Running Head: HOLISTIC ALTERNATIVES TO OPIOID THERAPY 1

The Use of Holistic Medicine to Treat Chronic Pain

as an Alternative to Opioid Painkiller Drugs

Jack E. Schmeiser

Global Connections

Instructor: Gregory Falls

December 17th, 2018

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 2

Table of Contents

Table of Contents 2

Abstract 3

Introduction 4

Limitations 5

Literature Review 6

Discussion 8

The Opioid Crisis 8

Holistic Medicine 12

The Swedish Healthcare System 16

Conclusion 17

References 20

Appendix A 29

Appendix B 34

Appendix C 35
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 3

Abstract

Prior to the 1990s, the United States had an ineffective system of treating patients with chronic

pain. To solve this problem, the medical community began rapidly prescribing extremely

addictive and dangerous opioid painkiller drugs, often without proper evaluation of the patient’s

pain. As time progressed and opioids were continuously prescribed to patients with minor

ailments, the crisis of extremely high opioid addiction and overdose statistics began. The rapid

increase of opioid prescription to treat pain quickly created a fatal epidemic. While opioid drugs

have purpose in a controlled hospital environment, they are not safe in the way that they are

often used today. Contrary to opioids, holistic medicine offers safe and efficient methods of

treating pain. The healthcare system in Sweden which integrates holistic medicine into treatment

of pain serves as a prime example. This system of alternative methods for pain management in

addition to conventional medicine has allowed Sweden to develop into one of the most healthy

countries in the world. This system of integrated holistic practices to balance the use of

conventional medicine has proven to be a successful system that should be instituted into

opioid-heavy countries, such as the United States.

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 4

The Use of Holistic Medicine to Treat Chronic Pain

as an Alternative to Opioid Painkiller Drugs

Everyone experiences pain. Whether it be minor pain from a concussion, or excruciating

pain from surgery, everyone has experienced the uncomfortable biological phenomenon known

as “pain”. As science and medicine have progressed, many different ways of treating pain have

developed. One of the most popular, yet controversial treatments of pain today is opioid therapy.

Opioids, such as Morphine, Oxycodone, and Hydrocodone are lab-synthesized pharmaceuticals

that treat severe pain such as trauma injuries, post-operational pain, and cancer-induced pain

(Fields, 2011). This class of drugs has proven to be extremely effective, however, the success of

these drugs also has a sizeable cost. Opioids are incredibly addictive drugs with nearly 43,000

cases of overdose and 2.1 million cases of misuse each year in the United States (U.S. Health &

Human Services, 2018).

In contrast to the use of opioids for pain, complementary and alternative medicine (CAM)

has been used for centuries by many different populations of people to treat pain. Today, CAM is

still used for this purpose, though its effectiveness and minimal deficits to human health often go

unrecognized by the medical community. CAM is an umbrella term that includes any form of

medical treatment that is not conventionally practiced (U.S. National Library of Medicine, 2018).

Examples of CAM include herbal medicine, acupuncture, yoga, meditation, massage therapy,

along with many others. These methods have been proven by several studies and testimonies to

effectively treat pain. In fact, contrary to the healthcare system in the United States, where CAM

is not covered by health insurance or practiced in hospitals, Sweden has embraced the practice of

CAM and integrated it into their healthcare system. This has allowed Sweden to have a very
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 5

healthy population with no opioid epidemic (Nilsson, Trehn, & Asplund, 2001). Non-addictive,

alternative medical treatments, such as those integrated into the Swedish healthcare system, offer

a rational, safe, and non-addictive alternative to pain management that would drastically reduce

the opioid and prescription painkiller addiction and overdose rates in the United States.

Limitations

The author of this paper has no obvious or blatant biases. However, to provide the most

relevant information and synthesis, the author has chosen to purposely exclude certain topics.

