, and participation in Fredericton will take part in Fredericton. J Eanne Armstrong talked to Dr. Sara Davidson. https://www.cbc.ca/news/canada/new-brunswick/fredericton-river-stone-stone-tial-meth-1.7230339 (https://www.cbc.ca/news/canada/new-brunswick/ Fredericton-River-Stone-Centre-Prial-1.7230339)
British Colombia also has several emergency management programs, although very limited.
“This is an important part of the continuum of the care of the use of the substance,” said a spokesman for the Ministry of Health in a statement.
BC programs are run by Vancouver Coastal Health and Fraser Health and contain a 12-week group counseling program provided by AIDS Vancouver. Most of them focus on using stimulants.
The need for effective treatment programs has become more urgent in recent years when the toxic crisis has deteriorated.
Although Fentanyl and other opioids have been on the headlines since 2016 in Canada and North America as a whole, stimulants are also present in the growing part of overdose deaths. In Canada, stimulants were found next to opioids in 64 percent of deaths with a toxic drug in 2024.
In the same year, 52 % of infestation reports were detected in BC cocaine, and methamphetamine was found in 43 percent.
The new report states that after the start of Covid-19 pandemic, overdose deaths in Ontario from many substances exceeded deaths from one substance.
Bains claims that unforeseen management gives people a chance to succeed.
“There are so many programs or nothing, you must be 100 % sober or you will not succeed. It is simply not what emergency management is. “
Bains also witnessed the pride of some of the 40 participants of the Plymouth annual pilot project.
“I saw how it changes people. It gives them the opportunity to have $ 20 a week for someone who has no income, changes life. “
Patients had a better chance of ending
Although you might think that financial prizes would not work so well for more wealthy patients, McDonnell claims that they turned out to be a strong encouragement regardless of income.
“I have doctors, lawyers and other people who are very well -compensated financially, but really desperately desperately ceases to use their substances … and are motivated by the idea that they are rewarded,” explained the researcher.
If anything, then people will do badly in the emergency management program.
“It is less likely that they will complete the program because they have so many other things they are dealing with,” said McDonnell. He added that they could rely on stimulants so as not to fall asleep for safety.
“It is dangerous to be homeless: someone can come and steal your things, you can be attacked,” said McDonnell.
According to Lester, being in Plymouth for six years made you more likely to say that.
Despite the fact that he is low income, he says that incentives were less important than the process of accounting and make someone believe in his success.
“I could say that I feel better now than ever all my life,” he said proudly.