Chiropractor John Rosa was a board member for the Maryland University of Integrative Health in the early 2000s when practitioners across the country started noticing an uptick in the prescribing of opioid painkillers. It started with OxyContin, he said, and moved onto Percocet, Opana, Vicodin — a slew of potent narcotics prescribed for even acute injuries.
“We were all in these rooms together thinking, ‘Why is this happening?’” Rosa said. “I would go into meetings and be like, ‘Guys, are you noticing this, too?’”
For a provider of chiropractic therapy — an alternative, or complementary form of treatment that advocates for healing without drugs — the new trend was particularly concerning. Rosa has been in the business for 25 years and pushes for non-medicated pain management through musculoskeletal manipulation, movement therapy, and common-sense lifestyle changes such as diet and exercise.
Rosa, a regional provider with 14 treatment centers in the D.C. area, recently opened a clinic at the Menocal Family Practice on Baughmans Lane in Frederick, where he treats patients free of charge. He likes to say that he predicted the opioid epidemic before the issue became a source of national attention. Since then, the nationwide crisis has become a personal crusade.
Opioid prescriptions have gone down by 70 percent at Menocal Family Practice since Rosa started treating patients for pain management, a statistic confirmed by Dr. Julio Menocal, the owner of the office.
The chiropractor has also taken his advocacy to the federal level. In 2017, he was asked to serve as a surrogate to the White House commission on the opioid crisis. In March, he participated in the White House opioid summit and presented on the importance of integrative care.
“There’s just zero degrees of separation,” Rosa said. “I have friends, family, co-workers who have all been affected. And there are so many discussions on recovery, but when are we going to have a conversation about stopping the addiction in the first place?”
For Rosa, and a slew of alternative medicine providers across the country, complementary therapies should play a critical role in preventing opioid dependence and treating patients with substance use disorder.
Several states have expanded Medicaid to cover treatment such as chiropractic therapy and acupuncture, another nontraditional modality that uses needles to stimulate different points on the body.
As concern over opioids continues to grow, alternative providers have campaigned for more involvement and collaboration with more traditional forms of treatment. Kallie Guimond, a lobbyist turned acupuncturist with a practice in Frederick, has become another vocal advocate.
Last November, she organized a Congressional briefing on the role of acupuncture with help from Rep. Tim Ryan (D-Ohio) and Rep. Judy Chu (D-California), co-sponsors of a bill to expand acupuncture services to veterans.
The American Society of Acupuncturists (ASA) — on which she sits as a board member — helped write a white paper titled “Acupuncture’s Role in Solving the Opioid Epidemic.” Guimond also serves as a consultant for the Integrative Health Policy Consortium, which also held a briefing in March to announce the formation of an Integrative Health and Wellness Congressional Caucus and tout complementary solutions to the opioid crisis.
Like Rosa, Guimond has experience treating patients with opioid dependence and using alternative therapies to treat pain. She began her clinical training at the Penn North Community Resource Center in Baltimore, using acupuncture to treat substance abuse patients.
She started acupuncture treatment herself during a painful battle with cervical cancer and continued as she recovered from a hysterectomy and two surgeries to remove seven major tumors.
“From the minute I had my first acupuncture treatment, it was magic,” Guimond said. “I felt like I was superhuman in that moment — like I knew what it felt like to be firing on all cylinders. Acupuncture was the one thing I could put my hands on that really made me feel better.”
One of her patients, Terri Winn, feels just as strongly about the treatment. The 59-year-old Frederick woman began acupuncture with Guimond after the death of her son in September 2016 from a fentanyl overdose.
For Winn, acupuncture is more than just an effective treatment for the pain — manifested by grief, she said — that settled into her back and shoulders after her son’s death. She also believes that the therapy, and other alternative treatments, could have saved his life as he worked through the recovery process.
Her son was prescribed Suboxone — a synthetic opioid used to treat addiction — after being hospitalized for a hole in his esophagus, caused by violent vomiting as he was withdrawing from heroin, Winn said. But as he worked through recovery, her son often had trouble filling his prescription due to tighter regulations on opioids — an experience that made him feel alienated and stigmatized.
“I truly believe that if alternative therapies were an option for him, he might be alive today,” Winn said. “Can you imagine someone like my son — someone who’s 23 — going through that alone? We’re talking about kids, whose brains aren’t even fully developed, getting addicted to dangerous narcotics. They need to be looked at as a whole person.”
The problem for practitioners like Rosa and Guimond is that alternative therapies often remain inaccessible to the substance abuse patients who need them most.
While Maryland Medicaid covers both chiropractic and acupuncture for children under the age of 21 under the Early and Periodic Screening, Diagnosis and Treatment program, adults are not eligible for the service, according to Brittany Fowler, a spokeswoman for the Maryland Department of Health.
That totally excludes the majority of patients with addiction, who generally find themselves on medical assistance, Rosa said.
Alternative therapies are often controversial or overlooked among the medical establishment, he added. While chiropractic has been subjected to more rigorous research, clinical studies on the efficacy of acupuncture remain mixed.
Few doctors are willing to recommend either therapy over medication-assisted treatment — the current gold standard for substance abuse — and most don’t know enough about alternative medicine to make referrals.
“It’s frustrating because, in my mind, we’ve gone down the path of treating symptoms and moved away from healing the whole person,” Rosa said. Both he and Guimond would like to see their services covered by Medicaid, as well as private insurance, and for them to be seen as a first-line defense for both pain management and substance abuse recovery.
“When I see a patient, I almost don’t care about the specific pain they’re feeling,” Rosa continued. “I want to know the root cause — be it diet, obesity, or lifestyle changes they could make to help alleviate what they’re feeling. We’re the ones equipped to take a holistic approach — getting to the cause of the symptom rather than treating the symptom itself.”