These limitations are listed below:

This research paper will not discuss the use of medical or recreational marijuana for pain

management. While marijuana is a trending topic of discussion both politically and medically,

the topic is controversial and vast in itself. The extensive research that could be done on the topic

of medical marijuana is rather political and its complexity would take away from the focus of

this paper, which is to reduce the use of addictive painkiller drugs and implement holistic

medicine into the medical forefront.

The second limitation of this paper is the financial motive of pharmaceutical companies

to sell Opioids. Although it is widely believed that the dawn of the Opioid crisis had largely to

do with the pursuit of economic gain from the pharmaceutical industry, this is a conspiratorial

concept that this research paper will not discuss. Rather, this research will focus on the science

behind prescription opioids versus alternative medical treatments in healthcare systems, not the

economic conspiracies of the pharmaceutical industry.

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 6

Lastly, this research will primarily focus on the healthcare systems of the United States

and Sweden. This narrowed scope will allow for a more detailed and focused comparison of the

two systems.

Literature Review

The Pharmaceutical Journal released a publication in 2015 revealing the factors that

contributed to the global Opioid crisis. In the publication, the author discussed the persuasion

from pharmaceutical companies to the medical community to increase the prescription of Opioid

painkillers in the early 1990s in order to combat the so-called “epidemic of untreated pain”

(Lyapustina & Alexander, 2015). The push from the pharmaceutical industry led to a drastic

increase in Opioid prescription rates. As these addictive painkiller drugs hit the markets, the

epidemic of prescription painkiller addiction, commonly referred to as “the Opioid crisis”, was

born (Lyapustina & Alexander, 2015).

As the Opioid crisis grew, the medical community began further researching the effects

of Opioid drugs on the human body and brain. In 2002, the National Center for Biotechnology

Information released a study that evaluated the neurological processes involved in Opioid intake

and addiction. The publication by Thomas R. Kosten, M.D. and Tony P. George, M.D. explained

that opioids cause the Mesolimbic Reward System (MBS) of the brain to send signals to the

Ventral Tegmental Area (VTA) to release copious amount of Dopamine, the neurotransmitter

linked to pleasure and adrenaline, into the Nucleus Accumbens. Normally, the Prefrontal Cortex

(PFC) prevents the brain from making irrational decisions and receiving large amounts of

dopamine, however, the opioids quiet the PFC and prevent it from regulating dopamine release

(Kosten & George, 2002). As a result, opioids impair the brain’s ability to make rational
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 7

decisions and release vast amounts of dopamine which leads to a dependence. While Opioids do

effectively treat pain, they also cause a nearly unbreakable addiction (Kosten & George, 2002).

Years after the opioid crisis began and the epidemic of overprescription gained

recognition, many medical doctors began to reveal that they received inadequate training for

prescribing opioids. The American Medical Association released an article in 2016 responding to

the 2016 Center for Disease Control (CDC) guidelines for opioid prescription. The publication

exposed the extensive, increasing opioid overdose rates in the United States. Between 1999 and

2014, there had been over 165,000 opioid overdoses in the United States, as well as an estimated

1.9 million opioid users in 2013 alone. In response to the worsening statistics, the CDC released

new guidelines that suggested simply “to improve communication between clinicians and

patients about the risks and benefits of opioid therapy” (Dowell, Haegerich & Chou, 2016).

However, the National Institute of Health released new opioid statistics in 2018 that stated that

opioid-related overdoses have increased by 30% since 2016 (National Institute of Health, 2018).

This recent update proves the ineffectiveness of the 2016 CDC guidelines.

Opioids have undoubtedly created havoc in the world of prescription medicine. However,

contrary to prescription opioid painkillers, homeopathic medicine for pain management has

proven effective and un-harmful to the body and mind. Jennie Tsao and Lonnie Zeltzer from the

David Geffen school of medicine at the University of California at Los Angeles (UCLA)

published a review of alternative medicine as a method of treating pediatric pain. In this study,

acupuncture therapy was tested on a group of pediatric patients with a wide variety of chronic

pain-causing conditions. Upon completion of the study, 70% of the participants responded that

the acupuncture therapy helped with their pain. The same report then goes on to discuss the use
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 8

of peppermint oil for abdominal pain. In this separate study, 71% of the children reported that the

peppermint oil helped tremendously with their pain (Tsao & Zeltzer, 2005).

