In Four States, Doctors Can Get Paid to Treat Meth Addiction. In Arizona, There Is No Treatment.

There is exactly one evidence-based intervention for methamphetamine use disorder with strong support from randomized controlled trials, and it is not a medication. Contingency management — a behavioral treatment that provides vouchers or modest cash payments for drug-free urine tests — has reduced methamphetamine use in 26 of the last 27 RCTs that studied it, according to a meta-analysis published by the National Health Law Program. The evidence is not subtle or recent. It has been accumulating for four decades.

The problem has always been who pays for it.

As of 2026, four states cover contingency management under Medicaid for stimulant use disorder: California, Montana, West Virginia, and Washington. California launched statewide coverage in July 2024 through a DHCS policy decision, enrolling more than 3,000 participants by the end of the year. The other three followed with their own frameworks in 2025. The Biden administration’s final rulemaking in January 2025 eliminated the federal regulatory barriers — primarily anti-kickback statute interpretations — that had prevented other states from implementing Medicaid CM at scale.

Arizona is not among the four. There are no FDA-approved medications for methamphetamine use disorder; the bupropion-naltrexone combination that showed modest results in a NEJM trial (reducing positive urine screens from 43 percent to 34 percent) remains off-label and unapproved after years in trials. The state’s AHCCCS program covers MAT for opioid use disorder and several evidence-based psychosocial treatments, but not contingency management. For a person in Arizona seeking evidence-based treatment for methamphetamine use disorder from a provider who can bill Medicaid, the options today are effectively none.

This matters right now because Arizona is one of the states moving against the national trend. ADHS data shows overdose deaths rose 17 to 20 percent year-over-year through 2025, against a national decline. Methamphetamine is the second leading cause of overdose death in the state after fentanyl — and the two substances are increasingly mixed: 12.5 percent of powder methamphetamine samples tested in Arizona contain fentanyl, according to surveillance data. A person using methamphetamine in Arizona is more likely to encounter fentanyl than they were two years ago, and less likely to have any reimbursable treatment available to them if they decide they want help.

The 46 states without Medicaid CM coverage are not refusing to act out of ignorance of the evidence. The barriers are structural: CM requires robust drug testing infrastructure and consistent clinical oversight, and the reimbursement frameworks for behavioral health services haven’t been designed with CM’s operational requirements in mind. The regulatory clearing the previous administration provided was the necessary precondition for expansion. Whether the current administration maintains that guidance — or whether additional states build the administrative infrastructure to implement it — will determine whether the treatment gap in Arizona and the other 45 states closes or persists.

In Arizona, today, the answer is: it persists.

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Arizona treatment access is tracked at /newsroom/category/arizona-watch. Stimulant treatment coverage at /newsroom/substances/stimulants.