The opioid epidemic remains a leading and escalating public health crisis with 2 million Americans now dependent on opiates at an annual cost of $78.5 billion in the U.S.

Integrative medicine, including acupuncture, remains a crucial and underutilized tool in the management of chronic pain that can minimize the need for chronic opiate medication. Attorneys general across the nation have united and taken action on this issue by expressing this view to American insurers.

Several weeks ago the National Association of Attorneys General sent a letter to the president of America’s Health Insurance Plans urging non-opiate integrative strategies for the treatment of chronic pain. It was signed by attorneys general of 37 states, including Hawaii’s Attorney General Doug Chin.

The letter said, “When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non- opiate alternatives, ranging from nonopioid medications to physical therapy, acupuncture, massage and chiropractic.”

Specifically, the letter recommended a review of payment and coverage policies.

While Hawaii insurers have made substantial progress in coverage during the past 20 years, access to integrative services is still suboptimal. Lack of coverage continues for some essential integrative services; reimbursement, although improving, is inadequate; and the number of treatment visits is restrictive. Benefit levels and reimbursement to providers are fraught with obstacles.

“Addressing the opiate crisis by enhancing drug treatment options and integrative treatments such as acupuncture is likely our only path out of this dark tunnel,” said state Sen. Josh Green (D, Kona-Kau). Green is an emergency medicine physician who routinely sees the damaged lives that result from opiate addiction and is now reaching out to the affected homeless population. “Anyone who asks for treatment, integrative rehabilitation of any form including acupuncture, in order to get off of opioids or manage chronic pain without relying on opiate medication should have |that service approved without hesitation. It will save lives and save health care dollars.”

Joni Kroll — who is co-founder of AcuPlan Hawaii, a nonprofit association of medical providers; past president of the Hawaii Acupuncture Association; and acupuncturist at the Kailua Acupuncture Clinic — agrees with the attorneys general and Green.

“Acupuncture, with its roots in Asian medicine, has long been accepted and integrated into health care in Hawaii,” Kroll said. “With the national focus now turning to non-addictive ways to treat pain, acupuncture is being spotlighted for its safety and success in treating both acute and chronic pain. The goal now is to find ways to create greater access to acupuncture care through inclusion with all Hawaii health insurance plans so that more patients can avail themselves of this time-tested and patient-centered therapy. Greater utilization of acupuncture for pain management will lead to less opioid addiction as well as cost savings to our health care system.”

Kudos to the 37 attorneys general for a bold and decisive recommendation to American insurers to review payment and coverage policies for integrative services with the goal of solving a major public health crisis — opiate addiction.

Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.