In addition to the alternative pain management strategies discussed in the UCLA

publication, Science Daily released a study done by Dr. Catherine Bushnell of the National

Institute of Health (NIH) in 2015, evaluating the practice of Yoga as a means of pain

management. Dr. Bushnell found that yoga stimulates the brain’s grey matter, which is located in

the Cerebral Cortex and is linked to cognitive functioning and pain management. Upon

completion of the study, Dr. Bushnell determined that yoga can in fact counteract chronic pain

(Science Daily, 2015).

This collection of studies and publications provides insight into the harm of the opioid

epidemic and the extent to which it has grown, as well as the use of alternative medicine for pain

management and its effectiveness. These sources create a clear contrast between these two

methods of pain management and prompt for a relevant discussion on how the medical

community can reduce the use of opioids for pain management and further establish the use of

alternative pain treatment.

Discussion

The Opioid Epidemic

Prior to the 1990s, opioid medications were strictly administered in hospitals at very

controlled amounts. For at-home care, patients were given mild medications such as Tylenol or

Acetaminophen. This made prescription drug addiction rather uncommon. However, this system

also rarely treated pain effectively due to its mildness (Good Medicine, Bad Behavior, N.D.).

During the early 1990s, professionals in the medical community began to realize the
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 9

ineffectiveness of pain treatment in hospitals. As a response, many pharmaceutical companies

began adimatelty proposing an increase in opioid prescription (Lyapustina & Alexander, 2015).

Between 1996 and 2012, global sales of OxyContin and other opioid drugs grew from

just under $50 million to nearly $2.5 billion (Lyapustina & Alexander, 2015). This drastic

increase in opioid production, sale, and prescription created a very effective solution for the issue

of pain management. However, this quick solution to an enormous problem came with many

costs.

Opioid prescription drugs are scientifically proven to be extremely addictive. In fact,

opioid therapy tiggers a dramatic change in neurobiology and brain chemistry which allows for

addictive behaviors to form (Kosten & George, 2002). The molecular structure of opioid drugs

resembles natural neurotransmitters such as dopamine and endorphins very closely. The

similarity between the neurotransmitters and the synthetic drug essentially tricks the brain’s pain

receptors into accepting the opioids, arousing the nerve cells, and producing excessive amounts

of the neurotransmitters (The National Alliance of Advocates for Buprenorphine Treatment,

2008). This interaction causes the brain’s Mesolimbic Reward System (MBS) to send signals to

the Ventral Tegmental Area (VTA) to release extensive amounts of Dopamine into the nucleus

accumbens. The Prefrontal Cortex (PFC) typically communicates with the VTA to prevent the

brain from making irrational decisions to receive pleasure. However, opioids impair PFC

communications, causing a drastic reduction in pain (Kosten & George, 2002).

Beyond the initial reaction that opioid drugs have with the brain, frequent or repeated use

of opioid drugs builds a neurological tolerance, which eventually leads to withdrawal, and then

addiction. This frequent use of opioids causes the brain to behave normally when on opioid
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 10

drugs, and dysfunctionally when not on opioid drugs. This neurological phenomenon requires

more and more of the opioid drug to release the same amount of dopamine over time. As opioid

tolerance grows, susceptibility to withdrawal develops as well. Neurons in the Locus Coeruleus

(LC) area of the brain produce and release a neurotransmitter known as noradrenaline. This

neurotransmitter is responsible for essential functions of the body, such as maintaining breathing,

blood pressure, and responsiveness. Opioid consumption conceals the release of noradrenaline

which impacts the ability of the body to perform these basic life functions. In contrast, after

frequent opioid use, when the body is not on opioid drugs, and the release of noradrenaline is no

longer contained, the brain over-produces this chemical, which causes withdrawal symptoms,

such as jitters, nervousness, muscle aches, and diarrhea. To rid of the withdrawal symptoms,

opioid users take more drugs. This vicious cycle rapidly builds a crippling addiction (Kosten &

George, 2002).

