In the heart of San Francisco's bustling city hall, a pivotal discussion unfolded regarding the future of substance abuse treatment in the county. The meeting, held on July 4, 2025, focused on the introduction of a new pilot program called "Cash Not Drugs," aimed at providing innovative support for low-income individuals struggling with substance use disorders.

Deputy Director for Policy Planning and Public Affairs at the Human Services Agency, outlined the program's framework, emphasizing its connection to the recently passed Proposition F. This legislation mandates that recipients of the County Assistance Program (CAP) engage in treatment if a substance use disorder is suspected. Currently, approximately 5,500 low-income single adults benefit from CAP, which offers cash assistance and support, contingent upon their participation in mandated activities such as job training or educational programs.

The "Cash Not Drugs" initiative is designed to integrate contingency management strategies into existing treatment options, providing financial incentives for individuals to remain drug-free. This approach has garnered support from various stakeholders, including health experts and community organizations, who recognize the urgent need for effective solutions in light of rising overdose deaths, particularly from methamphetamine.

Gary McCoy, Vice President for Policy and Public Affairs at HealthRight 360, highlighted the program's potential impact, citing decades of research that demonstrate the effectiveness of contingency management in promoting positive behavioral changes. He stressed the importance of timely implementation, given the alarming statistics surrounding substance use in the city.

The Budget Legislative Analyst's Office provided a cost analysis for the program, estimating annual expenses ranging from $220,000 to $1.2 million, depending on the number of participants and the duration of treatment. However, funding remains a critical concern, as the program currently lacks a dedicated budget line. Discussions are ongoing about potential funding sources, including the general fund and Medi-Cal reimbursements.

As the meeting progressed, community voices echoed the importance of this initiative. Billy Lemon Walters, Executive Director of the Castro Country Club, shared his personal journey of recovery and the transformative role that contingency management played in his life. His testimony underscored the program's potential to provide hope and tangible support for those seeking to overcome addiction.

With a six-month implementation planning period ahead, city officials and health experts are poised to collaborate on refining the program's design and ensuring it aligns with best practices. The outcome of this initiative could not only reshape the landscape of substance abuse treatment in San Francisco but also serve as a model for other cities grappling with similar challenges. As the meeting concluded, the sense of urgency and hope lingered in the air, leaving attendees eager to see how this innovative approach would unfold in the coming months.