Study: Family Physicians Who Learn Acupuncture Prescribe Fewer Opioids

Study: Family Physicians Who Learn Acupuncture Prescribe Fewer Opioids

How are some family physicians treating one of the biggest public health problems of the past 25 years?

With a form of healing that has been practiced for millennia.

Since the mid-1990s, the opioid epidemic has resulted in the deaths of tens of thousands of Americans(www.drugabuse.gov)and created an economic burden that, according to some estimates, now totals more than $78 billion per year.(www.ncbi.nlm.nih.gov) In response, family physicians and other health care professionals are using every tool at their disposal to fight the epidemic, including what some consider a promising — albeit surprising — therapeutic protocol.

In a letter published online in the journal Pain Medicine, three researchers, including one member of the Uniformed Services AFP (USAFP), presented findings that showed an association between opioid prescriptions and acupuncture training when managing patients with chronic noncancer pain. The authors found that family physicians trained in acupuncture prescribed fewer “strong” opioids such as oxycodone and fentanyl than did FPs without training. And, in fact, those with more advanced acupuncture training prescribed far fewer opioids overall after their training than they did before.

“Research continues to highlight that nonpharmacologic treatments such as acupuncture may provide benefits to some patients,” said Julie Wood, M.D., M.P.H., AAFP Senior Vice President for Health of the Public, Science and Interprofessional Activities. “Given the effects of the ongoing opioid epidemic on pain management, nonpharmacologic options are important in helping patients manage pain.”

Study Methods and Findings

The authors reviewed data from the USAFP’s Clinical Investigations Committee, which sent a survey to all physicians who registered to attend the USAFP’s 2017 Annual Meeting & Exposition. The survey asked physicians to provide demographic information and to indicate whether they had no acupuncture training or had completed training in auricular acupuncture (a 20-hour course with an emphasis on stimulation of points on and around the ear) or medical acupuncture (a more comprehensive course spanning 220 or more hours of training on multiple forms of acupuncture).

In addition, physicians were asked a series of questions about their opioid prescribing habits, along with queries about how often they used or recommended nontraditional therapies such as nutrition, acupuncture and massage.

Specifically, participants were asked to estimate, averaged over the previous three months, the number of patients per month for whom they had written a prescription for either “weak” (codeine, meperidine, pentazocine, propoxyphene or tramadol) or “strong” (fentanyl, hydrocodone, hydromorphone, methadone, morphine or oxycodone) opioids for chronic noncancer pain. Those responses were then correlated with the respondents’ self-reported acupuncture training status.

The researchers found no significant difference between family physicians with no acupuncture training and those with any level of training when it came to the number of patients prescribed weak opioids for chronic noncancer pain.

There was, however, a difference when it came to prescribing strong opioids. More than 5 percent of family physicians with no training in acupuncture reported that on average, they wrote prescriptions for strong opioids for 11 or more chronic noncancer pain patients each month. In comparison, only 2 percent of family physicians trained in auricular acupuncture and no physicians trained in medical acupuncture said they wrote prescriptions for strong opioids for that many patients per month.

At least some proportion of physicians in both acupuncture groups also reported prescribing fewer opioids overall after receiving acupuncture training. One-sixth of family physicians in the auricular acupuncture group and more than 77 percent of FPs in the medical acupuncture group agreed or strongly agreed with the statement that they currently prescribed fewer opioids than they did before learning acupuncture.

Finally, acupuncture training was associated with an overall preference for nontraditional pain management therapies. Every family physician in the medical acupuncture group and 80 percent in the auricular acupuncture group reported that they often or always preferred using nontraditional therapies to manage pain, compared with 66 percent of those with no acupuncture training.