The United States is in the midst of the worst addiction epidemic in history and New Hampshire has become its poster child. The statistics are startling with nearly 64,000 lives lost to overdoses in 2016, a greater loss of life than the entire Vietnam War. As attention is focused on finding a solution to this crisis, the finger of blame has been pointed firmly in the direction of the pharmaceutical industry and a medical community encouraged for over a decade to generously prescribe some of the most addictive substances known to man. The CDC estimates that up to 80% of heroin addicts developed their addiction through the legitimate use of opioid medications.

As scientists and policymakers around the country have struggled to come up with strategies for this societal catastrophe, new research out of Dartmouth College lends support to treatment options endorsed by nearly every major health agency in the country. Upon reconsideration of the treatment of pain, the CDC, Joint Commission, FDA, Institute of Medicine, American College of Physicians and the Canadian government have all adopted new standards calling for non-pharmacologic methods as a “first-line” approach. Last month, The Lancet, one of the world’s most prestigious medical journals, called for non-drug therapies first in its comprehensive study on lower back pain.

Given New Hampshire’s high incidence of addiction and readily available data from the state required insurance reporting, Dartmouth researchers chose to study opioid use patterns in New Hampshire. Dr. James Whedon and co-authors have recently been published in the Journal of Alternative and Complementary Medicine for their research article entitled “Association Between Utilization of Chiropractic Services and Use of Prescription Opioids”. In their analysis of the treatment of lower back pain, the most common condition treated with opioids, Whedon and his team found that there was a 55% reduced likelihood of people filling a prescription for opioids when chiropractic was part of the patient’s care. Additionally, they found a 78% reduction in charges for clinical services related to that treatment. The study, based upon data provided by the New Hampshire all payor claims database of nearly 13,000 cases for 2013 and 2014 should create a sense of optimism, however, in New Hampshire, significant barriers exist where underutilization of chiropractic services is enhanced by discriminatory insurance policies. One example is excessively high “specialist” co-payments for chiropractic services which ultimately drives the consumer toward the seemingly less expensive option of drug-based care, typically through the substantially lower co-payment of the primary care physician.

Attempts to remedy this led to the commission of a study by the New Hampshire State Legislature in 2014. Based upon data from 2013, Compass Analytics Healthcare Inc. concluded in their report, “any use of and the amount of use of chiropractic care was associated with a statistically significant reduction in the use of opioids”. Furthermore, they also found, as did Whedon’s team, the overall cost of care was less while maintaining a very high patient satisfaction and outcome of benefits. Unfortunately, further studies requested by the legislature to be completed by the New Hampshire Insurance Dept by October 2017 was not performed and co-payment reform stalled as a result.

Several states around the country have embarked on creative programs to reduce opioid use and provide patients non-pharmaceutical based care. In Rhode Island, a program encouraging chiropractic, acupuncture, and massage therapy for higher risk Medicaid patients resulted in an 86% reduction in opioid prescriptions. Rhode Island has recently passed a law requiring insurance to cover non-opioid-based chiropractic care for people with substance use disorders. The Oregon Health Plan began encouraging the use of complementary therapies, including chiropractic, in January of 2016. Most recently, West Virginia passed legislation, effective in June, that requires medical providers refer patients with pain to an alternative care practitioner, such as a chiropractor, before opiates can be prescribed. In Ohio, the attorney general’s office is working directly with the state chiropractic association on new policies and drug education in the schools.

As America and the state of New Hampshire look for exit strategies to the opioid crisis with greater emphasis on non-pharmaceutical methods of care, the chiropractic profession in New Hampshire stands ready to work with our legislators and policymakers to improve public information, educate medical providers and payors of the benefits of non-drug approaches to health care.

Mark Stagnone, D.C.
President, New Hampshire Chiropractic Association