The main goal of this study is to tests the effect of incentivizing achievement of self-identified, personal harm reduction goals (Contingency management or CM) compared with standard of care (peer harm reduction service with incentives for peer visits) to increase the reach and effectiveness of methamphetamine (MA) harm reduction services.

Using a hybrid type 1 effectiveness-implementation framework and stepped-wedge design, this study will randomize eighteen community-based peer harm reduction sites to provide contingency management incentives for achieving self-identified harm reduction goals set with peer specialists using a participant-driven harm reduction goal-setting process (e.g. completing overdose prevention and supply training, daily life goals, treatment and care goals, relationship and social support goals) versus standard of care contingency management (i.e. incentives for peer encounter attendance).

Inclusion Criteria:

This intervention is at the site level. Community-based organization sites are eligible if they:

• Use peer support specialists to provide direct outreach and harm reduction services to people who use drugs
• Are willing to be trained in the two strategies for peer-facilitated contingency management

Clients who:

• Age 18 and older
• Any stimulant (methamphetamine, cocaine) use in the past 30 days
• Willing to accept peer services
• Willing to complete initial and follow-up assessments with peer
• Able to communicate in English or Spanish

Exclusion Criteria:

Community-based organization sites who:

• Do not use peer support specialists to provide direct outreach and harm reduction services to people who use drugs
• Are not willing to be trained in the two strategies for peer-facilitated contingency management

Clients who:

• Present any danger or threat of violence to peers