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Chiropractor says med-free options still not available

Opioid crisis continues, with little help for non-pill options

WARREN — Synthetic opioids and other drugs still are killing dozens, if not more than 100, people each day in the United States.

Some efforts have been made to curb the overprescribing of opioids in hospital settings, but little has been done to guarantee health care facilities and insurance plans are using and covering the medication-free interventions that have been proven to keep a person off the gateway drugs that can eventually lead to illicit use, said Dr. Patrick Ensminger, a local chiropractor.

When a plane crashes in the United States, it is pretty big news. Images of the fiery wreckage are plastered on Fox News, CNN and other news stations, he said.

However, many people may be shocked to find out the amount of people dying from accidental overdoses still is enough to fill a 737 jetliner with passengers and crash it every day, killing everyone on board, Ensminger said.

And if that doesn’t tickle your empathy bone, the cost to the American economy is estimated at $700 billion to $1 trillion, he said.

Curbing the deaths is in the best interest of doctors, lawmakers, budget writers, coroners, children, police officers, teachers, counselors, EMTs, people with or vulnerable to substance-use disorders, and the family and friends of people who have died or will die.

Efforts are being made to hold the drug makers and distributors responsible for flooding the market with the highly addictive opioids through a series of lawsuits filed in Ohio and other states. In addition, states like Ohio have made efforts to curb prescriptions and implement plans for monitoring and taking a person off opioids. But there is still a lot of work to be done, Ensminger said.

The restrictions on the prescriptions — without plans to wean a patient off the meds or to replace the treatment with a medication-free option, like physical therapy or chiropractic therapy — may have driven more opioid users to the streets, he said.

STILL OVERPRESCRIBING

Although prescriptions for opioids in some situations has been decreasing, it isn’t by enough, Ensminger said. An FDA report released in November states American patients were 70 times more likely to be prescribed an opioid than a person seeing a doctor in Europe.

The report found “U.S. physicians are still dramatically overprescribing opioids for pain, rather than referring cases to drug-free health care providers,” Ensminger said.

Methods to reduce the prescriptions often lead to just pushing back the time it takes for the physician to give an opioid, or replacing the opioid with a similar drug.

“That opioids are still actually commonly prescribed for run of the mill musculoskeletal pain is not progress,” Ensminger said. “Right now, the MD might say, ‘I don’t do opioids anymore, so I’m going to send you to pain management or I’m going to send you to an orthopaedic specialist.’ Guess what they’re going to get there? ‘Well, you don’t qualify for surgery, so here’s a course of opioids, go to the pain management.’ And the, ‘Well we tried an epidural and it didn’t work, so here’s some opioids.’ So they still end up getting that kind of management, it’s just being pushed upstream.”

And the opioids don’t treat the underlying issue; they cloud the pain of an issue. Physical therapy and chiropractic work may have a chance at eliminating the problem after a treatment plan is implemented and followed, Ensminger said.

These practices continue in health care facilities, despite federal and state guidelines that recommend the alternative treatments, Ensminger said.

A study of over 200,000 patients with first time back pain found if someone saw a chiropractor before an MD, 90 percent were less likely to get prescribed an opioid than if he or she saw a doctor first, said Ensminger, referring to the study published in BMJ Open, a national medical journal.

“Our doctors are well meaning and want to do the right thing for their patients but they are stuck in an American health care culture where there’s a drug for everything. The United States spends more than twice as much per capita on health care as other developed nations and yet we rank a disappointing 37th in overall health globally,” Ensminger said.

INSURANCE COVERAGE

One of the main detriments to patients and chiropractors like Ensminger, who has a practice in Howland, is still the culture in health care providers that stigmatizes chiropractic work, he said.

Though Ensminger can make referrals and call for scans like other doctors can, few health care facilities or insurance plans recognize the value chiropractors can add to their treatment teams.

The way health insurance plans are structured, chiropractic care can cost a patients 70 times more than an opioid prescription, Ensminger said. A patient can come see him, and find the copay under certain insurance plans at $50 for a round of treatment, but find a $10 copay for an opioid prescription.

Efforts to negotiate with insurance companies and health care facilities has led to little change, he said.

Ohio chiropractors want a “seat at the table” with regulators and insurance companies as they create rules and plans for the future because they want to help people with chronic pain in a way that doesn’t endanger their patient with addiction, Ensminger said.

Changing the price structures of the insurance plans can lead to a real change in what services people opt for and has a chance of changing the culture surrounding pain treatment in the U.S., he said.

rfox@tribtoday.com

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