Increasingly through the U.S., states are requiring physicians refer to or prescribe alternatives to opioids such as massage, chiropractic and acupuncture.

The opioid epidemic in the U.S. has made headlines nationwide and plagued communities as people die from overdoses in unprecedented numbers. Yet as it’s grown, so too has a move toward using complementary therapies, including massage, as alternatives to drugs.

The Opioid Reduction Act, a new law in West Virginia—a state that has been especially battered by opioid addiction—seeks to curtail overdose deaths by supporting the use of complementary therapies as prescription opioid alternatives.

Scope of the Opioid Problem

Nationally, about 72,000 Americans died of drug overdoses of all types in 2017, about a 10 percent increase from the previous year, according to preliminary data released by the Centers for Disease Control and Prevention (CDC) this summer. About 48,000 of those overdoses were from opioids, a class of drug that includes OxyContin, Vicodin and fentanyl, among others.

Opioid drugs work by binding to specialized opioid receptors in brain cells, causing them to send out signals that block pain and induce pleasurable feelings, according to the Mayo Clinic. These effects make the drugs highly addictive.

Opioid Deaths by the Numbers

In late October,  Health and Human Services Secretary Alex Azar, speaking at a healthcare event, said that the latest preliminary numbers from the CDC suggest that overdose deaths may be leveling off, reported the Associated Press (AP)

According to the AP, the new CDC estimates, released in mid-October, seem to indicate a plateau in the rise of overdose deaths. Over the period from December 2017 to March 2018, the CDC reports the rate of overdose deaths went from 10 percent to 3 percent.

While Azar cautioned that the opioid epidemic is far from over, he suggested that the strides being made in slowing the death rate can be attributed to the various efforts happening nationwide to curb the abuse of these drugs.

Those efforts include West Virginia’s new state law, which limits the prescribing of opioids and requires that patients try alternatives to opioids.

The new law went into effect in June, so it is too early to know what impact it may have on the state’s opioid crisis. However, in West Virginia, as in the nation overall, opioid-related deaths are slowing down.

West Virginia’s Opioid Problem

West Virginia has been one of the states hardest hit by the opioid epidemic. For a number of years, the state has exceeded the national average in its number of overdose deaths.

The CDC’s latest confirmed numbers, from 2016, show the state has the highest rate of drug overdose deaths in the U.S., at 52 deaths per 100,000 people. The next highest drug death rate is in Ohio, at 39.1 per 100,000.

In July, Rahul Gupta, MD, the state’s chief health officer, said that even though preliminary numbers from West Virginia’s Department of Health and Human Resources show more deaths in the first six months of this year than those recorded in the first six months of 2017 or 2016, the rate of increase has leveled off. (Gupta’s last day with the state was Nov. 5.)

According to MetroNews, Gupta said there were 356 opioid-related deaths in the first six months of 2016. That number for the same time period in 2017 surged to 469. And while the number for the first six months of this year is higher than last year’s at 498, it is only higher by 29 deaths versus the 113 deaths from 2016 to 2017.

West Virginia’s Opioid Alternatives

Gupta said the numbers may decline more in the last half of the year, reflecting the impact of West Virginia’s new opioid reduction law, which went into effect June 7.

Among the new law’s directives, healthcare providers are required to refer or prescribe pain treatment alternatives—such as acupuncture, massage therapy, chiropractic and movement therapy—before prescribing opioids. If opioids are prescribed, the law limits dosage strength and quantities.

According to the National Institutes of Health’s National Center for Complementary and Integrative Health, scientific evidence supports the effectiveness of complementary health approaches such as acupuncture, yoga, massage therapy, osteopathic/spinal manipulation, tai chi and relaxation techniques as chronic pain interventions and opioid alternatives.

Acupuncture, especially, has been found to reduce the need for opioids, according to a 2017 white paper in the Journal of Integrative Medicine.

The thinking behind the new legislation is that if patients can address their pain with complementary therapies that offer an effective alternative to opioids, fewer patients and physicians will have to turn to these drugs to manage pain.

An Integrative Approach to Pain

It is that theory and a desire to find a way to help end the state’s opioid crisis that prompted the creation of the West Virginia University Medicine Center for Integrative Pain Management, said Richard Vaglienti, an anesthesiologist and associate professor at the pain center.

Richard Vaglienti, MD

This facility, which opened in June 2017, offers a multidisciplinary approach to pain management, Vaglienti said, because often, especially with opioid addiction, patients need to tackle their pain and their addiction from different avenues.

Services offered include acupuncture, chiropractic, massage, mindfulness, movement therapy, nutrition, psychiatry and psychology.

Patients, for example, may get massage for musculoskeletal pain and counseling or medical management of depression or anxiety all at one location.

“We want you at your highest level of function at your lowest possible level of pain,” Vaglienti said. “That’s why this is a very nice combination of traditional medicine and complementary medicine aimed at the same goal.”

That goal, says Raymond Lemansky, LMT, a massage therapist at the pain clinic, is to treat the whole patient. One therapy alone may work—such as massage to treat lower back pain—but synergistically, using multiple therapies yields better results, he said.

Raymond Lemansky, LMT

The pain center has plans to conduct studies and track their results as its practitioners see more patients, said Vaglienti. And the center is already seeing more patients, added Lemansky, since West Virginia’s Opioid Reduction Act went into effect in June.

As word gets out about the new requirements for opioid alternatives, they expect to see even more patients.

What the New Law Requires

While West Virginia’s new law requires physicians to refer pain patients to complementary therapies, patients aren’t required to go the complementary therapy route or to exhaust all complementary therapies available before being able to get a prescription for opioids, Lemansky and Vaglienti said.

Some of the pain patients they see at the clinic are going through the motions of seeking complementary therapies, more intent on doing what is necessary to keep their opioid prescriptions than finding an alternative to opioids, but many are open to the idea of alternative therapies for treating their pain, Lemansky said.

“A lot of people are looking at the deleterious effects of the opioids,” he said, and are trying to avoid using them, while others who have been on them are trying to find an effective way to wean off them.

The new law was written with the intent of decreasing the amount of opioids prescribed to acutely injured patients, though it allows only 20 visits to complementary therapists to be covered by insurance, Vaglienti noted.

He hopes as the state continues to make progress against opioid usage and more evidence emerges that supports the use of complementary therapies in that fight, the law will be amended and the number of covered visits increased.

But for now, he said, “We’re on the right track.”

About the Author

Stephanie Bouchard is a freelance writer and editor based on the coast of Maine. She frequently reports news and features for MASSAGE Magazine; her articles include “Innovative New York Program Brings Massage Therapy to Military Veterans” and “In the Midst of Gentrification, Oakland Cancer Clinic Offers Massage to Low-Income Clients.”