Opioids and Prescription drug abuse and addiction is a significant problem in the United States. In fact, the U.S. Department of Health and Human Services (HHS) has declared it an epidemic.
Researchers estimate that as many as 36 million people worldwide abuse opioids. Estimates in the U.S. alone reached 2.1 million people in 2012. In 2014, six out of ten drug overdose deaths involved an opioid � including prescription opioids for pain relief.
Every day, 78 Americans die from an opioid overdose. As the Opioid drug problem continues to spiral further out of control, claiming more lives, people are looking for safer, drug free ways to relieve their pain. Chiropractic offers such an option.
What Are Opioids?
Opioids are prescription medications that are intended for pain relief. They work by diminishing the intensity level of pain signals as they reach the brain. They also affect the areas of the brain that control emotion thereby weakening the perception of the pain as well. There are several very popular medications that are classified as opioids:
Hydrocodone (Vicodin)
Oxycodone (Percocet, OxyContin)
Morphine (Avinza, Kadian)
Codeine
The most commonly prescribed opioids are hydrocodone products. They are used to treat pain from injuries, dental work, and typically moderate pain. Milder pain is often treated with codeine but it is also used to treat coughing as well as severe diarrhea. Overall, opioids are used to treat everything from cancer pain to post-op pain to osteoarthritis.
What Are The Dangers Of Opioids?
Opioids have a serious risk of abuse, addiction, and overdose. Even then they are taken as prescribed, opioids can have the following side effects:
Excessive sleepiness
Nausea
Dry mouth
Vomiting
Confusion
Dizziness
Depression
Constipation
Low energy
Sweating
Low testosterone levels that result in a diminished sex drive
Itching
Decreased strength
Increased pain sensitivity
Over time, the body can build up a tolerance to the drug which means that in order to achieve the same relief from pain they must take more of it. Physical dependence is also a concern, usually going hand in hand with tolerance. Once that point is reached the patient will experience symptoms of withdrawal if they stop taking the medication.
If Doctors Are Prescribing Opioids, How Are People becoming Addicted?
In 2013, doctors wrote almost a quarter of a billion prescriptions for opioids. To put that into perspective, that is enough for every adult in the U.S. to have their own bottle of the drug. Doctors prescribe opioids to their patients in an effort to treat pain, but most of the time it is just a band aid. Instead of seeking out the root of the problem and educating their patients on whole body wellness, they prescribe pills that numb the senses, cause unpleasant or even dangerous side effects, and create addictions.
As the patient develops a tolerance for the drug, the doctor increases the prescription. This cycle continues as the patient become more and more dependent upon the drug. They may even experience more pain as the drug increases their pain sensitivity. As patients become addicted, the number of prescription opioid overdose deaths is steadily increasing. The most common drugs involved in these overdose deaths include:
Hydrocodone (Vicodin)
Oxycodone (OxyContin)
Methadone
States are putting measures in place to monitor and regulate how doctors prescribe opiates, but when desperate, addicted patients will go to great lengths to obtain the drugs they are addicted to. They will go to different doctors to get additional prescriptions or even find ways to obtain the drug illegally. It is a heartbreaking problem that is completely preventable.
How Is Chiropractic A Safer Alternative To Opioids?
Chiropractic is a proven method for managing pain relief that is not only effective but safe and drug free. Numerous chiropractic studies confirm what chiropractic patients have been saying for decades: chiropractic care is an excellent pain management method. The spinal adjustments bring the body into balance but that is only the beginning of the benefits. Chiropractic focuses on whole body wellness so patients learn how to take proactive steps to treat their condition.
It also seeks to find the root of the problem and begin healing by treating the cause. Through exercise, diet, and lifestyle recommendations in addition to the chiropractic adjustments, patients can get relief from pain caused by injury, surgery, arthritis, and many other conditions. Chiropractic is so much more than a back pain treatment; it is a whole body, whole patient treatment.
Chiropractor, Dr. Alexander Jimenez�Finds Prescription Painkillers Most Common Treatment for Patients Seeking Care for Back Pain More than half of Americans suffer from back pain, as well as for those that seek treatment, doctors turn most often to prescription drugs
Ann Arbor, MI, May 19, 2017 � Many Americans (51 percent) have experienced back pain in the last 12 months, and of the 58% of those who sought treatment from a medical professional, 40 percent said they were recommended prescription painkillers, according to the Truven Health Analytics-NPR Health Poll.
