Poor Practices Among Treatment Providers Create Barriers for Female OUD Patients

As the nation continues to hit record numbers of overdose deaths due to substance use disorder (SUD), women are enduring unpleasant experiences in scheduling appointments for opioid addiction treatment.

That’s according to a new qualitative analysis published in the journal Women’s Health Issues, which draws on more than 18,000 comments from secret shoppers who sought out treatment for opioid use disorder (OUD).

In just one example of the treatment these secret shoppers documented, one of the participants reported a receptionist telling her that, “People usually don’t show up to appointments because they decide they want to have one last hoorah on dope before coming.”


The analysis was part of a study conducted by the Vanderbilt University School of Medicine, in which researchers trained participants to act as secret shoppers seeking OUD treatment in 10 states. In seeking assistance, participants made over 28,000 calls to clinics and buprenorphine providers across Florida, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Tennessee, Virginia, Washington and West Virginia.

Buprenorphine is one of three medications — along with methadone and naltrexone — that have been approved for use by the U.S. Food and Drug Administration (FDA) to treat OUD.

The qualitative study — in which participants provided comments regarding their experiences trying to receive treatment — is a follow-up to a study researchers conducted last year using over 10,000 secret shoppers in 10 states. In that study, participants were randomly assigned as being pregnant or non-pregnant, with some also posing as either Medicaid enrollees or private insurance members.


The study revealed that participants posing as pregnant women were 20% less likely to receive an appointment than non-pregnant women. Participants disguised as enrollees of Medicaid — the joint state/federal insurance program for low-income individuals — also reported problems receiving assistance during the phone calls.

For the study’s new qualitative addendum, participants across the board reported negative experiences such as long call wait times as they were either put on hold or transferred repeatedly.

When participants were able to speak with someone for assistance, many reported less than pleasant experiences, such as the example of being told that “one last hurrah on dope” prevents many patients from showing up to their appointment.

The study comes as the nation has reached another grim milestone in the ongoing battle against SUD.

The Centers for Disease Control and Prevention (CDC) released provisional data Wednesday showing that over 93,000 Americans last year died from SUD overdoses. The number is a nearly 30% jump from 2019 and marks the largest number of SUD deaths on record.

Many of those deaths were the result of overdoses on opioids such as fentanyl. Opioid-related deaths in 2020 — combined with overdose deaths from drugs like methamphetamines — also rose from the prior year.

The study’s researchers said that medications for OUD can improve pregnancy outcomes for women and recommended more clinics be established to increase access for both them and low-income women. Researchers also called for more employee training of call takers at clinics along with policy reform at the national level to address OUD.

“We’re setting record levels of overdose deaths in the U.S., very likely worsened by the COVID-19 pandemic,” Stephen Patrick, MD, director of the Center for Child Health Policy at Vanderbilt University School of Medicine, said in a press release regarding the new qualitative analysis. “We know medications to treat opioid use disorder reduce the risk of overdose deaths for mom and increase the likelihood that the birth is going to go to term with a higher birth weight. We should make access to treatment easy, and certainly not harder.”