Opioid use and addiction is undoubtedly extremely harmful to the human body.

Prescription opioids are in the same drug family as Heroin, another extremely addictive and

dangerous, but recreational drug. In fact, in a study done by the Washington University School of

Medicine in St. Louis, it was discovered that 65% of Heroin users used prescription opioid drugs

initially, and then moved to Heroin (Washington University School of Medicine in St. Louis,

2016). If opioid drugs were less accessible, over half of the Heroin users in the United States

would likely have never taken prescription painkillers, let alone Heroin.

This epidemic that is ruining hundreds of thousands of people’s lives is ironically largely

rooted in the medical community. Overprescription of opioid drugs by medical professionals is

the root cause of the opioid crisis. In fact, over 80% of all opioid painkiller prescriptions in the
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 11

world are written by medical professionals in the United States (Washington University School

of Medicine in St. Louis, 2016). Additionally, opioid prescription in the United States has

increased by 300% from 1991 to 2009 (Lyapustina & Alexander, 2015). These colossal numbers

accurately reflect the size of this issue.

What is even more daunting about the opioid crisis is that many doctors have reported

feeling unequipped to prescribe opioids. In a 2018 publication, the American Medical

Association stated that “primary care clinicians report concern about opioid pain medication

misuse, find managing patients with chronic pain stressful, express concern about patient

addiction, and report insufficient training in prescribing opioids” (American Medical

Association, 2018). Essentially, even though the opioid crisis is rooted in the medical

community, it was not caused by any individual doctor or group of doctors. In fact, many doctors

are challenged and concerned by this issue as well. However, rather than finding a scapegoat for

the opioid epidemic, it is more worthwhile to find a solution.

As a response to the opioid crisis, the Centers for Disease Control (CDC) released new

guidelines in 2016 suggesting a reform for opioid prescription. However, these new guidelines

were rather vague. The CDC simply suggested “to improve communication between clinicians

and patients about the risks and benefits of opioid therapy” (Dowell, Haegerich & Chou, 2016).

Two years later, the National Institute of Health (NIH) updated opioid-related statistics. The

newly published statistics showed a 30% increase in opioid overdose since 2016, which rendered

the 2016 CDC guidelines ineffective (National Institute of Health, 2018). By suggesting a stricter

control over opioids as a solution to the opioid crisis, the CDC’s idea would have only caused

regression back to before the 1990s when opioids were controlled, and pain was untreated. To fix
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 12

a problem, there needs to be a new and different solution; solely removing a problematic system

without having a plan to replace the system simply will not be effective.

Holistic Medicine

Finding a safe and non-addictive solution to pain management has been a crucial issue for

the past few decades. However, the answer might be in plain sight. The author of this paper

conducted an interview the Dr. Josephine Adamson, the medical director of the Association of

Research and Enlightenment (ARE), a center in Virginia Beach that specializes in holistic

medicine. In the interview, Dr. Adamson started by regarding opioids, stating the following:

“There is definitely a use for these medications. However, they are not designed for long term

pain management” (Adamson, 2018). Dr. Adamson gave a valuable perspective; opioids should

not be completely banned, but rather, they should be reduced and used alongside alternative

methods.

When asked if spreading alternative medicine as a means for pain management could

decrease the prescription of opioid painkillers over time, Dr. Adamson responded, “Yes. I think

it has to be a multi-faceted team approach to this. It can not be just the pharmaceutical companies

coming up with new pills for people to take that are less addictive...it is still important for us to

push these other options such as holistic medicine” (Adamson, 2018). The furthering of holistic

medicine could indeed have major implications on the treatment of pain. Many people are

skeptical of alternative medicine, however, the importance of this practice should not be

overlooked.

