Chiropractic insights: Managing pain without opioids

The American Society of Addiction Medicine (ASAM) reports drug overdose is the leading cause of accidental death in the U.S. and opioid addiction is driving this epidemic.

Specifically, in 2014, prescription pain relievers were responsible for almost 19,000 deaths and 10,600 people died from heroin overdose alone. Also that year, 21.5 million Americans twelve years and older had a substance use disorder related to opioids, which include heroin as well as legal drugs such as oxycodone, hydrocodone, codeine, morphine, fentanyl and others.

As death rates from prescription painkillers and opioid use continue to climb, the federal government is attempting to create measures that address the problem.

In March, President Obama introduced a number of new policies directed toward this crisis. His first priority is to expand access to treatment. To accomplish this, the Department of Health and Human Services (HHS) is releasing $94 million in new funding to more than 200 community health centers so they can offer more substance use disorder treatment services.

Expanding treatment options

Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has launched several initiatives designed to target the issue. Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid (MAT-PDOA) addiction grants will provide $33 million over three years to states that want to “enhance or expand their treatment service systems to increase capacity and provide accessible, effective, comprehensive, coordinated care, and evidence-based medication assisted treatment (MAT) and recovery support services to individuals with opioid use disorders seeking or receiving MAT.”

The agency has also published 10,000 pocket guides that provide a prescribing checklist as well as information on integrating non-pharmacologic therapies into the treatment plan for clinicians. SAMHSA will also increase the number of clinicians qualified to prescribe buprenorphine, known to decrease cravings and suppress withdrawal symptoms, through trainings conducted in states with the greatest need.

These measures are intended to double the number of providers that prescribe naloxone, which has been shown to reverse opioid overdose, and to bring awareness to more than four million health care providers regarding prescribing practices and other solutions to the crisis. Overall, the president hopes that more than 540,000 healthcare providers will be trained in opioid prescribing practices.

Increased education

The public and private sectors are also joining the battle to slow the opioid crisis. More than 60 medical schools, as of fall 2016, will require students to take a course in prescriber education as part of graduation requirements. This educational component will comply with the Centers for Disease Control and Prevention Guidelines for Prescribing Opioids for Chronic Pain.

As part of its recommendations, the CDC provided research findings that showed the effectiveness of using non-pharmacologic interventions. Based on contextual evidence, the CDC suggests using cognitive behavioral therapy (CBT), exercise, interventional treatments, and multimodal pain as well as medication options, such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants and anticonvulsants, in lieu of opioids.

Gregory Collins, MD, section head of Cleveland Clinic’s Alcohol and Drug Recovery Center, and chair of the Health Policy Committee on Heroin and Opioid Task Force, notes that Cleveland Clinic held Drug Enforcement Summits in 2012 and 2013, out of which grew a community action plan with a strong emphasis on education. Most important, he emphasizes that the collaborative efforts of lawmakers, law enforcement and the courts will help to “…reduce the spread of addiction and save lives.”

What you can do

Chiropractors are in a position to educate and advise patients on alternative pain management options, given the very nature of the health care they deliver. In January 2015, the American Chiropractic Association (ACA) applauded the CDC for its stance on encouraging more conservative interventions initially before prescribing opioids.

The ACA notes that exploring non-invasive and non-pharmacologic treatment for pain management, such as seeing a chiropractor, may result in more cost effective and safer options and enhanced health status.