White Paper - Acupuncture and the Opioid Crisis in Colorado
Researched and prepared by James Yardley, L.Ac. for the Acupuncture Association of Colorado on 02/2019 and later published by The Journal of the American Society of Acupuncturists Vol. 6, No. 3.
Problem
Colorado has a growing opioid crisis on its hands...
● Drug overdose death rates in Colorado continue to increase, fueled by opioid addiction… opioid overdoses“nearly quadrupled from 2.5 deaths per 100,000 population in 1999, to 9.8 in 2017.”1
● Opioid overdoses take more lives in Colorado than any other type of drug, including alcohol, methamphetamines, heroin and cocaine.1
● The number of people in treatment for opioid use disorders at state licensed facilities has increased 189% from 2,748 in 2011 to 7,949 admissions in 2016.2
● Heroin-related deaths have nearly tripled in six years: 2011 - 79 deaths, to 2016 - 228 deaths.2
Solution
Acupuncture is effective for pain management…
● “Acupuncture has a clinically relevant effect on chronic pain that persists over time… Referral for acupuncture treatment is a reasonable option for chronic pain patients.”3
● The American College of Physicians Clinical Practice Guidelines strongly recommends acupuncture as a non-pharmacological treatment for acute, subacute, and chronic low back pain.4
● Acupuncture resulted in pain relief and better function in low back pain compared with nonsteroidal anti-inflammatory drugs and was associated with a greater likelihood of overall improvement at the end of treatment.5
● Evidence supports the use of acupuncture in osteoarthritis by reducing pain, improving mobility and quality of life.6, 7, 8
Acupuncture’s role in recovery management…
● Studies show acupuncture and electroacupuncture significantly reduce patients’ postoperative analgesic requirement, reducing the consumption of opioid-like medications by more than 60% following surgery.9, 10, 11
● Utilizing electroacupuncture is shown to reduce opioid use across a wide range of major and minor surgical procedures.12, 13, 14
● When acupuncture was incorporated into treatments for pain at a United States Air Force medical center, opioid prescriptions decreased by 45%, muscle relaxants by 34%, NSAIDs by 42%, and benzodiazepines by 14%.15
● “Patients treated with acupuncture had significantly less pain and used fewer opioid analgesics on Day 1 after surgery compared with usual treatment,” according to meta-analysis from 2016 of 13 studies including 682 patients.16
Acupuncture also provides opioids- the natural ones…
● Acupuncture works to block pain by activating a variety of bioactive chemicals, including several classes of opioid neuropeptides through peripheral, spinal, and supraspinal mechanisms. Endogenous opioids desensitize peripheral pain receptors and reduce proinflammatory cytokines peripherally and in the spinal cord.17, 18
...and thus, can treat opioid addiction itself
● The World Health Organization and the National Institutes of Health have accepted acupuncture as a therapy for drug treatment for over 20 years.
● The World Health Association has approved acupuncture for the treatment of these significant withdrawal symptoms: vomiting, insomnia, emotional upheaval, muscle spasms, sweats.
● The US federal government’s Center for Substance Abuse Treatment (2007), the United Nations (2006), and the US Department of Defense/Veterans Affairs (2010) have each published best practice guidelines highlighting the value of acupuncture for chemical dependency.19
1. Center for Health and Environmental Data Report. Drug Overdose Deaths in Colorado Final Data for 1999-2017. https://drive.google.com/file/d/1w9pmIXJfMxxPBQc9KmYoHb_LH0sq0J_o/view Accessed January 10, 2019.
2. Heroin in Colorado report; Law Enforcement Public Health Data 2011-2016. Published April 2018 by Heroin Response Work Group. http://www.corxconsortium.org/wp-content/uploads/Heroin-in-Colorado-April-2018.pdf
3. Vickers A, Vertosick E, Lewith G, MacPherson H, Foster N, Sherman K, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain. 2018;19(5):455-74.
4. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Ann Intern Med. 2017;166(7):514.
5. Chou R, Deyo R, Friedly J, Skelly A, et al. Nonpharmacologic Therapies for Low Back Pain. Ann Intern Med. 2017;166(7):493-505.
6. Manyanga T, Froese M, Zarychanski R, et al. Pain Management with Acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Alternative Med. 2014;14:312.
7. Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Ann Intern Med. 2005;142(8):651-663.
8. Cao L, Zhang XL, Gao YS, Jiang Y. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Saudi Med J. 2012;33(5),526-32.
9. Wang B, Tang J, White PF, Naruse R, Sloninsky A, Kariger R, et al. Effect of the Intensity of Transcutaneous Acupoint Electrical Stimulation on the Postoperative Analgesic Requirement. Anesth Analg. 1997;85(2):406-13.
10. Tedesco D, Gori D, Desai K, Asch S, Carroll I, Curtin C, et al. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. 2017;152(10):e172872-e172872.
11. Liu XL, Tan JY, Molassiotis A, Suen LK, Shi Y. Acupuncture-Point Stimulation for Postoperative Pain Control. Evid Based Complement Alternat Med. 2015;2015,1-28.
12. An, LX. Ren, X. Wu, H. Electro-Acupuncture Decreases Postoperative Pain and Improves Recovery in Patients Undergoing a Supratentorial Craniotomy. Am J Chin Med. 2014;42(05):1099-1109.
13. Capodice JL, Parkhomenko E, Tran T, et al. A Randomized Double-Blind Sham-Controlled Study Assessing Electro-Acupuncture for the Management of Postoperative Pain after Percutaneous Nephrolithotomy. J Endourol. 2019.http://doi.org/10.1089/end.2018.0665.
14. Coura LE, Manoel C, Poffo R, Bedin A, Westphal G. Randomised, controlled study of preoperative electroacupuncture for postoperative pain control after cardiac surgery. Acupunct Med. 2011;29(1):16-20.
15. Crawford P, Penzien DB, Coeytaux R. Reduction in Pain Medication Prescriptions and Self-Reported Outcomes Associated with Acupuncture in a Military Patient Population. Med Acupunct.201729(4):229-231.
16. Wu MS, Chen KH, Chen IF, et al. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS One. 2016;11(3):1-12.
17. Zhang R, Lao L, Ren K, Berman BM. Mechanisms of Acupuncture- Electroacupuncture on Persistent Pain. Anesthesiology. 2014;120(2):482-503.
18. Han JS. Acupuncture and endorphins. Neurosci Lett. 2014;361(1-3):258-261.
19. Bemis, R. Evidence for the NADA Ear Acupuncture Protocol, Summary of Research. National Acupuncture Detoxification Association (NADA), 2013. http://acudetox.com/phocadownload/Research_Summary_2013%20(2).pdf. Accessed January 25, 2019.
