Opiod Crisis and Massage Therapy

I normally don’t watch C-SPAN and especially not 2 hour-long Senate hearings, but I came across an article on the AMTA website for massage therapists. It was stating that massage therapy is recommended in the help with the Opioid Crisis/ Epidemic. I wanted to see the transcript of these claims and couldn’t for the life of me find one! I tried googling for videos that were made mentioning massage and came up with nothing. That’s how I ended up watching 2 hours of “Testimony for the Senate Health, Education, Labor and Pensions Committee Hearing on managing Pain During the Opioid Crisis (February 12, 2019.)”

In February, The U.S. Senate Health, Education, Labor & Pension Committee (H.E.L.P) held a hearing on the opioid crisis in the US focusing on alternatives to opioids for pain relief. Emphasizing on non-pharmacological solutions to pain, it was loud and clear to the senators and witnesses that there is a huge demand for health insurance companies to cover alternative and complementary therapies.

The opioid crisis has been a long time coming. In the late 1990s, drug companies and the healthcare community did not believe opioid pain medication would cause addiction. Patients did become addicted however and doctors were prescribing them at an alarming rate not knowing it would become harmful to the patient. When it came on the White House’s radar, more than 72,000 Americans died of drug overdose in 2017 alone (many opioids), President Trump declared it a public health emergency. 

Two years later, there have been some new guidelines on the prescribing of opioids. Many states have limits on the duration/amount of opioid prescriptions with professionals now being in agreement that though opioids are powerful  and effective, they are extremely addicting.

With electronic monitoring of opioids through prescription drug monitoring programs (PDMPs) doctors can see clinical and pharmacy data to prevent doctor shopping and fraud. In addition, prescriptions were limited to 3 days and rarely more than 7 days. Exceptions being for active cancer, palliative, or end-of-life care. This left out chronic pain sufferers who rely on those medications for pain management.

Sue Glod, MD, palliative medicine specialist, “Drugs are being denied by insurance companies…(and) pharmacies aren’t stocking sufficient quantities of opioids, leaving our staff to go through a lot of paperwork, so there are wait times.”

These wait times can be devastating. While the doctor is waiting for an authorization policy for a prescription, the patient waits sometimes up to several days. During that time, if the patient has been using the opioid prescription regularly then they begin to go through withdrawal almost immediately. Many chronic pain sufferers have accompanying illnesses or diseases that are being overlooked and instead scrutinized by the public and even some doctors dismissed as medication-seeking. 

At the Senate hearing, two doctors, a pharmacist, and an addiction advocate gave testimony. They agreed that there was no one size fits all approach to pain management or to the epidemic at hand. In January, the US Department of Health and Human Services published a report on best practices for pain management that calls for individualized, patient-centered pain management which includes recommendations related to massage therapy.   At the same time, the Centers for Medicare and Medicaid Services (CMS) wrote to Medicare Advantage programs urging them to cover massage therapy in 2020. 

“CMS encourages MA (Medicare Advantage) organizations to consider Part C benefit designs for supplemental benefits that address medically-approved non-opioid pain management and complementary and integrative treatments… In addition, non-Medicare covered chiropractic services, acupuncture, and therapeutic massage furnished by a state licensed massage therapist, may also be incorporated into plan designs. “Massage” should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion).”

I am hoping that after the Testimony for the Senate Health, Education, Labor and Pensions Committee Hearing (February 12, 2019), additional statements from organizations, and more funded research, Medicare, Medicaid, and more private insurance companies will consider including massage therapy in their coverage. All things considered,  I was really only left with the Big Question. Where as a country do we go from here? 

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