Alternative medicine practices have significant implications on neurobiology just as

opioid intake does. Holistic medicine is a broad field with many treatment options that can each
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 13

help heal pain. Some of these treatments include acupuncture, herbal supplements, yoga, and

massage therapy.

Yoga, a rather common and modernized holistic practice has been researched heavily in

the modern era. Science Daily published research done by Dr. Catherine Bushnell of the National

Institute of Health (NIH) on the biological effects of yoga. Dr. Bushnell found that the practice

of yoga has a direct correlation to grey matter growth in the brain. Grey matter is healthy tissue

that grows in the Cerebral Cortex of the brain and is linked to cognitive functioning and pain

management. This study allowed Dr. Bushnell and the American Pain Society to conclude that

yoga can in fact help reduce chronic pain (Science Daily, 2015). However, unlike opioids, yoga

has no adverse implications on bodily health, such as addiction or withdrawal.

Additionally, acupuncture can have positive impacts on bodily health and pain

management. Acupuncture is the insertion of small needles into multiple spots on the skin in

order to relax the body and relieve pain. The strategically marked areas on the skin are called

“acupoints”. The insertion of the needles into the acupoints releases endorphins, the biochemical

that relieves pain (Harvard Health, N.D.). While this practice may sound daunting or painful, it

has been practiced for centuries and has proven to be very effective. In a forum published by

Consumer Reports in 2016, respondent Joel Sisk stated the following:

Nine years ago, I ruptured a disc in my upper back (C7, to be specific). The pain was a 9

on a severity scale of 1 to 10. Definitely the worst pain of my life. It was also incessant -

it would not abate whether I was sitting, standing or laying down. The doctor prescribed a

strong opioid medication for the pain and physical therapy. The medication was partially

effective (brought the pain down to a level 5), but would leave me with strong negative
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 14

side effects, and would only work for a few hours. I was also not able to start physical

therapy as the pain was still too intense. A friend recommended acupuncture treatment

and, after only one 45 minute treatment, the pain was down to a level 3, with no negative

side effects. I had two treatments a week for the next three weeks. The combination of

acupuncture and physical therapy over this time completely and permanently eradicated

that pain (Sisk- Consumer Reports, 2016).

Sisk had a serious spine injury and was prescribed opioids. However, after trying acupuncture,

he found that this method was more effective than opioids and in no way harmful to his body.

This testimony provides insight and evidence into the vast range of use for alternative methods

such as acupuncture.

A study was done by Lonnie Zeltzer of the David Geffen School of Medicine at the

University of California at Los Angeles (UCLA) that reviewed the use of acupuncture to treat

pediatric pain. In this study, the patients had a variety of conditions including: chronic migraines,

endometriosis, and reflex sympathetic dystrophy. Upon completion of the study, 70% of the

patients stated that the acupuncture helped tremendously with their pain (Tsao & Zeltzer, 2005).

This data is especially interesting because many children are afraid of needles, and yet the

majority of the children in this study had a positive experience. This study provided valuable

insight into acupuncture therapy, however the study did not stop there.

The publication goes on to talk about another study done with a different group of

pediatric patients with chronic pain. However, this study focused on the response of the patients

to herbal treatments. The study examined peppermint oil and its ability to treat abdominal pain.

The patients were randomly divided into a placebo group and a peppermint oil group. Upon
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 15

completion of the study, 71% of the peppermint oil children reported a sizable reduction in their

abdominal pain, whereas only 43% of the placebo group reported to have their pain reduced. The

researchers were thus able to conclude that the peppermint oil was effective in treating chronic

pain (Tsao & Zeltzer, 2005). Peppermint oil is one of many examples of herbal medicine that can

be used to treat pain. White willow bark, turmeric, and maritime pine bark are just a few

examples of other natural herbs that can treat chronic pain. Herbal remedies may vary in origin,

however, they all have one thing in common. These herbal remedies allow for activation of the

COX-1, COX-2, and NF-kB enzymes which reduce inflammation, which reduces pain. Aspirin

and many other pain-reducing agents activate these enzymes as well. However, the synthesized

medications have side effects, whereas the herbal medications do not (Maroon, Bost & Maroon,

2010).