Truven Health Analytics�, element of the IBM Watson Health business, and NPR run a national poll that is bimonthly to gauge opinions and attitudes on a broad variety of health�issues.
Following Are The Poll�s Findings:
Back Pain Plagues�Americans: Fifty one percent of Americans said they’ve endured from back pain in the last 12 months, and 46 percent of people who experienced pain said they are still in distress. Over half (58 percent) of back pain sufferers sought attention, with 70 percent visiting a medical doctor and 14 percent seeing a chiropractor.
Prescription Pain Killers are the Most Common Treatment: Of the 70 percent of back pain sufferers who sought care from a medical doctor, 40 percent were prescribed prescription pain killers, a rate that tended to decrease with increasing age of the patient. Other treatments prescribed were exercise/physical therapy (31 percent), shots (20 percent), massage (17 percent), steroids (17 percent), over-the-counter painkillers (13 percent), operation (12 percent), or another form of treatment (37 percent).
Almost a Third Stay in Pain with Treatment: Among all respondents, 25 percent said their back pain remained the same and five percent said their pain got worse. Forty-five percent said their pain improved, and 25 percent said it went away entirely.
�Experiencing back pain is extremely common among Americans, and there are a number of factors that may contribute to it, some of which are treatable without prescription pain killers, � said Anil Jain, MD, Vice-President and Chief Health Informatics Officer, Value-Based Care, IBM Watson Health. �These data reveal that when care is sought by the patients, they are generally prescribed painkillers. Compounding this challenge, back pain sufferers that are prescribed opioids for pain may be particularly at risk for dependency and addiction. Checking inappropriate opioid prescriptions for long-term pain is a focus of efforts by suppliers to fight the current opioid epidemic.�
To date, the Truven Health Analytics-NPR Health Survey has investigated numerous health topics, including vaccines generic drugs, data privacy, narcotic painkillers, and sports-related concussions. NPR archives reports on the surveys online in the Photos health blog here. Truven Health keeps a library of survey results here.
The Truven Health Analytics-NPR Health Poll is powered by the Truven Health PULSE� survey, an independently funded, nationally representative, multimodal poll that collects information about health-related behaviours and approaches and healthcare use from 80, 000 U.S. homes annually.
The results represent responses from 3, 002 survey participants interviewed from March 1 � 16 , 2017. The margin of error is /- 1.8 percentage points.
About NPR
NPR is an award winning, multimedia news organization and an influential force in American life. In collaboration with more than 900 independent public radio stations nationwide, NPR strives to generate a more educated public�one challenged and invigorated by way of a deeper understanding and grasp of ideas, events and cultures.
About Truven Health Analytics, section of the IBM Watson Health Company
Truven Health Analytics�, a part of the IBM Watson Health� company, supplies market-leading performance development solutions built on advanced analytics, data integrity and domain expertise. For over 40 years, our insights and alternatives have already been providing hospitals and clinicians, employers and health plans, state and government services, life sciences companies and policymakers, the facts they must make confident choices that directly alter the health and well-being of people and organizations in america and around the world. The firm was acquired by IBM in 2016 to help form a new business, Watson Health. Watson Health aspires to improve lives and give expectation by presenting innovation to deal with the world�s most pressing health challenges through cognitive insights and data.
Doctor of Chiropractic, Dr. Alexander Jimenez examines people that see�a chiropractor and their reduced�usage of opioids and other types of drugs.
The draft Guidance for Prescribing Opioids for Chronic Pain, issued in December 2015 by the U.S. Centers for Disease Control and Prevention, included �many complementary and alternative therapies (e.g., manipulation, massage, and acupuncture)� among its recommended non-pharmacologic approaches. However, when the final Guidance was released three months later, manipulative therapy and its 75,000 licensed chiropractic practitioners was not directly referenced. A recent study from James �Jim� Whedon, DC, MS, pictured, suggests that the CDC harmed its mission with its excision of explicit reference to manipulation. Patients using chiropractors were less likely to use prescription opioids.
