Integrative Care

The Only Way to Prevent Opioid Abuse

Preventing Opioid Abuse

How do we get a handle on the opioid abuse epidemic?

Our families, communities, and the country as a whole have been grappling with this question.

Progress has been made by increasing access to addiction treatment facilities, naloxone kits, prescriber registries, and safe drug disposal sites.

But as lawmakers debate opioid legislation and states sue pharmaceutical companies, average Americans with chronic back problems or a recent knee injury are still being prescribed narcotics to treat their pain. Some are offered other drugs, or even surgery. Sometimes these treatments help. But often they do not.

This helps explain why 1 in 3 Americans report having pain “often” or “very often”—and why opioid use and abuse persists.

The following represents the position of Northwestern Health Sciences University:

  • The most effective means to stop opioid abuse is ending opioid use.
  • Pain management should begin with non-drug treatments; complementary and integrative healthcare (CIH) professionals like chiropractors, massage therapists and acupuncturists are ideal candidates to provide these treatments.
  • An integrative care approach for recovering addicts should involve CIH professionals to help prevent relapse and provide alternatives to drug treatments.
  • Truly effective integrative care empowers a range of healthcare providers, including CIH professionals, to provide services not limited by arbitrary visit restrictions and other measures unrelated to the actual successful care of patients.
  • The high patient satisfaction realized by CIH practices should be made more widely available to those suffering from pain.
  • Removing the barriers to CIH can transform the current system and provide a remedy to the current opioid abuse crisis.

Please read on for more information on each of these points.

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The best solution: Stop taking opioids

We at NWHSU believe that the only surefire way to prevent opioid abuse is to not take an opioid in the first place. Most importantly, we have to give patients suffering from pain safer, more effective treatment alternatives for pain management.

On a social level, we have to change our relationship to pain and our expectations for a pain-free life. Certainly both can be accomplished with whole-person, integrative care that takes pain reduction into account by fostering greater overall health and well-being.

Who is prepared to take up this charge? We believe that complementary and integrative healthcare (CIH) professionals are. For example, these include chiropractors, acupuncturists and massage therapists working in collaboration with a range of other providers and social support services.

Pain management guidelines recommend non-drug treatments before resorting to prescription medications.

First line treatment as primary prevention

Pain management guidelines recommend non-drug treatments before resorting to prescription medications. Treatment delivered by CIH providers like chiropractors, acupuncturists and massage therapists has been shown to be as effective as, or more effective than, usual medical care for a range of pain conditions—with lower risk of side effects.

These CIH providers focus on providing effective care that doesn’t involve prescription medications, expensive imaging, or unnecessary tests in initial visits.

All of this means that patients can get evidence-based treatments faster—increasing the likelihood that they improve sooner.

Integrative care relies on a team of providers to coordinate pain management.

Secondary prevention for at-risk populations

Recovering addicts need pain management that does not put them at risk for relapse. Similarly, people at higher-than-average risk for poor outcomes with medication use — e.g. the elderly, pregnant women, children and adolescents — need alternative treatments that do not unduly threaten their safety.

Integrative care relies on a team of providers to coordinate pain management that is customized to meet individual patient needs. After all, patients aren’t simply the complaint they present with but are also complex human beings who bring unique expectations, biologies, mindsets and social contexts.

Non-drug treatments may help initiate rehabilitation, remain in treatment and prevent relapse.

Tertiary prevention for addicted individuals

Substance abuse problems are often an unintended consequence of inadequate pain relief. Whether abusing prescription pain relievers or using illicit drugs to self-medicate, the prospect of rehabilitation is often coupled with the fear of unmanaged pain.

Non-drug treatments may help some individuals initiate rehabilitation, remain in treatment and prevent relapse. A multi-modal approach to both addiction recovery and pain management is crucial. That’s why CIH providers should be considered an important part of addiction teams.

Integrative care can modernize pain management

The opioid crisis has made pain management an all hands-on deck situation. Therefore, we need to empower a range of healthcare providers to work at the top of their license. They need to serve the public in a way that reflects the full scope of their education and training.

Arbitrary visit limits and restrictions on which providers can provide certain services has nothing to do with good patient care. To clarify, it should have no place in healthcare policy.

Patients deserve to work with the qualified provider of their choice. Particularly when shouldering a considerable financial burden of healthcare through high deductibles, co-pays and premiums.

Integrative care has a context around it that lends itself naturally to health and healing. The hands-on, high-touch care delivered by chiropractors, acupuncturists, and massage therapists creates connection and a sense of community with patients. Also, their longer visit times and informal surroundings create the space needed to deepen patient-provider relationships.

All these factors contribute to the high patient satisfaction realized by many CIH practices. Most importantly, everyone, especially those in the vulnerable state of pain, deserves to experience these qualities that put the healing back into healthcare.

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Change the system to change the crisis

There are a number of barriers within the healthcare system. Many prevent pain patients from gaining access to evidence-based, patient-centered treatment. They include:

  • Limited patient access in the form of arbitrary visit and procedure limits based solely on provider type, not patient need
  • Depressed third-party payer reimbursement for covered service when delivered by a CIH provider, including doctors of chiropractic and licensed acupuncturists and massage therapists
  • Lack of care coordination across providers and between health systems and private practices

Leading researchers and thought leaders from around the world are calling on governments. Specifically, in regard to healthcare plans to incentivize high-value care for pain. This includes chiropractic spinal manipulation, acupuncture, and massage therapy.

We believe the following steps need to be taken to address the lack of adequate pain management for Americans and at the same time stem the opioid misuse epidemic:
  • Increased policy consideration of primary and secondary prevention for opioid misuse
  • Financial incentives to triage pain patients at risk of opioid abuse toward CIH care
  • Public relations strategies to promote non-pharmacologic pain management, especially among high-risk and abuse populations
  • Continuing medical education programs for physicians and other healthcare professionals focused on the education, roles and services offered by CIH providers
  • Sufficient attention to mental health resources and an appreciation for the mind-body connection
  • Prioritization of the therapeutic relationship between patient and clinician, which is often enhanced in CIH
  • Integration of CIH within pain management clinics and treatment abuse centers

Solutions to the opioid misuse epidemic go far beyond opioid use proper. Our healthcare system must include more comprehensive approaches to pain management. In conclusion, complementary and integrative healthcare is an important partner for preventing abuse and ultimately creating healthier communities.

For more information, see Northwestern Health Sciences University’s policy statement, Looking Beyond the Opioid Misuse Epidemic: The Role for Non-Pharmacologic Treatment of Musculoskeletal Pain.

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