While there are many more holistic pain treatment methods, this paper will only detail

one more example in addition to yoga, acupuncture, and herbalism. Massage therapy is very

similar to acupuncture, in that it is a very old practice consisting of nerve stimulation and

relaxation, that has developed in the modern era. In the UCLA publication by Tsao and Zeltzer,

there is an additional section that describes a study conducted regarding the use of massage

therapy to treat the pain of pediatric burn patients. The study showed that massage therapy

reduced crying and distress, increased mobility, and decreased overall pain in the pediatric burn

patients (Tsao & Zeltzer, 2005). Additionally, in the exclusive interview conducted by the author

and featuring Dr. Adamson of the ARE, Dr. Adamson stated that the massage therapy offered at

the ARE was by far their most popular treatment. She elaborated by explaining how the

masseuse can tailor the massages to the ailments of each individual patient. Dr. Adamson
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 16

confidently stated that after experiencing the treatments and atmosphere at the ARE, “they

almost always come back”. Massage therapy focuses on stimulating nerve endings and pressure

points, which not only reduces pain tremendously, but also relaxes the body and mind

(Adamson, 2018).

Holistic medicine practices have proven to be extremely effective on many different

occasions. They have high rates of success and no side effects or harmful outcomes. However,

despite the potential for holistic medicine in the United States healthcare system, many American

hospitals and insurance companies reject the use and coverage of these treatments. Health

insurers often omit coverage for medicals treatments that they deem unconventional or

unnecessary. Due to the extensive history and natural components of alternative medicine, it is

often seen as less conventional and less necessary than modern medicine (Renter, 2015).

Additionally, American medical professionals are not trained to practice alternative medicine and

the hospitals are not provided with the resources to practice holistic treatments (Lee Ventola,

2010). The combination of the disapproval of insurance agencies, lack of training, and lack of

resources has led to a healthcare system with relatively little practice of holistic medicine. Due to

this situation, holistic treatments in the United States are often paid out of pocket, which is less

economical, and thus less attractive to the majority of people (Renter, 2015).

The Swedish Healthcare System

In contrast to the American healthcare system, Sweden has a healthcare system that

incorporates holistic medicine into their hospitals and national health insurance policy. Health

insurance is controlled by the government in Sweden, which allows for more uniform coverage

policies (Ham & Brommels, 1994). The national health insurance essentially covers any
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 17

treatment given or prescribed by a registered healthcare professional. When treatments such as

herbal medications or acupuncture are administered by a healthcare professional, the treatments

are covered. Alternative medicine for pain relief has interestingly become quite popular in

Sweden and is given for many different forms of pain (CAM Regulation, N.D.). The majority of

other European countries are stricter with holistic treatment policies, in that the treatments will

only be covered if performed by registered physicians. Due to the lack of training of medical

doctors in holistic medicine, this restricts access to this form of treatment. However, Sweden is

much different and much more liberal with their insurance policies. Practitioners of holistic

medicine are still covered by the national insurance, as long as a medical doctor referred the

patient (CAMDOC Alliance, 2010). The unique healthcare system of Sweden allows for patients

to have increased access to holistic treatments, thus allowing them many different alternatives for

pain management.

The use of holistic medicine in Sweden has had noticeable effects on the health of the

population. In 2016, Sweden had less than 600 reported cases of drug overdose, and that is

including all drugs, not just opioids (European Monitoring Centre for Drugs and Drug Addiction,

2018). This contrasts immensely with the 42,000 people that overdosed on opioids in the United

States in 2016 (US Department of Health and Human Services, 2018). These statistics reflect

how opioids are made readily available in the United States, whereas they are rarely, if ever,

used in Sweden. If the United States introduced a new system that promoted alternative pain

management, rather than opioid therapy, it is very likely that overtime, the opioid crisis would

reduce. Fostering cooperation between the government, private insurance companies, and

healthcare providers to begin the facilitation and coverage of holistic medicine would
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 18

undoubtedly be a timely process, however, it would be worthwhile. The introduction of holistic

medicine into the United States healthcare system could save millions of lives each year and

create a simple and practical solution to the obstruct phenomenon of pain.