Whedon is currently a researcher at the Southern California University of Health Sciences, and is co-chair of the Research Working Group of the Academic Collaborative for Integrative Health. He is a relatively rare resource in the integrative health community, as a specialist in diving into huge data sets of insurers and seeking to extract useful information. Whedon is a veteran of arguably the most important research center in this type of work, The Dartmouth Institute at the Geisel Medical School at Dartmouth College.
Whedon�s research began with awareness that �little is known about the comparative effectiveness of non-pharmacological care for low back pain as a strategy for reducing the use of opioid analgesics.� What is well known, as Whedon shared in his poster and presentation at the 2016 conference of the Academy of Integrative Health and Medicine, is that patients with such pain are swimming in opioid prescriptions. Whedon�s presentation included a Baskin-Robbins-like list of 39 opioid varieties. He postulated that opioid use would be less likely among those receiving chiropractic care.
Association Between Utilization Of Chiropractic For Back Pain & Use Of Prescription Opioids
Preliminary results of a health claims study,� Whedon reports what he found through examining the New Hampshire All Payer Claims Database.� Of roughly 33,000 adults registered as having low back pain, slightly over a third saw a chiropractor. Of these, 38 percent had at least one opioid prescription. Of those who did not see a chiropractor, 61 percent had at least one opioid prescription.
The core question that interested Whedon was how many prescription fills the two sets of insured patients received. Those whose opioid prescription was integrated with chiropractic care had an average of 3.9 fills. Those who did not receive chiropractic manipulative therapy averaged 8.3 fills per patient. He estimated that the average per person opioid charges were $88 for those using chiropractors. The figure was $140, or 60 percent higher for those not using chiropractic care.
Whedon�s conclusions were, first, that the likelihood of filling a prescription for a high-risk drug of any type was 27 percent lower. Secondly, the likelihood of filling a prescription for an opioid analgesic was 57 percent lower in the chiropractic-using population.
�These are preliminary results,� Whedon cautioned. �We intend to analyze the data further, applying robust methods to reduce the risk of bias that can result from other differences between people who use chiropractic care and those who do not.�
Comment: While Whedon takes care to note that �no causal inferences can be made,� the associations should be of real interest to the CDC and other policy makers. A follow-up study might attempt to compare the whole costs of the chiropractic-using population and those who didn�t.� These costs could include, on the one hand, the cost of chiropractic treatment, and on the other, the costs of other medications or treatment that may be prescribed for those on longer-term opioid treatment who may end up cycling into the addiction.
Seizing on the opioid epidemic as a chance to expand their reach, naturopaths and chiropractors�are aggressively lobbying Congress and state governments to elevate the role of�alternative therapies�in treating chronic pain. They�ve scored several victories in recent months, and hope the Trump administration will give them a further boost.
Their Most Powerful Argument: We Don�t Prescribe Addictive Pain Pills
Shunning pharmaceuticals, they treat pain with everything from acupuncture to massage to castor oil ointments. They offer herbal supplements and homeopathic pills.
There�s little rigorous scientific research to back up such treatments. Yet patients often say they feel relief. And providers say their alternative approaches are vitally needed at a time when more than 30,000 people a year die of opioid overdose in the US alone � and half of those deaths involve a prescription painkiller, according to the Centers for Disease Control and Prevention.
�I am surprised that with the crisis where it is today, more people aren�t picking up on alternative treatments,� said John Falardeau, a senior vice president with the American Chiropractic Association.
Chiropractors scored a big victory recently in Oregon, where the state Medicaid program decided to cover spinal adjustment for lower back pain starting in 2016. Vermont, Virginia, and Nevada are considering similar moves.
Another win came earlier this year, when the American College of Physicians recommended non-surgical interventions such as acupuncture, yoga, and chiropractic care as the go-to treatments for lower back pain.
�The American College of Physicians is our new best friend,� said Robert Hayden, a Georgia chiropractor and spokesperson for the�American Chiropractic Association. Hayden said the the industry considers the decision �a direct result of the fact that we are in an opioid crisis in this country.�
Hoping For Help From The Trump Administration
Hoping to make even more inroads, both naturopaths and chiropractors are lobbying Congress to push the Veterans Affairs health system to hire alternative providers. Chiropractors are also pushing for a role in the National Health Service Corps, which puts providers to work in community health centers, often in rural areas.
