The Opioid problem is especially bad in New Jersey, but is a national crisis. Those who caused it are not owning up to it, but the short list includes major health insurers such as Horizon Blue Cross Blue Shield among others by raising co-payments, deductible’s and premiums while confusing the public with tiered networks that offer fewer affordable choices of provider.
The healthcare industry economically forced primary doctors into using 10 minutes or less office visits. Years of predatory practices resulted in larger hospital systems, larger practice groups run by large corporations and like in other areas of our economy, caused large scale consolidation with fewer competition. The result is of course is that we all pay more, while care is more fragmented than ever. This has partly led to the widespread use of pain medication to relieve their patients complaint, leading to chronic conditions later on and an Opioid crisis.
Recently, it was reported that Partnership HealthPlan in California took ownership of a problem they helped cause with Opioids. They began to change the way they treated pain in 2014 and eventually used chiropractors with the money they saved to help treat patients in pain without medication. The result is that fewer patients took Opioids or other pain killers and the plan saved billions, allowing them to use chiropractors who have helped these patients with solutions that addressed the pain problem head on.
This is unlike NJ where Horizon has systematically excluded most doctors of chiropractic in their Omnia plans from the less expensive tier, while indemnifying those large hospital system that are the cost problem. The result was that because of “uncertainty”, they raised Omnia premiums for the current year, while many patients found out their more effective providers were now tier 2 and they had to pay more to see them. The good news is that their advantage plan which is not tiered can be purchased for slightly more from your local insurance agent, but not on the insurance exchange.
While I understand the new buzzword in healthcare is population health, one size fits all solutions don’t fit all. There is growing evidence that a better fed public is healthier and has fewer diseases. There is also growing evidence that countries such as Brazil who eat more poor quality processed foods courtesy of the large food conglomerates have higher obesity levels and more illness.
Perhaps, health insurers should be more on the prevention side of the equation, instead on the expensive treatment side which makes us ill and drives medical costs. The wrong foods can cause inflammation, diabetes, and chronic pain, while those who are on statins for cholesterol are treating a “what if” problem that is far riskier and less effective than a low inflammation diet would be, at a higher cost. Since insurers earn more when we pay more in premiums, a side effect of the 80/20 rule in Obamacare, they earn more if we pay more each year. So far, they have followed this path to satisfy their company shareholders.
Doctors who caused the Opioid problem include pain management practices who treated pain broadly, without understanding why their patients hurt. Recently, their magazine Practical Pain Management even went to far to send a booklet on Opioid Prescribing and Monitoring, which hardly seems like they learned anything from the mess doctors created here in the USA. While I applaud their effort to help manage the Opioid problem they partly created, they continue to treat pain medicinally, even though most chronic pain is a mechanical problem requiring a mechanical approach to management and treatment.
Primary doctors after the advent of HMO’s that had nurse practitioners telling their patients to stay away and take meds for pain are part of the problem as well. Years later, many of these patients may have had knee and hip as well as other joint replacements as the medications made their pain more chronic.
When a patient gets worse or does not improve with the primary doctors, they refer to other doctors who follow the reductionist thought process of evaluating where we hurt, but not holistically evaluating why. We are sent out for tests that never tell us why we are ill, but the solution always seems to end up with a pill. The Opioid phenomenon an expression of reductionist approaches to pain by making pain treatment a priority, rather than using those who are better trained to evaluate and treat it such as doctors of chiropractic.
A recent NY Times article from Jane Brody on Alternative’s to drugs for treating pain also misses the mark by including some complementary methods, ignoring chiropractic entirely and suggesting that we treat our symptoms using non drug methods whose symptoms usually just go away anyway such as lower back pain. This is more reductionist folly, since we are now using complementary healthcare, which usually evaluates and treats the body holistically as we would a drug to relieve our symptom which is pain.
Doctor’s of Chiropractic have the highest levels of satisfaction for problems such as back pain, and many sports certified providers effectively resolve knee, hip, foot, ankle, wrist, shoulder and neck problems, as well as disc issues without the use of drugs or surgeries. While it would seem logical that surgery should always be an option, unfortunately, many people have been harmed by these and other invasive approaches that attempted to fix something that is poorly understood by medicine; why people hurt. Medications cannot fix mechanical problems in the body, which is why Chiropractic, a mechanically based approach is growing even when insurers fail to properly insure the public for their services.
The book, Cheating Mother Nature explains how and why we hurt, can help the general public understand the mechanisms behind chronic pain. An enlightened practitioner who evaluates and treats the body holistically is most likely to help those in chronic pain.
You are not a protocol, even though most healthcare providers treat you as if you are due to reductionist approaches to care. In the U.S., doctors usually first give you a medication yet, they are ill equipped to properly perform a quality musculoskeletal evaluation in the 10 minutes they have to do your evaluation and treatment recommendation. They need to be retrained to make appropriate referrals to a primary spine practitioner such as a chiropractor.
To fix the Opioid problem we need to
1. Refer those in pain to chiropractors who are underutilized in today’s healthcare marketplace for evaluation of their body mechanics and to better understand why they hurt.
2. Recommend foot orthotics to those who are built asymmetrically. This is a huge healthcare cost driver. Chiropractors are primary care for the musculoskeletal system. Why do we need to see a foot doctor, a rehab person, an orthopedist, and have an MRI of a painful part. A chiropractor can evaluate and treat the problem in house and in most cases, solve it without resorting to a disjointed and error prone treatment path that is more costly and less effective while being a one stop shop for most chronic and acute pain?
3. Insurance carriers must fully partner and embrace doctors of chiropractic, and stop being predatory. Sometimes your chiropractor may need to spend an hour with you if they need it for evaluation, treatment or both. If this improves or resolves the problem, why do insurance companies continue to question their approach if it is effective? Insurers are constantly trying to make chiropractors a one size fits all provider, even though they treat sports injuries, chronic pain and even foot problems, which can be time consuming. Most recently, Optimum Healthcare had the wonderful idea of paying chiropractors a low global fee and they are no longer paying for the evaluation which is time consuming for the doctor. Insurance companies continue to incentivize doctors to take short cuts and do volume, rather than make their care more patient centric which is what many people require. Again, we see how insurers can be the problem, and when the problem does not resolve, their primary doctor will prescribe medications which is partly how we ended up with an Opioid problem.
Chiropractors are indeed part of the solution to the Opioid crisis. They should be the first on your list if you suffer from back, knee, foot, leg, shoulder, neck and even arm or elbow problems. They should be the first on your doctors list for whom to refer to.