America is being rocked by what medical authorities are deeming an “epidemic” of growing proportions. Opioids, a family of mid- to high-strength painkillers that are routinely prescribed to treat everything from chronic fibromyalgia to pain caused by cancer treatment, are highly addicting.
Evidence is beginning to suggest that percentages of opioid users who are prescribed a routine opioid medication find themselves quickly “hooked” — progressing through the stages of opioid addiction by building tolerance, consuming increasing dosages, and developing dependencies that ultimately cause strong addictions.
Increased or long-term consumption drastically increases the risk of opioid overdoses and fatalities. The American opioid epidemic has been estimated to cost the country hundreds of billions of dollars annually.
The opioid epidemic is a complex adversary.
- Evidence of opioid addiction, if detected at all, is often mistaken for psychological instability, mood swings, or even the effects of aging.
- Limited regulations control the use and prescription of opioids, and pharmaceutical providers have invested countless dollars in promoting the usage of opioid medications to physicians and healthcare providers.
- Many patients who become opioid-dependent employ methods of duplicating, stealing, buying, or otherwise obtaining illicit prescriptions to feed their addictions.
- This healthcare emergency is costing the American population unfathomable problems and must be addressed.
This guidebook will give an overview of the opioid epidemic and then provide information on how acupuncture has proved to be a viable alternative for treating pain to mitigate the use of opioids, as well as a treatment strategy for rehabilitating those suffering from opioid addiction. Content will be divided into the following chapters:
- Ch. 1: Opioid Epidemic Statistics
- Ch. 2: Acupuncture Therapy for Pain and Addiction
- Ch. 3: New to Acupuncture: Questions and Answers
Read on to find out how acupuncture can make a difference in combating opioid addictions.
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Chapter 1: Opioid Epidemic Statistics
Opioid overuse is occurring in epidemic proportions. The National Institute on Drug Abuse (an agency within the National Institutes of Health, or NIH) has reported a huge increase in opioid overdose deaths over the past 10 years, with the most dramatic increase over that time period occurring between 2013 and 2016.
Monetary costs associated with opioid abuse have recently been calculated in the billions. The opioid epidemic has been declared a public health emergency. Opioids pose a significant threat to the American economy, healthcare system, and population.
The Numbers: Opioids in the U.S.
The stereotypical drug overdose case born from systemic poverty can often be far from reality. Stories emerge every day of individuals outside of poverty across the country who succumbed to powerful opioid addictions and then experienced drastic deteriorations in their physical condition, social standing, and quality of life. Some of these cases advance rapidly enough or continue long enough to add their victims to the death tolls rising every year, with opioid addictions often developing from seemingly harmless opioid painkiller prescriptions written after routine surgeries or during injury recovery periods. In many cases, patients had no idea how powerful their medications were and how easily an addiction could take hold — sometimes in as few as 10 days of prescribed consumption.
Opioid Epidemic Statistics
What makes opioid addiction such a severe problem is its subversive nature. Opioid addictions are often instigated by prescribed usage. Because opioid prescriptions are made in relative abundance by practicing healthcare providers, it can be easy for a patient on the fringes of an addiction to obtain more opioid medications and thus strengthen his or her need for the drug.
- According to the Centers for Disease Control and Prevention (CDC), nearly 250 million opioid prescriptions were written in 2013 alone in the United States.
- That exceeds 2013’s total American adult population (numbered at 242,625,484, according to data from the U.S. Census Bureau).
- Because opioid addictions are at once easy to fall into and easy to hide, it is difficult to extrapolate how many opioid addictions may exist.
- Opioid usage is on the rise, however, and could lead to a huge and frighteningly undetectable increase in addictions.
- According to CBS News, the National Survey on Drug Use and Health found that more than 33 percent of American adults were prescribed an opioid painkiller in 2015.
- That same survey revealed that 1.9 million Americans reported being fully addicted to opioids in 2015 alone, though the number of unreported addictions is almost certainly drastically higher.
How Much of the Opioid Industry Is Consumed by the U.S.?
