ByÂ Deborah Rothman
In recent months, there has been extensive media coverage on the current opioid epidemic in the U.S. The trend of even short-term opioid usage can have the tragic effect of causing addiction. Addiction is a devastating problem we are facing in our communities. The record-high number of teenagers and young adults overdosing is devastating. The move towards a holistic approach, away from opioids, is becoming more prevalent within the medical field.
On February 14, the American College of Physicians released new clinical guidelines (Qaseem, Wilt, McLean, & Forciea, 2017). The new guidelines are based on a systematic review of randomized control trials regarding treatment for both acute and chronic lower-back pain. The guidelines gave strong recommendations that all physicians move away from pharmacological treatment, and instead make recommendations for non-pharmacological, noninvasive holistic treatment including acupuncture and other multidisciplinary treatments. It further stated that opioids should only be used as a last resort if all other intervention has failed.
The trials reviewed NSAIDs, acetaminophen, corticosteroid, opioids (including morphine and others), and benzodiazepine for pain relief. The evidence base showed that the previous guidelines of pharmaceutical intervention were insignificant. The new guidelines based upon the clinical trials showed significant improvement with acupuncture and other modalities. The new guidelines make further points in recommending that clinicians go a step further and guide their patients to avoid pharmaceutical intervention, which does not have a proven effect on pain relief and whose tendencies towards addiction are too great a risk. This is a huge change in the focus of medical intervention, and a big milestone for acupuncture and holistic medicine overall.
According to an article published in the New York Times (Goodnough & Tavernise, 2016) opioid prescriptions have dropped for the first time in two decades. Doctors are heeding the constant warnings of the link between opioids for painkillers and addiction. The article demonstrated that some medical practitioners were ahead of the time. They recognized the extreme danger of overprescribing opioids for pain prior to the release of the new clinical guidelines referenced previously. OxyContin in particular showed a sustained drop. Federal guidelines tightened prescribing rules for hydrocodone in 2014. Physicians are now recognizing that even a small amount of opioids for pain management for a patient is “rolling the dice on whether the patient will become addicted.”
NSAID overuse is something we are seeing a lot of now as well. When patients fill out their initial intake forms, they may not even include them in the section asking for current medications. Patients mistakenly believe that over-the-counter medications and supplements are not true medications. A recent article shows a link between NSAID and cardiac arrest (Torjesen, 2017). This article reviewed nationwide clinical trials done in England and reviewed by the European Heart Journal. The trial results found that frequent use of NSAIDs should be avoided by patients at risk for cardiovascular disease, and the general population overall. Long-term use increased cardiovascular incident by an alarming 31%.
The opioid epidemic is not limited to those we previously deemed “users” or “addicts.” The most frightening finding is that addiction can be linked to even short-term opioid use. An article published earlier this month (Mole, 2017) references the effect of a 10-day supply of opioids. The misconception was that only long-term opioid use put the patient at risk for addiction. It has now been proven that while long-term use has a higher risk, the transition to addiction can occur in a matter of days. According to the CDC, it is estimated that within the U.S., 91 people die of opioid overdose daily. This number is staggering.
The role of acupuncture in the midst of the opioid crisis is of key importance. As referenced in an article in Forbes, “Acupuncture has the potential to reduce or even in some cases eliminate the need for opioids while also helping to treat opioid addiction.” It can do this by using the body’s own chemistry to stimulate synapses to naturally release the pain-relieving hormones without pharmacological intervention–risk-free! (Utley, 2016) The Joint Acupuncture Opioid Task Force, Acupuncture Now Foundation, and American Society of Acupuncturists identify the release of endorphins, including dopamine and serotonin, for pain relief. This has a direct effect on both the physical pain and emotional wellbeing of the patient.
Furthermore, the NADA protocol of the National Acupuncture Detoxification Association, established in 1985, is utilized all across the U.S. and the UK. The World Health Organization recommends acupuncture and the NADA protocol as an accepted alternative therapy for addiction. In yet another recent article expressing the importance of acupuncture relative to addiction, Dr. Helene Langevin stated, “You have temporary pain relief with opiates, but the underlying problem is still there. Whereas in a technique like acupuncture, there’s at least the potential for helping people actually heal” (Masterson, 2017).
We must avoid opiates at all costs. The risk is simply too great. Utilizing non-pharmaceutical holistic intervention is essential. This is a work in progress. Physicians and patients must join forces to avoid unnecessary prescribing of opioids. We owe it to ourselves, our children, and future generations to do our part to stop the opioid epidemic in its tracks. Addiction is real and it has painful consequences to the individuals and families that are unimaginable. We must strive toward a holistic approach for physical pain relief and emotional balance.Â v
- Goodnough & S. Tavernise (2016), Opioid Prescriptions Drop for First Time in Two Decades. The New York Times. Page A1.
- Masterson K. (2017), “Can Acupuncture Offer Pain Relief and Reduce Opioid Use? Vermont funds Medicaid Study. VPR
- Mole (2017), With a 10-day supply of opioids, 1 in 5 become long-term users. Scientific Method.
- Qaseem, T. Wilt, R. McLean, M. Forciea (2017), Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine.
- Torjesen (2017), NSAID Use Linked with Increased Risk of Cardiac Arrest. Onmedica.
- Utley, (2016), The Role of Acupuncture in the Midst of the Opioid Crisis. Forbes.
Deborah Rothman is a licensed acupuncturist and a Diplomate of Acupuncture with a private practice in Woodmere. Comments and questions are welcome. She can be reached at 516-203-4500 or deborah@AcuZen.com. Please visit www.AcuZen.com and follow Acuâ€‘Zen on Facebook.