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Presenting themselves as heroin users seeking help, the researchers contacted hundreds of treatment clinics in the US states that had the highest overdose mortality rates. "Secret buyers" were often denied appointments, especially if they claimed to be insured through Medicaid.
The study revealed other hurdles: high fees and a government website riddled with bad phone numbers.
Finding a doctor can be difficult for anyone. But for those struggling with addiction, motivation can be fleeting. Every day without treatment can lead to a deadly overdose, said co-author Dr. Michael Barnett of Harvard T.H. Chan School of Public Health.
"Think about the last time you had to make four or five phone calls in a row and how annoying it was," Barnett said. "Addiction makes it even more difficult for such tasks."
Families know the issues well, said Jessica Hulsey Nickel, founder of the lobbying group Addiction Policy Forum. She described the Medicaid disparity as "very worrying". Nearly 4 in 10 opioid-addicted older adults are covered by Medicaid, the federal and state insurance program for low-income patients.
Two researchers made the calls, following a scenario that used them as 30-year-old heroin users.
"I found amazing the number of calls I had to make before I was offered an appointment," said Tamara Beetham, a graduate student, who met compassion and reprimanded clinic staff. "If you have money in your pocket can determine if you have access to a treatment that saves lives." The study appears Monday in Annals of Internal Medicine.
With nearly 48,000 opioid-related deaths annually in the United States, researchers wanted to understand why more and more people are not being treated with buprenorphine, an opioid-based drug available in doctors' offices. doctor who can prevent weaning, without euphoric effect.
They rejected a survey of conventional doctors.
"It's the front desk employees who work hourly every hour. The best way to get the information the patients had was to call ourselves, "said Barnett.
The appellants tried to reach 546 prescribers with work numbers listed on a government website, which also contained hundreds of obsolete contacts.
In 2018, they phoned prescribers in Massachusetts, Ohio, Maryland, West Virginia, New Hampshire, and the District of Columbia.
They were unable to reach the planners for 77 prescribers after three trials.
If the callers said that they would pay in cash, 38% were informed that no appointments were available. But 46% were denied an appointment when they said they were on Medicaid. The callers canceled all the appointments made at the end of each call.
Nurse practitioners and medical assistants performed better than physicians participating in the study, accepting new patients with Medicaid in 70% of cases, versus 40% of physicians with similar patient loads.
Starting a buprenorphine treatment costs around $ 250 and can reach $ 500, with some clinics charging additional fees for lab tests.
When appointments were available, the wait was less than two weeks. This suggests that doctors have room in their schedule but are fleeing Medicaid as they pay less than other insurance.
Medicaid rules in some states make it more difficult to treat addiction, requiring counseling or requiring patients to discontinue other treatments before starting buprenorphine.
"These barriers should be eliminated," said Dr. Nora Volkow, director of the National Institute of Drug Abuse, which funded the study.
For now, people who want to get rid of opioids "need to bite their teeth and persevere" to make an appointment, said Barnett. "It takes a ton of patience."
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Follow Carla K. Johnson, AP Medical Site Editor on Twitter: @CarlaKJohnson
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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.
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