Hawaii lawmakers were asked on Thursday to help make non-pharmaceutical alternatives more available to patients who use opiods, the addictive pain-killing drugs.
The state House and Senate health committees heard from medical experts and therapists who say multi-disciplinary options like acupuncture, massage therapy and physical therapy can work in managing pain and are cost-effective. But legislators were told insurance coverage of such alternative therapies is limited.
Dr. Jerald Garcia, a pain management specialist, says this helps explain why doctors turn to opiods.
"Who's going to pay for acupuncture for a patient in poverty? Who's going to pay for the physical therapy for a patient in poverty? Or someone who is very debilitated further down into their pain who is going to pay for their $200 injection, right?" he asked. "So that's why the temptation is opiods, it's cheap, let's give them. So that's why we have the problem we have today."
Physical therapist Herbert Yee told the lawmakers he sees patients at the Waianae Coast Comprehensive Health Center. They are treated under a chronic pain management program funded by health insurer HMSA to see if a multi-disciplinary approach could reduce costs. "We're meeting with some success," he said.
Yee described a 73-year-old woman who has been on the pain drug OxyContin for several years for her back and knee. She had limited mobility and walked with a cane. She admitted taking the drug was not a good thing, he said.
When asked why she takes OxyContin every morning, she said she was afraid of pain. She was convinced to wait to take any medication in the morning when she only had stiffness and to do a little bit of stretching -- and if she needed it, to take an anti-inflammatory drug instead.
Over the course of a month, she said she was only taking OxyContin when she needed it.
"Lots of patients who are on OxyContin or opiods take it on a regular basis like a vitamin pill or a heart medicine. They don't realize this is for pain and you only take it when you have pain," Yee said, adding part of the multi-disciplinary approach involves education.
Methamphetamines are a larger problem in Hawaii than opiods, which have devastated some parts of the country and prompted thousands of lawsuits against opiod drug manufacturers. Still, both meth and opiods contribute to substance use disorders that need addressing, said Edward Mersereau with the state health department's Behavioral Health Administration.
Hawaii sees about 67 deaths from opiods each year and 170 patients are transported to medical facilities for non-fatal overdoses, said Mersereau. About 47 percent of those who died or suffered non-fatal overdoses were on Medicaid, the medical coverage program for those who are poor.
He said policy changes should target that low-income group for services. He also supported the expansion of CARES, the state's Coordinated Access Resource Entry System that links those with substance abuse problems to needed services.