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Review of US Health Policy on Acupuncture Application for Opioid Abuse Crisis

Article information

J Korean Med. 2020;41(2):137-149
Publication date (electronic) : 2020 June 1
doi : https://doi.org/10.13048/jkm.20020
Juchul Kim1orcid_icon, Eunhye Hyun2orcid_icon, Dongsu Kim3,orcid_icon
1Research Institute of Korean Medicine Policy, The Association of Korean Medicine
2Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University
3KM Policy Research Center, Korea Institute of Oriental Medicine
Correspondence to: 김동수 대전 유성구 유성대로 1672 한국한의학연구원 한의학정책연구센터, Tel: +82-42-869-2713, E-mail: dskim12@kiom.re.kr
Received 2020 May 6; Revised 2020 May 25; Accepted 2020 May 27.

Abstract

Background

Opioids are a class of drugs found in the opium poppy, and used primarily as a pain reliever. About 130 people die every day from opioid abuse in the U.S., and the number of deaths was 6 times higher than it was 20 years ago.

Objectives

To derive the implications on Korean Medicine(KM), this study aimed to investigate the current state of opioids abuse in the U.S. and analyze cases to solve opioids abuse using acupuncture.

Methods

Literature on opioids abuse in the U.S. were searched through the websites of government, agency, and research institute.

Results

There were several cases using acupuncture on opioids abuse. First, the Act on the use of acupuncture was enacted. Second, the clinical practice guidelines by the American College of Physicians recommended using acupuncture. Third, a large clinical study was conducted on whether acupuncture could replace opioids. Fourth, Vermont and Washington State conducted pilot projects on insurance coverage of acupuncture.

Conclusions

As opioids issues are also valid in Korea, KM can serve a critical role in pain management to pursue expanded insurance coverage. In order to do so, building the discourses of KM in opioid issues is critical by defining its medical advantage, conducting large-scale clinical researches and implementing pilot projects to tackle social problems.

Keywords: Opioid; US health system; Acupuncture; Health insurance; Pain management; Law

NIH HEAL(Helping to End Addiction Long-term) Initiative Research Plan

Multilateral policy response efforts using acupuncture as an alternative to opioid

Acknowledgements

이 논문은 한국한의학연구원의「한의정책기반연구사업(KSN2013422)」의 연구비 지원을 받아 수행된 결과로 이에 감사드립니다.

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Table 1

NIH HEAL(Helping to End Addiction Long-term) Initiative Research Plan

Category Category subject Research title Research plan
1st Investigators Interested in Early Stage Clinical Research: Does the Novel Intervention Have Promise for Future Trials? The Early Phase Pain Investigation Clinical Network (EPPIC; RFA- NS-19-025) Provide infrastructure for in-depth phenotyping and biomarker studies in patients with specific pain(low-back pain) conditions, as well as rapid design and performance of Phase 2 clinical trials to test the safety and collect early clinical data for promising novel therapeutics for pain (devices, biologics, and drugs)
NIH Back Pain Consortium Research Network(BACPAC; RFA -AR-19-029) Phase 2 trials on interventions for chronic low-back pain, including complementary therapies, conducted within the infrastructure of the EPPIC-network
2nd Investigators Interested in Effectiveness Research: Does the Intervention Work in “Real World” Conditions? Which Intervention Works Better for a Particular Pain Condition? The Pain Management Effectiveness Research Network(HEAL PainERN; RFA-NS-19-021) For interventions already supported by published safety and efficacy data, the HEAL PainERN will support comparative effectiveness trials of existing therapies or effectiveness of existing or novel approaches for preventing and managing pain while reducing risk of addiction
3rd Investigators Interested in Implementation Research: When the Intervention is Implemented in Health Care Settings, Does It Still Work? Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM; RFA-AT-19-004) Study the integration of interventions with demonstrated efficacy for pain treatment into health care delivery with partnering health care systems, or to study the implementation of health care system changes to improve adherence to evidence-based pain management guidelines
Pragmatic Randomized Controlled Trial of Acupuncture for Management of Chronic Low Back Pain in Older Adults (Acupuncture; RFA -AT-19-005) large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low-back pain

source: National Centers for Complementary and Integrative Health. “HEAL Initiative Offers New Funding Options for Clinical Trial Research on Pain. 2018 Dec 21 [cited 2019 Dec 4]; Available from: URL: https://nccih.nih.gov/research/blog/heal-funding-options-for-clinical-trial-research-on-pain.

Table 2

Multilateral policy response efforts using acupuncture as an alternative to opioid

Category Countermeasure Content
Law Legislation of Dr. Todd graham Pain, Management, Treatment, and Recovery Act of 2018

  • - Recommendation of acupuncture to acute and chronic pain

  • - Medicare and Medicaid service centers make guarantees that are not favorable for receiving medical expenses when prescribing narcotic analgesic instead of alternative treatments to narcotic analgesic
Legislation of AB-888

  • - Before overall pain treatment, drug-free pain alleviation treatment is discussed with the patient

  • - As drug-free pain treatment, acupuncture, chiropractic, and tai chi chuna are stated as drug free pain treatment
Public Insurance The State of Vermont’s Medicaid acupuncture pilot project

  • - A study has been conducted on the effectiveness of acupuncture as an alternative treatment to narcotic analgesic for a year from 2016. Due to positive clinical study results, inclusion of acupuncture in Medicaid is being considered.
The State of Washington’s acupuncture pilot program

  • - A pilot program on back pain has been conducted for 2 years from October 2017. Based on the results, acupuncture is guaranteed in occupational health and safety insurance in 29 US states in 2019
Clinical Issuance of drug-free treatment guidance for acute and chronic back pain by A.C.P.

  • - Both the medical personnel prescribing narcotic analgesic and the patient being prescribed or demanding narcotic analgesic are recommended acupuncture before prescription.
Research A scientific basis is prepared through promoting clinical study on pain at the National Institutes of Health(NIH)

  • - Research on the efficacy of acupuncture on chronic pain through large scale, practical, randomized comparative study with the subject of the elderly who are 65 or older