Posing as heroin users seeking help, researchers contacted hundreds of treatment clinics in US states with the highest overdose death rates. The “secret shoppers” were denied appointments much of the time, especially if they said they were insured through Medicaid.
The study revealed other roadblocks: high fees and a government Web site riddled with wrong telephone numbers.
Finding a doctor can be tough for anyone, but for those fighting addiction, motivation can be fleeting.
Every day without treatment can lead to a deadly overdose, said coauthor Michael Barnett of the 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 that was,” Barnett said. “Addiction makes doing tasks like that even harder.”
Families know the problems well, said Jessica Hulsey Nickel, founder of the advocacy group Addiction Policy Forum.
She called the Medicaid disparity “very concerning.”
Nearly four in 10 non-elderly 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 script that cast them as 30-year-old heroin users.
“I found it surprising how many calls I had to make before being offered an appointment,” said graduate student Tamara Beetham, who encountered both compassion and scolding from clinic staff.
“Whether you have cash in your pocket can determine whether you have access to life-saving treatment,” she said.
The study is to appear on Monday in Annals of Internal Medicine.
With nearly 48,000 annual US deaths involving opioids, researchers wanted to understand why more people are not treated with buprenorphine, an opioid-based medication available in doctor’s offices that can fend off withdrawal, without a euphoric high.
They rejected a conventional doctor survey.
“The front desk staff are the ones working the schedule every single hour. The best way to get the information that patients would get was to call ourselves,” Barnett said.
Callers tried reaching 546 prescribers with working numbers listed on a government Web site, which also included hundreds of outdated contacts.
They made calls last year to prescribers in Massachusetts, Ohio, Maryland, West Virginia, New Hampshire and the District of Columbia.
They were unable to reach schedulers for 77 of the prescribers after three tries.
If callers said they would pay cash, 38 percent were told no appointments were available.
However, 46 percent were denied appointments when they said they were on Medicaid.
The callers canceled any appointments they had made by the end of each call.
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