Physical Therapy, Acupuncture Reduce Opioid Dependence
More Oregonians die of drug overdoses than in car crashes, even though the number of adults living with chronic pain has held steady for the past 20 years.
To combat the overdose deaths, Oregon has adopted Centers for Disease Control (CDC) guidelines for prescribing opioids and work groups are looking at medical marijuana and other potential remedies. The Oregon Health Plan recently began paying for physical therapy and acupuncture rather than surgery for low back pain.
But physical therapy and acupuncture didn’t help Amanda Siebe cope with her complex regional pain syndrome. Siebe founded Disabled Americans 4 Change, to stop the CDC guidelines from taking effect. She fears the guidelines leave 116 million Americans who take daily opiates to function “with alcohol, street drugs and suicide” to ease chronic pain.
Rural communities often lack access to physical therapy and acupuncture, said Dr. Andrew Suchocki, medical director of the Clackamas Health Center who’s aware of an instance where a broken foot wasn’t treated with opioids because “new residents are terrified of opioids.”
“It’s easier to not start opioids than to diminish your dependence,” said Dr. John Muench, director of behavioral medicine in the Department of Family Medicine at OHSU. During the 1990s, providers came under fire for failing to do enough to treat pain and relied on research by the pharmaceutical industry that encouraged use of new opioids.
It takes just four doses of an opiate for people to develop resistance, said Dr. Kevin Wilson, a Hillsboro naturopath who teaches at NUNM.
“I see a lot of addicts in my practice. There’s tons of resources and medications to help OxyContin addicts taper off. I don’t know what to do to (taper off) heroin addicts.”
Insurance companies are partially to blame for the high incidence of prescription drugs, Wilson said, because traditional treatments such as naturopathy frequently are not covered, requiring people to pay for treatment themselves.
He believes topical cannabis is helpful as an anti-inflammation or anti-itch treatment and that practitioners who take an either-or approach to opioids or cannabis are “doing patients a disservice.”
“If you have two treatments and one has harms, I’m in favor of the one without harm,” said Dr. Paul Lewis, health officer for the Portland metropolitan area. “No one has ever died of cannabis” yet marijuana remains a Schedule 1 drug, the same as heroin.
“There is no life without pain,” cautioned Wilson, treatment should empower patients to understand their pain and manage expectations. “You may be uncomfortable but you shouldn’t stop daily living.”
Jan can be reached at [email protected].