State Attorney General Urges Coverage of Non-Drug Therapies for Pain
In a letter dated 18 of September 2017, Vermont Attorney General T.J. Donovan calls for insurance coverage of non-opioid pain management options. Donovan joins 36 other Attorneys General in states from Maine to Montana in signing the letter, which recommends health insurers increase coverage for non-drug therapies, and substitute non-narcotic drugs when possible. Specifically, the signers cite techniques including physical therapy, acupuncture, massage and chiropractic care.
The rationale behind this proposed change is that patients are much more likely to utilize covered therapies. While there is widespread coverage and payment for prescription opiate painkillers, insurance coverage of modalities like acupuncture and chiropractic remain limited.
Non pharmaceutical pain management has been recently gaining acceptance by the medical establishment. This statement by the attorneys general is preceded by a change in clinical practice guidelines earlier this year by the American College of Physicians, which recommends increased usage of non-drug therapies, including acupuncture, for the treatment of back pain.
The letter highlights the monetary and human costs of the opioid epidemic, which have steadily increased in recent years. The cost of opiate use to the economy is measured in the billions yearly; the cost in lives lost is just short of a staggering one hundred Americans daily. It is estimated that two million people across the United States are currently dependant on prescription opioids for medical reasons. However, there is weak evidence to support their use in many types of chronic pain conditions. An additional twelve million Americans are able to obtain and misuse these prescription drugs for non-medical uses.
The letter concludes with the hope that incentivizing the above alternatives reduces long term costs in a way that benefits “patients, society, and insurers alike.”
The proposed adjustments to insurance procedures are a welcome change. Narcotic painkillers have a place, as the letter agrees, citing cancer pain as one example. As well, there are certainly other conditions that shouldn’t be excluded. While there is little doubt about the efficacy of these drugs short term, there is mounting evidence that they are not appropriate for most individuals as a long term pain management strategy. Acupuncture is a comparably safe treatment which has been determined effective for common pain syndromes. Part of the known mechanism of acupuncture is its activation of the body’s endogenous opioids. These are chemicals that the body manufactures, that provide pain relief in a way that is self-regulated and impossible to overdose. Because of acupuncture’s autonomic modulating effect, it’s not unusual to get beneficial side effects: reduced stress, smoother digestion, and more restful sleep. Our hope is that this nod by the attorney general is a first step in increasing accessibility to a powerful healing modality. By Beth Bloomfield, L.Ac., MS