The Opioid Epidemic and Chinese Medicine's Role in Helping

Every day in the United States over 115 people die from overdosing opioids. Between 21-29% of patients prescribed opioids for chronic pain, misuse them. 8-12% will develop an opioid use disorder. That is 2 million people. And while the National Institute of Health says the overall economic burden in the US is $78.5 billion dollars per year, the White House’s Council of Economic Advisers says this reaches up to $504 billion per year. These numbers are staggering.

Acupuncturists and Chinese medical practitioners can help.

There is growing but still controversial evidence that acupuncture and Chinese medicine can help the epidemic of opioid addictions. The reality is it may be years or even decades before science catches up with what we practitioners know already: acupuncture does help addiction, and for reasons, we will discuss especially opioid addiction. However, even if we do absolutely nothing for opioid addiction, acupuncture can be a huge contributor to solving the problem simply by doing what each of us already does every day: relieve pain.

Let’s first look at addiction. According to the DSM-5, opioid use disorder is defined as having at least 2 criteria (out of 11) occurring within 12 months. Many of these are obvious (such as a persistent desire or unsuccessful efforts to reduce or control opioid use). Two are important and several experts say these define the addiction to substances: tolerance and withdrawal. Tolerance is defined as either needing increased amounts of a substance to achieve intoxication or desired effect. The other definition and basically the flip side of this last one is a diminished effect occurs when maintaining the same dose of a substance. Withdrawal is defined as either having a characteristic withdrawal syndrome when stopping (or reducing) a substance or a substance is taken to relieve or avoid a withdrawal syndrome.

When we look at these two criteria, when opioids are used for relatively short periods of time for acute conditions, tolerance generally does not develop nor does a withdrawal syndrome. And addiction does not develop. However, when used for a chronic pain condition, tolerance will occur and when attempting to stop, a withdrawal syndrome. And an opioid use disorder can happen.

Opioid withdrawal syndrome is defined as having three or more of the following after reducing, ceasing opioids, or administering an opioid antagonist: dysphoric mood, nausea and/or vomiting, muscle aches, tearing or runny nose, dilation of pupils or goosebumps or sweating, diarrhea, yawning, fever, insomnia. These effects must cause significant distress or impairment of functioning and cannot be attributable to another condition.

That was a very quick overview of opioid addiction. So how can Chinese medicine help?

First, we are an excellent choice to prevent the use of opioids in the first place. By treating chronic pain, we can reduce the need for opioids. While we have made great strides, and research is generally supporting our effectiveness, we still have a way to go to convince the medical establishment. Using the context of the opioid epidemic, we are already opening more doors than ever before (for example by getting acupuncture into the Veteran’s Administration and even TriWest for active-duty military). We need to do more to advocate for the use of acupuncture especially in the context of chronic pain.

Second, we can directly treat opioid use disorder. Of course, the National Acupuncture Detoxification Association(NADA) protocol is a widely recognized approach to treating addiction with acupuncture. Assuming most acupuncturists are familiar with this protocol, let’s discuss other approaches. 

One interesting 2013 review article (White) looked at the literature about acupuncture for drug dependence. It had some very interesting summaries from the literature. Most importantly it showed three interesting treatment variables. The first is body acupuncture was useful for craving and withdrawal symptoms and not useful for abstinence or attrition (dropping out of a recovery program or the research project). The second was electroacupuncture was beneficial for all four of these outcomes. The last was bilateral needling was helpful for abstinence, craving, and withdrawal symptoms. Based on this, our approach to addiction of all types should be to use electroacupuncture bilaterally.

Adding to this, several papers and reviews looked at the use of different frequencies of electroacupuncture and their effect on different neurotransmitters and effects. For example, Han, Cui, & Wu (2011) state low frequency (2 Hz) is most effective for treating withdrawal symptoms while high frequency (100 Hz) is best for alleviating craving.

One of the complicating factors with using acupuncture in opioid addiction is how acupuncture treats pain. While the pain-relieving effects of acupuncture appear to be multifactorial including increasing blood flow, reducing inflammation, regulation of various hormones and autocoids, one mechanism is the activation of the endorphin system. This system is what opioids high jack for their effects as well. This means a few things. One is acupuncture may be a useful substitute for opioids. However, it also means non-novice opioid users will probably have reduced effects from acupuncture due to tolerance. This means a chronic opioid user may never have the same pain relief from acupuncture than an opioid non-user.

A review article (Shi, et al., 2006) cited many herbs that can be helpful in treating opioid addiction including gan cao (licorice) and tian ma (gastrodia) for eliminating the effects of toxicity, ren shen (ginseng) and huang qi (astragulus) for reinforcing healthy qi, and ban xia (pinellia) and suan zao ren (sour jujube seed) for relieving withdrawal symptoms. This article also talked about a few useful points in treating opioid addiction, however, they were based on research in rats and may not be useful in humans. Finally, there is some research coming out about combining acupuncture with biomedical approaches to treating opioid use disorder and opiate withdrawal syndrome. One meta-analysis looked at combining acupuncture with opioid receptor agonists (Liu, et al., 2009) and found this combination lowered withdrawal symptoms, adverse effects, and the required dose of the agonist. However, despite these advantages, the overall relapse rate was unchanged after 6 months.

In summary, there are many ways acupuncturists and Chinese medical practitioners can contribute to the solution for the opioid epidemic. We can prevent their use in the first place. Use acupuncture, whether the auricular, body, and/or electroacupuncture and herbs to help treat the addiction and minimize withdrawal symptoms. Or we can work with biomedical approaches to the epidemic. And nothing prevents us from doing all three. However, it all starts with us feeling confident of our abilities and spreading the word...