Acupuncture new weapon in fighting US opioid crisis

AP
Acupuncture is increasingly being embraced by patients and doctors, sometimes as an alternative to the powerful painkillers behind the US opioid crisis.
AP

Marine veteran Jeff Harris was among the first to sign up when the Providence VA hospital started offering acupuncture for chronic pain.

“I don’t like taking pain medication. I don’t like the way it makes me feel,” he said. Harris also didn’t want to risk getting addicted to heavy-duty prescription painkillers.

Although still questioned by some medical experts, acupuncture is increasingly being embraced by patients and doctors, sometimes as an alternative to the powerful painkillers behind the nation’s opioid crisis.

The military and Veterans Affairs medical system has been offering acupuncture for pain for several years, some insurance companies cover it and now a small but growing number of Medicaid programs in states hit hard by opioid overdoses have started providing it for low-income patients.

“We have a really serious problem here,” said Dr Mary Applegate, medical director for Ohio’s Medicaid department. “If it’s proven to be effective, we don’t want to have barriers in the way of what could work.”

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David Ramsey, a Medicaid patient who suffers from chronic pain after falling off a cliff in 2011, receives acupuncture treatment in Warrensville Heights, Ohio.

The epidemic was triggered by an explosion in prescriptions of powerful painkiller pills, though many of the recent overdose opioid deaths are attributed to heroin and illicit fentanyl. Many opioid addictions begin with patients in pain seeking help, and acupuncture is increasingly seen as a way to help keep some patients from ever having to go on opioids in the first place.

For a long time in the US, acupuncture was considered unstudied and unproven. While there’s now been a lot of research on acupuncture for different types of pain, the quality of the studies has been mixed, and so have the results.

Federal research evaluators say there’s some good evidence acupuncture can help some patients manage some forms of pain. But they also have described the benefits of acupuncture as modest, and say more research is needed.

Among doctors, there remains lively debate over how much of any benefit can be attributed simply to patients’ belief that the treatment is working — the so-called “placebo effect.”

“There may be a certain amount of placebo effect. Having said that, it is still quite effective as compared to no treatment,” said Dr Ankit Maheshwari, a pain medicine specialist at Case Western Reserve University.

Many doctors are ambivalent about acupuncture but still willing to let patients give it a try, said Dr Steven Novella, a neurologist at Yale University and editor of an alternative medicine-bashing website. 

Acupuncture has been practiced in China for thousands of years. Practitioners say needles applied at just the right spots can restore the flow of energy — called “qi” — through the body.

In government surveys, one in 67 US adults say they get acupuncture every year, up from one in 91 a decade earlier.

The largest federal government insurance program, Medicare, does not pay for acupuncture. Tricare, the insurance program for active duty and retired military personnel and their families, does not pay for it either. But VA facilities offer it, charging no more than a co-pay.

Jeff Harris signed up for acupuncture two years ago. The 50-year-old Marine Corp veteran said he injured his back while rappelling and had other hard falls during his training in the 1980s. Today, he has shooting pain down his legs and deadness of feeling in his feet.

Acupuncture “helped settle my nerve pain down,” said Harris. Another vet, Harry Garcia, 46, tried acupuncture for his chronic back pain after years of heavy pain medications.

Acupuncture is “just like an eraser. It just takes everything away” for a brief period, and keeps pain down for up to 10 days, said Garcia.

About a decade ago, the military and Veteran Affairs began promoting a range of alternative approaches to pain treatment, including acupuncture, yoga and chiropractic care.

In 2009, former Army Surgeon General Dr Eric Schoomaker chartered a task force to re-evaluate the Army’s approach to pain, which had centered on opioids. The focus was understandable — “nobody who has his leg blown off screams for acupuncture,” said Schoomaker, who is now a professor at the Uniformed Services University of the Health Sciences, a military medical school.

But he added there was also openness to acupuncture and other approaches among soldiers and sailors who, while overseas, had tried non-drug approaches for chronic pain. Now two-thirds of military hospitals and other treatment centers offer acupuncture.

The military’s openness to alternatives is “because the need is so great there,” said Emmeline Edwards of the National Center for Complementary and Integrative Health, a federal scientific research agency. “They’re more willing to try an approach and see if it works.”

Her agency is teaming up the Pentagon and the VA to spend US$81 million on research projects to study the effectiveness of a variety of non-drug approaches to treating chronic pain.

And insurance coverage of acupuncture keeps expanding. California, Massachusetts, Oregon and Rhode Island pay for acupuncture for pain through Medicaid. Massachusetts and Oregon also cover acupuncture for substance abuse.


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