And this month, naturopaths will descend on Washington, D.C., for a meeting all about chronic pain. �Naturopathic doctors are poised to be the leaders in combating the opioid epidemic,� the promotional materials claim.
The pain workshops will be followed by a three-day conference to set a lobbying agenda and teach naturopaths organizing techniques.
The American Association of Naturopathic Physicians clearly sees an opening to make gains: The arrival of the Trump administration and a new, Republican-controlled Congress �opens up new opportunities for AANP to push for insurance non-discrimination, to have [naturopaths] included in the VA, and to emphasize that naturopathic care is a much-needed alternative to opioids for the treatment of chronic pain,� the AANP website declares.
Chiropractors, too, are hopeful. President Trump has talked about giving more Americans access to flexible spending accounts�for health care. That, they say, will make it easier for�consumers to pay for treatments that insurance doesn�t cover � like chiropractic care.
�I think they see an opening. Whether it actually works or not is secondary. It�s basically an opening for them to try to claim some legitimacy.�
Dr. David Gorksi, surgical oncologist
Some mainstream doctors � who often range from skeptical to fiercely critical of alternative medicine � are wary. They worry that naturopaths or chiropractors might persuade patients with serious diseases to shun conventional medical care. And they point out that some herbal treatments interact badly with chemotherapy or other pharmaceuticals.
Other skeptics dismiss the push to claim a role in treating pain as a public relations ploy.
�I think they see an opening,� said Dr. David Gorski, a surgical oncologist and an editor of the blog Science-Based Medicine. �Whether it actually works or not is secondary. It�s basically an opening for them to try to claim some legitimacy.�
He finds it particularly galling that alternative providers often mix sound advice on diet and exercise, drawn from mainstream medicine, with fringe therapies that have no evidence behind them, like homeopathy pills. �It becomes hard for the average person to figure out what is and it isn�t quackery,� he said.
But other doctors are cautiously embracing the idea of new ways to treat chronic pain. They say if alternative remedies help � even if only through a placebo effect � patients may be able to avoid addictive pills.
Helping Patients Gain Control Over Their Pain
Emily Telfair, a naturopath in Maryland, said she often sees chronic pain patients who feel frustrated that conventional treatments haven�t worked to treat their pain. Or those patients haven�t been able to tolerate the tough side effects of pain medication. They come to her hoping for relief.
�That�s the place where naturopathic medicine shines. It offers another option for folks who haven�t found help,� Telfair said.
Telfair uses massage therapy, including a specific type of treatment known as craniosacral massage. She also sends patients home with castor oil packs and topical creams to apply to their pain points, all of which she said are noninvasive ways �to invite the body to heal and let go of the chronic symptom.�
�It offers another option for folks who haven�t found help.�
Emily Teflair, naturopath
She said her job isn�t always to cure a patient�s pain � it�s to help patients see that their pain won�t always be unrelenting and oppressive, and to help them gain control.
�Knowing their pain can be different from one day to the next, that is a very powerful tool,� she said. �I know I can�t help everybody with chronic pain. But you [can] change the person�s relationship to their pain.�
That�s been the case for 70-year-old James Fite, who has had both hips replaced and now needs a shoulder replaced. He�s hesitant to have the surgery because of his chronic pain.
�It�s always there. Sometimes it�s just blinding, excruciating,� he said. But he�s found relief with an acupuncturist and naturopathic care from Telfair.
He uses roll-on castor oil, sticks to an anti-inflammatory diet, and also receives massage therapy. Other times, he takes opioids. Fite said he has had 15 providers trying to treat aspects of his pain. He feels his acupuncturist and Telfair are the most �tuned in� to his body�s condition.
�None of these things are cure-alls for a chronic condition like mine,� he said. �But I�ve gotten as much help from them as from anybody.�
With various combinations of treatments, Fite said he�s more able to manage his pain than he has been before. He�s found the energy to teach chess after school twice a week at a nearby library and can spend more time playing with his grandkids.
Other naturopaths said they see their goal as finding and addressing the root cause of a patient�s pain. And they argue they have more time than a medical doctor to do that.