Conclusion

Throughout the past three decades, the United States has developed one of the worst

opioid problems in the world. Tens of thousands of people in the United States die each year due

to opioid related deaths. This fatal issue is largely a result of overprescription of opioid painkiller

drugs. American medical professionals were pushed heavily by pharmaceutical companies in the

early 1990s to drastically increase the prescription of opioids for pain. However, despite

increasing use of these drugs, medical professionals were never thoroughly trained how to safely

prescribe and administer them. This ubiquitous practice of overprescription without thorough

evaluation of the patient’s pain essentially placed opioid drugs into the hands of people who did

not need them. Many patients began taking these drugs with the consent of their physician,

though they did not need opioids, which led to an increase in opioid use, addiction, and overdose.

Opioids have a purpose in hospitals to treat extreme, short-term pain; however, the use of these

drugs in American hospitals has far exceeded what should be the limits of their use.

Rather than providing opioids to patients who experience chronic pain, the American

medical system should recognize and begin facilitating the use of holistic medicine. Holistic

medicine treatments such as yoga, acupuncture, herbalism, and massage therapy have extremely

positive effects on neurobiology and the nervous system. However, unlike opioid therapy,

holistic medicine poses no negative implication on the body or mind.

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 19

The medical system in Sweden incorporates holistic medicine into their hospitals and

allows for these alternative treatments to be covered by national health insurance. This combined

system of conventional and alternative medicine has allowed for patients to have access to many

different forms of treatment, all of which are financially feasible. Due to this excellent system,

Sweden has an extremely healthy population with no opioid crisis. If the United States followed

the integrative healthcare system in Sweden, Americans would be able to efficiently manage

their pain while having far less risk of opioid addiction and overdose. Alternative pain treatments

could likely be a solution to a problem that has taken and ruined millions of lives. In order to

gradually abolish the United States opioid crisis, while efficiently treating patients with chronic

pain, the American healthcare system must consider the Swedish healthcare system model, and

begin the integration of holistic medicine into chronic pain treatment.

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 20

References

American Pain Society. (2015, May 15). Yoga and chronic pain have opposite effects on

brain gray matter. Retrieved from

https://www.sciencedaily.com/releases/2015/05/150515083223.htm

Yoga stimulates grey matter growth in the brain. Grey matter is located in the cerebral cortex

and is essential for cognitive functioning and pain management. Dr. Bushnell of the NIH

did research which linked the practice of yoga to grey matter increase overtime. This

shows that natural practices such as yoga can be used as an alternative, non-damaging

means to pain management.

CAMDOC Alliance. (n.d.). The regulatory status of Complementary and Alternative

Medicine for medical doctors in Europe. Retrieved from

http://www.camdoc.eu/Pdf/CAMDOCRegulatoryStatus8_10.pdf
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 21

This source is one of the references of the Health Affairs article. It discusses how northern

Europe is more liberal with the use of alternative medicine.

Complementary and Alternative Medicine - U.S. National Library of Medicine Collection

Development Manual. (2018, March 26). Retrieved from

https://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html

Provides a definition for Complementary and Alternative Medicine (CAM). This term is

referenced frequently throughout the different sources used in the paper.

Consumer Reports, & Sisk, J. (2013, July 13). Should You Try Acupuncture? Retrieved from

https://www.consumerreports.org/health/should-you-try-acupuncture/

This forum gives real consumer reports of acupuncture. The reviews posted were very

interesting and provided great insight into the success stories of acupuncture.

DEA Museum and Visitors Center. (n.d.). The History of Prescription Drugs. Retrieved from

http://www.goodmedicinebadbehavior.org/explore/history_of_prescription_drugs.html

This source outlines the history of pain management and medicine and the different drugs that

were used to treat pain throughout history. This source provides meaningful context for the

issue proposed in the paper.

