Starting in the 1970s and developing over a decade of assessment and improvement, the South Bronx's Lincoln Recovery Center staff refined the method of using five basic ear-points, which became the National Acupuncture Detoxification Association (NADA) protocol for the treatment of addiction.

By 1985, NADA incorporated as a not-for-profit training and advocacy organization, which uses the ear acupuncture protocol for addictions, mental health, as well as disaster and emotional trauma. NADA's website states it has "trained more than 10,000 health professionals, including counselors, social workers, nurses, medical doctors, psychologists, acupuncturists, chiropractors, outreach workers, drug court judges, corrections officers and others to use the protocol."

In 1987, as the crack-cocaine epidemic hit, the Lincoln Acupuncture Program formed a historic alliance with the criminal justice system to provide a pathway to probation for those convicted of drug offenses in New York City (NYC). From testimony presented by Michael O. Smith, MD, to the Select Committee on Narcotics of the U.S. House of Representatives on July 25, 1989,¹ 34 clients referred to the Lincoln Acupuncture Program by NYC Probation Department in 1978-88 were tracked. Eighteen clients (64 percent) received 10 or more acupuncture treatments over a two- to 15-month time period; only one had his probation revoked and was sent to prison.

Five of the 18 clients were given early discharges from probation due to significant progress. Five of the clients who received fewer than 10 treatments re-offended with none given early discharge. Dr. Smith reported that consistent (10 or more treatments) participation in the Lincoln acupuncture program correlates with increased odds of a 5:1 improvement in outcome.

Fast forward 30 years, and as we see on the news, hear from politicians, and know from our own communities, the opioid epidemic in the U.S. effects over 2 million people, with two deaths every hour caused by opioid overdoses. No long-term studies have substantiated the value of any one approach (medications, behavioral therapies, etc.); thus, there is no agreed-upon standard of care. Furthermore, addiction treatment does not have one size fits all effects or benefits; addiction is a disease of relapse.

Two tasks are at hand: one, preventing opioid addiction though the management of pain without the use of opioid treatment; and two, treating those already addicted. Acupuncture remains a cost-effective viable public health response to both issues of the epidemic, yet the silence on inclusion in public policy is deafening.

John Weeks, publisher and editor of the Integrator Blog News & Reports (and now the editor-in -chief of the Journal of Alternative and Complementary Medicine), penned "Open Letter to Barack Obama on Your $1.1 Billion Opioid Initiative: The Imperative for Integrative Medicine"² in the Huffington Post in February 2016. In this letter, Weeks cites first, the omission of integrative approaches in the costly plan; and two, the recommendation of the Pain Action Alliance to Implement a National Strategy (PAIN) brief Never Only Opioids³ that every clinical model should include a non-pharmacologic method as part of the plan.

In the position paper of The Joint Acupuncture Opioid Task Force,⁴ initiated by The American Society of Acupuncturists and the Acupuncture Now Foundation, extensive research findings support acupuncture's role as an endogenous opioid and anti-inflammatory. The position paper details four main points:

• Acupuncture is an effective, safe, and cost-effective pain treatment that should be prescribed before opiates.
• Acupuncture produces and releases endogenous opioids.
• Acupuncture has the capacity to reverse adverse neuroplastic changes associated with chronic, severe pain.
• Acupuncture is a useful adjunctive therapy in opiate treatment and recovery.

Both the American Medical Association (AMA) and American Public Health Association (APHA) have also put forward policy recommendations supporting non-pharmacological approaches to pain management. Even a letter to the CDC in January 2016 from the Joint Acupuncture Opioid Task Force, Acupuncture Now Foundation and the American Society of Acupuncturists states: "We strongly believe that the CDC is undervaluing the best chance we have as a nation to address this crisis: non-pharmacologic alternatives."

