Vermont has already invested significant time and money in combating the opioid addiction, from special drug courts to laws regulating prescription monitoring. Now the state is considering a new tool in its arsenal: acupuncture.
The idea isn't to use acupuncture to treat addiction — though that's not unheard of — but instead to investigate if acupuncture could be useful in treating chronic pain, as a way to avoid or reduce reliance on opioid medicines.
The same bill last year that created the Vermont Prescription Monitoring System also allocated $200,000 to fund a study to see if making acupuncture accessibly to Medicaid patients is feasible — and useful.
"The Legislature, in learning about this opioid problem, said, 'Hey, why aren't these things more accessible to people?' And one of the reasons is very few insurances in Vermont cover acupuncture," says Robert Davis, who has been an acupuncturist for 17 years and is running this study.
As acupuncture is increasingly considered a viable option for pain relief, Vermont legislators want to explore how it could impact the lives of others — particularly those living below the poverty line.
Over a span of three months, different acupuncturists in Chittenden County, Montpelier and White River Junction will offer free sessions to qualifying Medicaid patients with chronic pain.
Davis readily admits that often the people who seek out acupuncture are those who can afford it. But he says this doesn't mesh with the larger trend toward including non-pharmaceutical options for treating pain and other illnesses.
"For example, the Joint Commission, which is a nonprofit organization that credentials hospitals and health organizations, they made it clear that you can't just rely on pharmacologic treatments for pain," says Davis. "You should also consider non-pharmacologic treatments, and they specifically mentioned things like acupuncture, massage, mindfulness."
While it is not without controversy, there is growing evidence that acupuncture can be effective for some types of pain relief.
Not only that, acupuncture "may be helping the tissues heal, in addition to dulling the pain," says Dr. Helene Langevin, a visiting professor of neuroscience at the Larner College of Medicine at UVM. "Because the problem with an opiate that you take is that you have temporary pain relief, but the underlying problem is still there. Whereas in a technique like acupuncture, there's at least the potential for helping people actually heal."
Langevin has built her career on studying the molecular and cellular impacts of acupuncture. She's also the director of the Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital.
Langevin says that lack of access to acupuncture and non-pharmacologic treatments is a harmful disparity in health care:
"If somebody, for example, could have, especially access to acupuncture before they start taking opiates, it might even be better," she says. "Because then you don't have to deal with opiates, so you could avoid all kinds of problems down the road."
In fact, in 2010, 93 percent of deaths from opioids in Vermont involved overdosing on prescription medicine. That percent has since decreased as use of heroine has risen. But misuse of prescription opioids continues to be a problem.
Addiction issues stemming from prescription medicines are still a significant part of the opioid epidemic. [Courtesy of Jess Aloe, Burlington Free Press]
The Legislature-funded study is looking to see if acupuncture could provide an alternative, or a complement, to prescription opioids. It isn't evaluating the science of acupuncture; there won't be any comparing its effectiveness to a placebo — and there's already evidence it can provide pain relief.
Instead, the research project is set up to see just how feasible it would be for Medicaid patients to use acupuncture. And what impact it might make on their lives.
"One of the things that we'll learn from this study is: Will these people utilize acupuncture if offered?" says Davis.
The study will also measure if people's pain was reduced, and will look at a whole range of health measures, from the ability to do daily activities to the patient's psychological status to whether his or her use of painkillers decreases.
The study is even measuring how acupuncture might impact the patient's use of other health services.
"In other words, we're interested to see: Did it affect the amount of times that people went to the emergency room? Did it affect how often they went to doctor, or filled prescriptions, or things like that?" says Davis.
If early indications hold any weight, there's certainly interest in acupuncture among people suffering chronic pain. The trial just began soliciting volunteers a few weeks ago, and already 75 people have been processed and enrolled.
The study will continue through April, and the results will be submitted to this Legislature later this spring.