The United States of America accounts for a consumption of the world’s opioid drug production that is far larger than proportional. According to a CNBC article, “Approximately 80 percent of the global opioid supply is consumed in the United States.”
The same article reveals that American consumption for hydrocodone, a specific opioid in the form of a high-strength painkiller, has reached 99 percent. The BBC echoes these grim facts, reporting that the U.S. is the No. 1 country in the world for opioid consumption, surpassing Canada, Germany, Denmark, and Austria by a wide margin.
Annual Deaths from Opioids
Image source: https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html
According to the NIH, the number of overdose deaths due to opioids has skyrocketed in recent years, increasing from less than 5,000 reported deaths in 2013 to more than 20,000 in 2016.
In fact, the drastic increase in American drug-related deaths has impacted the CDC’s U.S. life expectancy projections, and drug-related deaths were partially blamed for consecutive annual decreases in the average life span expectancy (decreasing from 2014 to 2015 and then again in 2016).
Costs of the Opioid Epidemic
Though it would be impossible to calculate the total fiscal, emotional, and physical costs of the opioid epidemic because of its far-reaching and pervasive effects, even the calculable costs to the inhabitants of the United States alone are staggering.
The NIH reports the estimated cost of healthcare measures necessitated by prescription opioid overuse to be $72.5 billion per year.
The White House Council of Economic Advisers (CEA) estimated that the total cost of the opioid epidemic to the American economy reached $504 billion in 2015, which equals almost 3 percent of that year’s gross domestic product (GDP). And the numbers show no sign of slowing down.
Opioids and Illicit Drugs
Opioids are not the only drugs increasing in prevalence in the United States.
- Between 2006 and 2016, the number of deaths attributed to drug overdoses (including both opioids and illicit drugs) climbed from just over 30,000 to 64,000, according to data collected by the CDC.
- Opioid overdoses, however, account for a large percentage of those deaths, causing 20,000 (almost a third of the total) deaths in 2016 alone. The opioid epidemic has reached staggering proportions in the United States and is only beginning to incite corrective action and awareness.
- In October 2017, its growing severity caused President Donald Trump to declare the opioid addiction epidemic a “public health emergency” and direct that concerted action be taken to address the issue.
But many experts feel the efforts necessary to reverse the opioid addiction epidemic may extend far beyond those that have been enacted to date.
Chapter 2: Acupuncture Therapy for Pain and Addiction
Acupuncture, a form of alternative medicine, can provide an effective substitute for opioid painkillers in pain treatment efforts, perhaps even circumventing opioid prescriptions entirely in some cases. It can also provide an effective method of rehabilitation treatment for patients addicted to opioids.
Section A: Acupuncture as an Alternative to Opioid Prescriptions
What Are Opioids Used For?
According to the CDC, “Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer.” Opioids are prescribed to manage pain in the following cases, among others:
- Orthopedic, joint replacement, and cancer removal surgeries, as well as other types of medical procedures
- Cancer treatment
- Chronic illness
- Palliative care
There is a major difference between certain over-the-counter pain relievers (OTCs), such as aspirin, and opioid painkillers: namely, that the ceiling-proof nature of opioids makes it possible to compensate for a growing tolerance by increasing the administered dosage over time.
In contrast, OTCs reach a threshold beyond which they no longer have an effect. This makes them potentially less effective but much safer than their more powerful opioid counterparts; however, even though patients prescribed opioids can be susceptible to developing addictions, opioids are used to treat a large range of cases, from injury sufferers to individuals recovering from recent surgery and cancer patients.