At the annual American Nurses Association (ANA) gathering, nurses discussed the need for a sea change away from the belief that medication will make it all better. Dr. Cipriano, the 35th president of the ANA, says "we must promote alternative treatments, including physical and occupational therapy, acupuncture, mindfulness, and other holistic approaches. However, it was noted that many of these alternative treatments, which a nurse might recommend for pain management, are not covered by insurance companies to the extent that drugs are, if at all."⁵

Acupuncture has demonstrated value for treating pain, which is a significant predictor of self-medication, often in the form of drug or alcohol use. Acupuncture clearly has a long history of safely and effectively treating people with addictions. Although public policy on the inclusion of acupuncture in the national plan to address the opioid epidemic is lacking, acupuncture has been well positioned as a community-based treatment option. Here are a few suggestions for acupuncturists wanting to be part of the solution:

• Have referral resources available for addiction centers that include acupuncture.
• Even if you don't practice addiction treatment, take a continuing-education course about it so you'll be able to knowledgeably advise patients and their families.
• If you do provide treatment addressing addiction, work as part of a team. Acupuncturists should realize the essential importance of providing treatment within the context of counseling and support. As acupuncturists, we're not trained to be counselors – we can be empathetic, of course, but experienced addiction counselors need to be part of recovery team. It takes a village.

One such model of public health integrated care is Recovery Without Walls (RWW) of Cape Cod, Mass. In 2015, RWW initiated an innovative acupuncture component to its services. Due to the profound success of the service (80 percent recovery rate in the acupuncture clients), RSS created a video about the benefits of acupuncture in preventing relapses.

Bill Dougherty, RWW executive director, shared some of this experience with us.

AT: How did you go about setting up the program?

Bill: I found three licensed acupuncturists in the area who had an interest in working with addiction. Since NADA protocol is not approved in Massachusetts, our acupuncturists provide full body treatments in their personal clinics.

AT: How would RWW describe an ideal acupuncture provider? What factors, traits and experiences are important?

Bill: I find providers I deal with have natural empathy and are non-judgmental, which are the two most important traits. They've been more than willing to help and have had phenomenal results.

AT: What central message(s) does RWW have for the acupuncture community?

Bill: The thing I want people to know is that acupuncture really works for addicted populations. I've been doing this for 30 years, and I have seen nothing that works like acupuncture. I have found it especially works well in conjunction with therapy and/or 12- step programs.

Acupuncture is the only treatment that works with addicted women with histories of sexual trauma. Within three or four weeks, there is a noticeable difference [compared to women with sexual abuse histories not receiving acupuncture]; within three weeks they can begin to deal with the trauma in therapy. Dealing with the contributors to addiction is critical for recovery to work.

AT: Any last comments you'd like to make to the acupuncture community?

Bill: It is really important not to judge, and to see the whole person, although acupuncturists seem to do that naturally. Deal with the client gently. This is not new news. Acupuncture is such a huge service, especially for the woman who has been abused and can't find her way back. Acupuncture is the key.

Editor's Note: RWW services are free to all clients. RWW reimburses the acupuncturists $55 a treatment that is raised via their donors.

References

1. Smith M. "Acupuncture Treatment for Drug Addiction." Testimony presented to the Select Committee on Narcotics of the U.S. House of Representatives, July 25, 1989.
2. Weeks J. "Open Letter to Barack Obama on Your $1.1 Billion Opioid Initiative: The Imperative for Integrative Medicine." Huffington Post, February 2016.
3. Menard M, Nielsen A, Tick H, et al. "Never Only Opioids." PAINS: Policy Brief, Fall 2014.
4. Bauer M, Bolash B, Camardella L, et al. "Acupuncture as a First Line of Treatment for Pain: An Evidence-Based Option to Decrease Opioid Dependence." Meridians Journal, Summer 2016.
5. Cipriano P. "America's Nurses Are Committed to Addressing the Opioid Crisis." Huffington Post, July 1, 2016.

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Click here for previous articles by Elizabeth Sommers, PhD, MPH, LAc.

Click here for more information about Kristen E. Porter, PhD, MS, MAc, LAc.

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