Acupuncture gains acceptance amid opioid crisis
U.S. military, some states offer to pay for treatment
PROVIDENCE, R.I.— Marine veteran Jeff Harris was among the first to sign up when the Providence Veterans Administration hospital started offering acupuncture for chronic pain.
“I don’t like taking pain medication. I don’t like the way it makes me feel,” Harris said, adding that he also didn’t want to risk getting addicted to heavy-duty prescription painkillers.
Although long derided as pseudoscience and still questioned by many 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 lowincome patients.
Ohio’s Medicaid program recently expanded its coverage after an opioid task force urged state officials to explore alternative pain therapies.
“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.”
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 United States, acupuncture was considered unstudied and unproven. While there has been a lot of research on acupuncture, the quality of the studies has been mixed — and so have the results.
Federal research evaluators say there is 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.
A lively debate remains among doctors over how much of any benefit can be attributed simply to patients’ belief that the treatment is working.
“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, who sees it as valuable for neck pain, migraines and a few other types of pain problems.
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. He considers acupuncture a form of patientfooling theatre.
Acupuncturists and their proponents are “exploiting the opioid crisis to try to promote acupuncture as an alternative treatment,” he said. “But promoting a treatment that doesn’t work is not going to help the crisis.”
Acupuncture has been practised in China for thousands of years, and customarily involves inserting thin metal needles into specific points in the ears or other parts the body. Practitioners say needles applied at just the right spots can restore the flow of a mystical energy through the body, and that can spur natural healing and pain relief.
In U.S. government surveys, one in 67 adults say they get acupuncture every year, up from one in 91a decade earlier. That growth has taken place even though most patients pay for it themselves.
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 copay.
Harris signed up for acupuncture two years ago. The 50-year-old Marine veteran said he injured his back while rappelling and had other hard falls during training in the1980s. He has shooting pain down his legs and deadness of feeling in his feet.
Acupuncture “helped settle my nerve pain down,” said Harris, of Foxboro, Mass.
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 centred on opioids. The focus was under- standable — “nobody who has his leg blown off screams for acupuncture,” Schoomaker said. 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.
Schoomaker said he was inspired to seriously consider alternative approaches by his wife, a yoga instructor. Now two-thirds of military hospitals and other treatment centres offer acupuncture, according to a recent study.
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.
Her agency is teaming up with the Pentagon and the VA to spend $81 million (U.S.)on research projects to study the effectiveness of a variety of non-drug approaches to treating chronic pain.
Meanwhile, insurance coverage of acupuncture keeps expanding. California, Massachusetts, Oregon and Rhode Island pay for acupuncture for pain through their Medicaid insurance programs. Massachusetts and Oregon also cover acupuncture as a treatment for substance abuse, though scientists question how well it reduces the cravings caused by chemical dependency.