Advantages of Acupuncture Therapy Compared with Opioids
Acupuncture is healthier and more holistic. “Acupuncture helps the body to regulate our innate natural pain relievers; such as endorphins, serotonin and dopamine, which in turn helps patients dealing with pain relief, stress and addiction,” says Greg Lane, the Director of Clinical Operations at Pacific College of Oriental Medicine. According to DrugAbuse.gov, opioid drugs function by targeting the opioid receptors throughout the brain and the body. By interacting with the receptors, the drugs are able to reduce the flow of pain messages from nerve endings throughout the body to the brain, effectively reducing pain sensations. Opioids artificially stint the body’s natural chemical processes. Acupuncture, alternatively, makes use of natural mechanisms to promote natural pain relief
Acupuncture does not cause addiction tendencies. “The body’s natural chemistry can be used to replace external substances such as opioids,” says Lane. “Acupuncture helps to reduce cravings, decreasing the need for external stimuli such as pain killers.” In January 2016, the Joint Acupuncture Opioid Task Force (JAOTF), formed by the Acupuncture Now Foundation and the American Society of Acupuncturists, issued a letter to the CDC regarding the value of non-pharmacologic alternatives to opioids, which included the following statement: “Research is showing that acupuncture can effectively stimulate the production of the body’s own ‘endogenous opioids’ as well as natural anti-inflammatory compounds. In other words, acupuncture can facilitate the better usage of the body’s own natural chemistry creating the potential for similar or sometimes better benefits than synthetic drugs, without the risks of addiction or side effects.”
Acupuncture has a lower associated cost. Acupuncture safely treats pain without risking the slough of associated costs that accompany opioid overuse.
During a pilot program from 2014 to 2015, as documented by the California Health Care Foundation, health plan provider Central California Alliance for Health (CCAH) made alternative medicines available to its members and witnessed significant reductions in medication dosages, pain levels, and overall care costs, as pharmacy savings offset the costs of acupuncture care visits. The CCAH has since made the program available to all its members, and other medical service providers will likely follow suit in the coming years.
Acupuncture boasts proven results. In a 2015 study published in The Spine Journal, 21 methods for treating sciatica were compared. These methods included both acupuncture and conventional opioid treatments, among other strategies.
The results indicated that “biological agents were significantly better for pain reduction than bed rest, non-opioids, and opioids.” The study also reached the following conclusion: “For overall recovery as the outcome, compared with inactive control or conventional care, there was a statistically significant improvement following disc surgery, epidural injections, non-opioid analgesia, manipulation, and acupuncture.”
And this is just one of many examples. According to JAOTF, “The risk-to-benefit ratio of acupuncture for common chronic pain conditions is clearly superior to opioid medications and often better than other non-opioid therapies, regardless of mechanism. … There is growing research evidence to support the effectiveness and efficacy of acupuncture for the relief of pain, especially chronic pain. Acupuncture has been shown to be effective for treating various types of pain with the strongest evidence around back pain, neck pain, shoulder pain, chronic headache, and osteoarthritis.”
Section B: Using Acupuncture to Treat Opioid Addiction
In addition to providing a viable pain management alternative to opioids in order to mitigate opioid usage and help prevent opioid addiction, using acupuncture for addiction treatment could provide an effective way of rehabilitating patients who have become addicted to opioid painkillers.
Benefits of Acupuncture in Cases of Opioid Addiction
The California Highlands Addiction Treatment center cites the following observed acupuncture benefits:
- Reduced drug cravings and withdrawal symptoms
- Lessened pain
- Improved sleep
- Supported physical and emotional healing
A white paper co-produced by six organizations of acupuncture or traditional Chinese medicine (TCM) titled “Acupuncture’s Role in Solving the Opioid Epidemic” revealed widespread usage of acupuncture in addiction treatment.
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It cited more than 1,000 treatment centers across the United States and Canada that currently utilize acupuncture in their rehabilitation programs. Acupuncture treatment is relatively inexpensive, portable, and low-threshold, making it easy to use in a variety of contexts that range from clinics to prisons, rehab centers, in- and outpatient facilities, and more.
The National Acupuncture Detox Association (NADA) published its own research supporting the use of acupuncture in addiction rehabilitation, citing its widespread use in U.S. and Indian military units; U.S. and European prisons and psychiatric hospitals; and other facilities.
Use of acupuncture is rapidly expanding and gaining ground as a respected and effective treatment method for addiction sufferers.
