High profile manufacturers such as Johnson and Johnson continue to go to court because of their part in the opioid crisis, yet the problem could not have occurred without insurers and medical providers who did not understand why their patients hurt. Ironically, professions such as chiropractic have the tools to help these patients without the use of drugs or surgeries, yet, their talents are underutilized in favor of more costly and risky methods, drugs, and procedures.
Giving somebody medication for the relief of pain, while ignoring the mechanisms of pain is what caused the Opioid problem. Even as doctors prescribe other medications for pain, patients often do not realize the future harm they may experience years later through addiction, side effects or the long-term effects of ignoring the mechanism behind their pain. This methodology has helped the business of replacing hips and knees grow to what it is today, when these costs and risks may have been avoided with the right type of care early on.
The long term effects of Opioids are more than just the drugs themselves, but involves the insurance company and medical culture that makes it less expensive to get a drug and segments the care to different providers which is ineffective, expensive and potentially harmful.
The current diagnosis of Fibromyalgia is a prime example of how poorly patients in pain are managed or diagnosed medically. People diagnosed with Fibromyalgia often have other mechanical based problems that may have been either misunderstood or ignored entirely by their physicians who have little training in diagnosing the musculoskeletal system. Patients are sent from specialist to specialist, who diagnose their symptoms, and either inject the area or recommend therapies that could not possibly work. They are also given drugs such as Lyrica which are believed to work on Fibromyalgia which was a disease category developed by a group of rheumatologists in 1990.
Yesterday, I was with a new patient whose problems had a common cause, yet doctors have treated each of her symptoms which have worsened over time. Numerous doctors told her she had fibromyalgia. She had chronic lower back pain, a problem in her shoulders, sore knees, and other symptoms. There was a common element to her pain that was missed by her other healthcare providers because they looked at where she hurt, rather than looking at her holistically. The movement of the human body is holistic and it is impossible to properly understand the mechanism of pain if a patient is not properly examined. Studies show that pain and movement are closely related. There was a common mechanism behind why she was hurting and she had improved in her abilities to move by the second visit, with less pain, although she has a long way to go toward improvement.
Chiropractors are primary care for the musculoskeletal system. Insurers have made accessing a chiropractor more expensive when they needed to make access less expensive and easier. One insurance carrier has the data to support the idea and admitted that seeing the chiropractor first for problems such as back pain has saved them millions of dollars. Another carrier, Partnership Health Plan in California that is a Medicaid insurer realized that they were the cause of the opioid crisis there and added chiropractic care which reduced costs and drug use for pain overall as well.
Other carriers, such as Horizon Blue Cross in NJ continue to make it more difficult to see a conservative drug fee provider and recently, blamed the growing costs of care on professions such as chiropractic. Chiropractors and other therapists have not received a raise from Horizon for years, and 95% of chiropractors have been placed in Tier 2 in their Omnia plan which makes chiropractors more expensive to visit, while large hospital systems became larger and charged more for their services. Medication and procedure-based care is still much less expensive because Horizon has made it this way.
Utilization has gone down, while opioid use has gone up, so how can chiropractors be Horizons costs problem? Many patients eventually visit a chiropractor anyway, as they often are the only doctor that safely gives them relief of their pain.
Patients are paying for the care, rather than the plan even though they are insured which is absurd. Increasing access is how you solve an opioid crisis. Suing the companies who manufactured opioids so states have money to detox patients who became addicted at the hand of their doctor and their insurer does not solve the drug culture that caused the opioid crisis.
Solving the opioid crisis requires utilizing providers who have the skills to properly diagnose and treat these patients. Experts agree that this can only happen with the right incentives, such as low copayments which will make it much less expensive for patients to access the care they need. High deductibles have been inflationary for healthcare costs and we are all paying the bill. Maybe we do need a public option that people can buy into that makes healthcare more affordable again.
A recent study published in the BMJ (1) supports the idea that seeing a conservative care provider helps people stay off drugs. The study included 216,504 people 18 or older with new-onset back pain. They concluded that initial visits to chiropractors or physical therapists are associated with substantially decreased early and long-term use of opioids. Incentivizing the use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.
The solution to the opioid crisis is simple. Patients must be able to get the care they need affordably, and primary care doctors must refer them to drug-free providers such as chiropractors first. The pill for a problem narrative has never been the answer and the long term has driven healthcare costs higher. Drug-free providers are the answer.
1. An observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use
Lewis E Kazis1, Omid Ameli1,2, James Rothendler1, Brigid Garrity1, Howard Cabral3, Christine McDonough4, Kathleen Carey1, Michael Stein1, Darshak Sanghavi2, David Elton5, Julie Fritz6, Robert Saper7