Acupuncture: A Solution In The Opioid Crisis
The Opioid Crisis
More than 30% of Americans have acute or chronic pain, and among older adults, 40% have chronic pain (Volkow & McLellan, 2016). Opioids are the most commonly prescribed medication for both acute and chronic pain (Volkow & McLellan, 2016). Approximately 20% of patients receive an opioid prescription, and in 2012 there were 259 million prescriptions for opioids written, which amounts to one bottle for every adult in the United States (Centers for Disease Control and Prevention [CDC], 2016).
However, opioid medications are highly addictive, leading to development of tolerance and physical dependence. This has led to abusers substituting with lethal non-medical (heroin) or synthetic (fentanyl) opioids. In 2015, there were reported to be 50,000 drug-overdose deaths, with 63% involving opioids (The Council of Economic Advisors, 2017). It has been reported that “opioid drug abuse has killed more Americans than the Iraq, Afganistan and Vietnam wars combined” (Goldberg, 2017). This number has been increasing at an alarming rate, doubling in the past 10 years, and quadrupling in the past 16 years (The Council of Economic Advisors, 2017). In 2016, an estimated 2.1 million people were reported to have an opioid addiction (Substance Abuse and Mental Health Services Administration, 2017).
Public Policy Response
In 2017, the President declared a nation-wide public health emergency under the Public Health Services Act. Due to the rising rates of abuse and addiction, physicians and medical associations are questioning opioid prescription practices. Many physicians admit they are not confident on how to prescribe safely or how to detect abuse or addiction (Volkow & McLellan, 2016). The CDC released new guidelines to address 1) when to use opioids, 2) opioid prescription practices (selection, dosage, duration, discontinuation), 3) assessing risk and addressing harms of opioid use (CDC, 2016).
The Joint Commission also released new pain assessment and management standards in 2017. The Leadership clause LD.04.03.13 requires Joint Commission accredited hospitals to provide non-pharmacologic pain treatment modalities as a complimentary approach for pain management to potentially reduce the need for opioid medications (The Joint Commission, 2017). The treatment strategies mentioned include acupuncture, chiropractic therapy, osteopathic manipulative treatments, massage, physical therapy, relaxation therapy, and cognitive behavioral therapy (The Joint Commission, 2017).
Similarly, the CDC also now recommend non-pharmacological interventions for pain as an alternative to drug therapy (CDC, n.d.). In addition, the Provision of Care, Treatment and Services clause PC.01.02.07 requires hospitals to develop a patient-centered approach to pain management, which incorporates patient involvement in treatment strategy through assessed needs, collaboration towards pain management goals, and education on pain management, treatment options, and the safe use of opioid and non-opioid medications (The Joint Commission, 2017).
Acupuncture has been shown to be the most evidence-based, cost-effective modality in the treatment and management of pain and is at the forefront of non-pharmacologic therapies available to decrease opioid dependence (Fan et al., 2017). Early literature in the British Medical Journal indicates that acupuncture has been shown to release opiate-like peptides, producing an analgesic effect (British Medical Journal, 1981). More recent research with imaging techniques also indicates that acupuncture with mechanical stimulation of the needle produce neural signaling influencing opioid peptide, glutamate and adenosine levels and affecting the central nervous system (Yang, Li, Nilius, & Li, 2011). A systematic review of previous research indicates that acupuncture improves post-operative pain and reduces opioid use (Wu et al., 2016).
Traditional Chinese Medicine including herbs and acupuncture have been used for the treatment of drug addiction for over 200 years, and there are currently ten Chinese medicines for the treatment of opiate addiction approved by the Chinese State Food and Drug Administration, with at least 6 in clinical trials (Shi, Liu, Fang, Gu, Zhai, & Lu, 2006). Benefits of using TCM for opiate detoxification include less harmful side effects, and they have also been shown to rehabilitate impaired body function induced by chronic drug use, including improving immune function, memory and neurological function (Shi et al., 2006).
In the face of changing national views and health policies regarding opioid medication, acupuncture stands to provide an effective solution not only to reduce opioid consumption with the treatment of pain, but to treat and prevent the increasing rates of addiction, abuse and mortality as well.
Dr. Erin Lee, DACM, L.Ac. is a doctor of Acupuncture & Chinese Medicine, licensed acupuncturist and board certified Chinese herbalist. She obtained her Doctoral degree and Master of Science degree in Traditional Oriental Medicine from the Pacific College of Oriental Medicine in New York. Previous experience includes working with cancer patients at Mount Sinai Beth Israel Integrative Oncology Center, acute stroke and long-term rehabilitative care at NYU Lutheran Neurological & Orthopedic Rehabilitation, Housing Works (HIV/AIDS), Columbia Health Medical Center and Bronx Lebanon Hospital Center. Residing and practicing in New York City, Dr. Lee specializes in neurofunctional acupuncture for the treatment of musculoskeletal pain and dysfunction.
Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report (MMWR). (2016, March). Retrieved from https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Centers for Disease Control and Prevention (CDC). (n.d.). Opioid Overdose.Retrieved from https://www.cdc.gov/drugoverdose/patients/options.html
Fan, A.Y., Miller, D.W., Bolash, B., Bauer, M., McDonald, J., Faggert, S., . . . Pang, J. (2017, November). Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017. https://www.ncbi.nlm.nih.gov/pubmed/29103410
Goldberg, B. (2017, November). Opioid abuse crisis takes heavy toll on U.S. veterans. Retrieved from https://www.reuters.com/article/us-usa-veterans-opioids/opioid-abuse-crisis-takes-heavy-toll-on-u-s-veterans-idUSKBN1DA1B2
How does acupuncture work? (1981). British Medical Journal (Clinical Research Ed.), 283(6294), 746–747.
Shi, J., Liu, Y.L., Fang, Y.X., Xu, G.Z., Zhai, H.F., & Lu, L. (2006, October). Traditional Chinese medicine in treatment of opiate addiction. https://www.ncbi.nlm.nih.gov/pubmed/17007736
Substance Abuse and Mental Health Services Administration. (2017, September). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/report/key-substance-use-and-mental-health-indicators-united-states-results-2016-national-survey
The Council of Economic Advisors. (2017, November). The Underestimated Cost of the Opioid Crisis. Retrieved from https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The Underestimated Cost of the Opioid Crisis.pdf
The Joint Commission. (2017, August). R3 Report | Requirement, Rationale, Reference (Publication No. 11). Retrieved from https://www.jointcommission.org/assets/1/18/R3_Report_Issue_11_Pain_Assessment_8_25_17_FINAL.pdf
Volkow, N.D., & McLellan, A.T. (2016). Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. New England Journal of Medicine,374(13), 1253-1263. doi:10.1056/nejmra1507771
Wu, M.S., Chen, K.H., Chen, I.F., Huang, S.K., Tzeng, P.C., Yeh, M.L., . . . Chen, C. (2016, March). The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. https://www.ncbi.nlm.nih.gov/pubmed/26959661
Yang, E.S., Li, P.W., Nilius, B., & Li, G. (2011, November). Ancient Chinese medicine and mechanistic evidence of acupuncture physiology. https://www.ncbi.nlm.nih.gov/pubmed/21870056