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Lower-income people need more help getting ‘clean’

People with low incomes sometimes succumb to substance abuse simply because they feel hopeless, it has been said and written.

It turns out that if they do become addicts, it may be tougher for them to get the help they need.

Lower-income people often cannot afford the same level of health care as those with more resources. That is one reason why programs such as Medicaid were established, to ensure that even the poor are not denied medical treatment when they need it.

Still, disparities persist. Some health care providers complain the amounts they receive for treating Medicaid patients are not adequate. People with cash or private insurance often can and do pay more.

A new study indicates that in our state and other places hit hard by the drug abuse epidemic, those whose only way of paying for treatment is Medicaid may be shuttled to the back of the health care line, because of patients who have private insurance or can pay cash.

Conducted by the T.H. Chan School of Public Health at Harvard University, the study used the “secret shopper” technique. People posing as heroin users called 546 prescribers of the drug buprenorphine, which can be used to treat those suffering from what scientists call opioid use disorder.

Prescribers in West Virginia, Ohio, Maryland, Massachusetts, New Hampshire and the District of Columbia were called. Each prescriber was called twice — once by a “secret shopper” offering to pay cash and again by one claiming to be covered only by Medicaid. All said they were using heroin.

Researchers found, among other things, that 38 percent of callers offering to pay cash were told no appointment slots were available with buprenorhine prescribers. But the percentage went up to 46 for those who said they had Medicaid cards.

More research on the subject is needed, of course. But if low-income drug addicts are finding it more difficult than more well-to-do people to even obtain appointments for potential treatment, we have a problem. One way of dealing with it might be to increase Medicaid reimbursement for substance abuse treatment. The very poorer Americans who, we’re told, are more susceptible to drug abuse probably need more, not less, help getting “clean.”

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