�It�s not as simple as a replacement for an opioid. We treat the cause of the pain. We don�t just mask it with a painkiller,� said Michelle Brannick, a naturopathic provider in Illinois who markets her services specifically to pain patients. Brannick relies on homeopathic arnica and herbal supplements, among other treatments.
A Cautious Approach From Physicians
Taxpayers subsidize roughly $120 million a year in federal grants to research alternative medicine through the National Institutes of Health.
Even after all that research, Dr. Josephine Briggs, the director of the NIH�s National Center for Complementary and Integrative Health, said she is aware there isn�t much robust evidence to support many alternative pain therapies.
�We can�t call this a slam dunk. This is not a situation where we�ve got an easy answer for a tough clinical problem,� she said.
But she pointed out that many alternative remedies are fairly low-risk. And some physicians are opening their minds up to the idea � with caveats.
�As a physician, I would never just say, �You have pain, so we�re going to just put you on pain medicine,�� said Dr. Andrew Esch, a clinician and consultant with the Center to Advance Palliative Care in New York.
Doctors stress that pain can vary wildly from one patient to the next, and treatments won�t be the same for every patient, either. �Sometimes that�s physical therapy and Motrin, sometimes it�s acupuncture and antidepressants,� said Esch.
Dr. Charles von Gunten, a palliative care specialist at OhioHealth, agreed alternative therapies like acupuncture and massage can be part of a doctor�s toolkit.
�They�re not either-or types of approaches,� he explained.
�As a physician, I would never just say, �You have pain, so we�re going to just put you on pain medicine.��
Dr. Andrew Esch, palliative care expert
But doctors also are leery of sending cancer patients or others with serious illnesses to a naturopathic provider who might convince them to go off of chemotherapy or forgo conventional medical care.
�That�s certainly a concern,� said Briggs. There�s also concern that homeopathic remedies like St. John�s wort will interfere with a patient�s prescribed medication and make those drugs less effective. Encouraging pain patients to experiment with alternative treatments might open the door to those risks.
But Esch said he doesn�t see those concerns as a reason for doctors to dismiss naturopathic approaches that their chronic pain patients are interested in trying. Most patients he sees are using some sort of alternative treatment � and many will continue to do so whether doctors like it or not, he said.
�If someone is going to take shark cartilage because they think it will make their pain better, my approach is not to immediately say no,� he said.
Instead, he scours the evidence, the side effects, and the potential drug interactions that might put a patient at risk. If it seems safe for a patient to try, he gives them the green light and checks back regularly to see if it�s helping.
�It�s part of the responsibility of physicians to know what people are taking and not dismiss it, because it�s our job to know they�re going to do it safely,� he said.
One State Weighs The Costs Of Treating Pain
Many dietary supplements � which don�t have to go through a regulatory review for safety or efficacy before hitting the market � are relatively cheap: Shoppers can snag 60 homeopathic arnica tablets off a drugstore shelf for less than $10.
But other alternative therapies can be costly: Craniosacral massage and acupuncture, for instance, can each run over $100 for an hourlong session, and patients may need multiple visits each month.
The Oregon Health Plan, which is the state version of Medicaid, weighed those expenses when deciding whether to cover chiropractic adjustment for lower back pain.
The chiropractic care costs more than would for a short course of opioids � a single vertebrae adjustment can cost around $65. But health officials are hopeful that they�ll save money in the long run by reducing the number of people addicted to opioids.
�We�re trying to offer up some of these treatment options from the beginning, with the goal of trying to reduce the transition from acute pain to chronic pain,� said Denise Taray, who coordinates the Oregon Pain Management Commission.
That commission spearheaded the research into what treatments should be covered and ultimately recommended that state Medicaid cover chiropractic care. They�re now looking at alternative medicine treatments for other pain conditions, such as fibromyalgia.
�We�re all focused on the opioid epidemic and managing prescribing,� said Taray. �The part that still seems to be falling through the cracks is the patient perspective and the treatment and the care of pain.�
When Prince reached out to Dr. Howard Kornfeld, a California-based chronic pain and addiction specialist, Kornfeld wasn�t immediately available to go see him. Instead, the doctor put his son Andrew on a plane to Minnesota to deliver the singer�s buprenorphine, a drug used to treat opioid addiction.
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