As Addiction Deaths Surge, Profit-Driven Rehab Industry Faces 'Severe Ethical Crisis' Many drug rehab programs use aggressive sales techniques, price-gouge patients and provide substandard care. The system often pushes people struggling with addiction into debt, but not recovery.

As Addiction Deaths Surge, Profit-Driven Rehab Industry Faces 'Severe Ethical Crisis'

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NOEL KING, HOST:

This country's addiction crisis is getting worse. Overdoses and deaths haven't gone down, even during the pandemic. A team of researchers found that a lot of rehab programs use aggressive sales tactics and charge high fees without actually providing proper medical care. Here's NPR addiction correspondent Brian Mann.

BRIAN MANN, BYLINE: Tamara Beetham, a researcher at Yale University, set out to answer a basic question - what happens when people suffering addiction try to get help? Her first step was to create an undercover identity.

TAMARA BEETHAM: A 26-year-old using heroine daily.

MANN: Using this fictional persona, members of Beetham's research team called more than 600 residential treatment programs all over the country.

BEETHAM: We'd kind of call and say, I'm looking to, you know, start treatment, and kind of go from there.

MANN: For people suffering addiction, this is a pivotal moment. More than 81,000 Americans died from drug overdoses last year. Studies show high-quality health care can make a big difference helping to keep people alive. So Beetham says what her team found was troubling.

BEETHAM: The people that we were talking to were generally not health care professionals, and so they would admit people without assessing the callers.

MANN: The people on the phone were salespeople trying to fill beds. Beetham says they regularly used aggressive marketing tactics to get credit card numbers, with for-profit programs charging more than twice as much as nonprofits. They also wanted a lot of cash up front, roughly $17,000 on average. Beetham's peer-reviewed study, published in the February issue of the journal Health Affairs, found many for-profit programs promised spa-like amenities, five-star chefs, massages and indoor pools, but they didn't provide the kind of medical treatment, like methadone or buprenorphine, proven to help people recover.

BEETHAM: We actually found less than a third of the programs offered medication maintenance treatment, which is the gold standard in treatment.

MANN: People who've navigated the rehab industry say they're not surprised by these findings. Ryan Hampton is an addiction activist who spent years trying to get help for his opioid use disorder.

RYAN HAMPTON: I think this Health Affairs study brings out what any of us who have been through this system have known for a very long time - not only is the treatment system broken; it's incredibly corrupt.

MANN: Experts interviewed by NPR say there are good rehab programs out there, but they can be hard to find. The industry's problems ballooned a decade ago when the Affordable Care Act required private insurance companies to cover addiction treatment. That reform is widely praised for saving lives as the opioid epidemic exploded, but according to Hampton, it also created a kind of gold rush as for-profit companies flooded in with little government oversight.

HAMPTON: You've got a highly unregulated addiction treatment industry on the greed side, and then you've got fear on the other hand, which are families and people who need help right away.

MANN: State regulations covering rehab programs vary widely, and there are no national standards for this kind of health care. Dr. Howard Samuels ran residential drug treatment programs in California until last year.

HOWARD SAMUELS: It's horrific. There isn't really any reform. You don't know what you're going to get because when you call the admissions of treatment centers, they'll tell you whatever you want to hear.

MANN: Samuels, who now works as a therapist treating individual patients, says his programs did provide high-quality care. But he acknowledges he was part of a profit-driven culture, regularly charging patients up to $60,000 a month.

SAMUELS: I'm one of the first people that created that. You have to seduce the client in by having nice accommodations. I mean, come on, you know what I mean?

MANN: There are efforts underway to reform the rehab industry. In 2019, a trade group called the National Association of Addiction Treatment Providers purged its membership and published a report describing, quote, "a severe ethical crisis" in addiction programs. A spokesman for the group, Peter Thomas, said this new study shows there's a lot of work still to be done.

PETER THOMAS: I do think that it's still a problem. Something that this article talks about - the hard sells, deceptive marketing practices, fraudulent billing.

MANN: Thomas says part of the problem is that addiction treatment has been marginalized in the medical field, which means patients in recovery rarely get the guidance and support they've come to expect for other life-threatening illnesses.

THOMAS: That you should get a referral from your primary care doctor - that has not happened because for so long, it was seen as a moral or personal failing.

MANN: Which means for now, most people suffering from addiction will navigate the rehab system alone, hoping the program they find offers real care.

Brian Mann, NPR News.

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