Chapter 3: New to Acupuncture: How It Works
According to the Journal of Natural Longevity, “Stimulating acupuncture points spurs the release of a substance called nitric oxide (NO) at the acupuncture site. NO, in turn, signals the release of natural painkillers in your body. NO also dilates your blood vessels. Subsequently, blood pressure is lowered, and blood flows more freely.”
Forbes magazine describes acupuncture this way: “Acupuncture has many benefits, including stress reduction and pain relief; however, psychologically, acupuncture is also reported to increase the levels of various chemicals in the central nervous system — enkephalin, epinephrine, endorphin, serotonin, norepinephrine, and dopamine.”
Utilizing a holistic and multifaceted practice such as acupuncture provides palpable benefits over using a drug or synthetic additive to treat maladies. Drugs may be hindered by any number of infinitesimal variations that exist within the patient and could also cause a host of unpleasant or dangerous side effects.
What Can Acupuncture Be Used For?
Acupuncture has quietly built a precedent and successful track record among widely varied application types around the globe over the past several hundred years in both Eastern and Western settings.
- According to JAOTF, “Acupuncture has been shown to be effective for treating various types of pain, with the strongest evidence around back pain, neck pain, shoulder pain, chronic headache, and osteoarthritis.
- In an individual patient meta-analysis of 17,922 people from 29 randomized controlled trials (RCTs), it was concluded that the effect sizes in comparison to no acupuncture controls were 0.55 SD (95% CI, 0.51-0.58) for back and neck pain, 0.57 SD (95% CI, 0.50-0.64) for osteoarthritis, and 0.42 SD (95% CI, 0.37-0.46) for chronic headache.
- In all analyses, true acupuncture was significantly superior to no acupuncture and sham acupuncture controls.”
Acupuncture has been applied to the following symptoms and conditions, among others:
- Mental health and psychological conditions (including anxiety, stress, and depression)
- Headaches and migraines
- Back, neck, and shoulder pain
- Joint pain
- Arthritis and osteoarthritis
- Pregnancy pain
Finding an Acupuncturist
Individuals interested in finding an acupuncture practitioner have a number of resources available to them:
- The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) provides a complete directory of licensed acupuncture practitioners who have been certified by the NCCAOM. This is not an exhaustive list of all licensed acupuncturists but does catalog those who have received NCCAOM certification.
- The Acupuncture Now Foundation (ANF) has compiled a list of several other helpful acupuncturist directories that may provide additional results.
- Acupuncture Today also provides users with a searchable database of acupuncture professionals, allowing searchers to filter by location, gender, college attended, services provided, and more.
In order to find a qualified acupuncturist, new acupuncture clients should look for specific certifications to identify levels of training and ensure quality of services. There are minimum requirements for licensure, which vary by state. Additional certifications, however, are available to practitioners to increase their levels of training.
- The NCCAOM provides acupuncturist certification and is the “only national organization that validates entry-level competency in the practice of acupuncture and Oriental medicine (AOM) through professional certification.”
In addition to the above resources, other organizations and geographically specific associations can help provide assistance in choosing professional and well-trained acupuncturists from whom to accept treatment services.
What to Expect from Acupuncture Treatment
- During a first visit, an acupuncturist will often ask for profiling and historical health information to most effectively design a treatment plan.
- Depending on an acupuncturist’s preferred modes of treatment, some may utilize electroacupuncture, moxibustion, or other forms of complementary TCM.
- The Cleveland Clinic describes the sensation of being treated with acupuncture needles as being somewhat akin to a “slight prick.” But the feeling is different than an injection, because the needles used in acupuncture are much thinner. After insertion, patients often describe a feeling of numbness or tingling at the insertion site.
The length of the appointment, the suggested duration of care, and various other methods of treatment that may be employed to complement or enhance the effectiveness of acupuncture vary by practitioner.
Acupuncture can provide a low-threshold, safe, and effective treatment method for a wide variety of ailments. Acupuncture is quickly gaining traction as an alternative to conventional pharmaceuticals and could change the medical landscape over the coming years.