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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. "Dependency makes it even more difficult to accomplish tasks of this type."
Families know the issues well, said Jessica Hulsey Nickel, founder of the lobbying group Addiction Policy Forum. She called the Medicaid disparity "very worrying". Nearly 4 out of 10 older adults with opioid addiction 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 graduate student Tamara Beetham, who met at the conference. times compassion and reprimand the staff of the clinic. "Knowing if you have money in your pocket can determine if you have access to life-saving treatment." 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. doctors that helps prevent weaning, without euphoric effect.
They rejected a survey of conventional doctors.
"The front desk staff is the one who works out the schedule every hour.The best way to get the information that patients could get was to call us 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. Callers canceled all appointments made successfully 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 hurdles need to be removed," said Dr. Nora Volkow, director of the National Institute for Combating 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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