Dowell, D. (2016, April 19). CDC Guideline for Prescribing Opioids for Chronic Pain, 2016.

Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2503508#122616517

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 22

This scholarly article outlines the CDC guidelines for Opioid prescription for pain

management. The prescriptive practices of the majority of medical doctors contradict the

CDC guidelines drastically. This article tells that MD’s are often without sufficient

prescription-training and feel overwhelmed by managing patients on opioids.

European Monitoring Centre for Drugs and Drug Addiction. (2018). Sweden Country Drug

Report 2018. Retrieved November 27, 2018, from

http://www.emcdda.europa.eu/countries/drug-reports/2018/sweden_en

This source provides 2018 statistics for drug use and prescription in Sweden. The statistics are

shockingly low. This source is crucial evidence for the paper and provides an immense

contrast with the United States statistic.

Fields, H. L., MD PhD. (2011, February 24). ​The Doctor’s Dilemma: Opiate Analgesics and

Chronic Pain[​ PDF]. San Francisco: Elsevier inc.

This paper starts by describing opioids and what they are typically used for (medically).

Opioids are prescribed for pain management, trauma, surgery, and cancer. The essay then

describes how opioids work in the body.

Griffin, R. M. (2001, March 9). Alternative Treatments for Chronic Pain. Retrieved from

https://www.webmd.com/pain-management/features/alternative-treatments#2

This source lists different forms of holistic medicine that can be used to manage pain. The

article then explains each method and its use in holistic medicine.
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 23

Ham, C., & Brommels, M. (1994). Health Care Reform in the Netherlands, Sweden, and the

United Kingdom. Retrieved from

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.13.5.106

Explains national health insurance system in Sweden. This source helps describe the system

in Sweden and provides contrast for the paper.

Harvard Health Publishing. (n.d.). Relieving pain with acupuncture. Retrieved from

https://www.health.harvard.edu/healthbeat/relieving-pain-with-acupuncture

This article explains how acupuncture helps relieve pain. The insertion of needles into

“acupoints” in the skin releases endorphins, the chemical that kills pain in the body.

Harvard Health Publishing. (2015, April ND). Yoga for pain relief. Retrieved from

https://www.health.harvard.edu/alternative-and-complementary-medicine/yoga-for-pain-re

lief

This article talks about how Yoga can be used for chronic pain relief. Yoga would be an

interesting topic to discuss in my research and even a potential action.

Kosten, T. R., MD, & George, T. P., MD. (2002, July ND). (PDF) The Neurobiology of

Opioid Dependence: Implications ... Retrieved from

https://www.researchgate.net/publication/5288549_The_Neurobiology_of_Opioid_Depen

dence_Implications_for_Treatment
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 24

This article explains how Opioids affect brain chemistry and neurobiology. Opioids cause the

Mesolimbic Reward System to send signals to the Ventral Tegmental Area (VTA) to

release large amounts of Dopamine into the Nucleus Accumbens. The prefrontal cortex

(PFC) normally communicates with the VTA to prevent the brain from making irrational

decisions to receive pleasure. However the opioids impair the ability for the PFC to make

these communications. The article then goes on to talk about the science behind

dependence, withdrawal, and tolerance.

Lyapustina, T., & Alexander, C. (2015, June 11). The prescription opioid addiction and abuse

epidemic: How it happened and what we can do about it. Retrieved from

https://www.pharmaceutical-journal.com/opinion/comment/the-prescription-opioid-addicti

on-and-abuse-epidemic-how-it-happened-and-what-we-can-do-about-it/20068579.article?f

irstPass=false

This journal details the history of the Opioid crisis and how it all began. In the article,

statistical information, such as consumption and addiction rates in specific countries. The

United States consumed 99% of the world’s Hydrocodone in 2009 and increased in Opioid

prescription by 300% between 1991 and 2009. The article then goes on to talk about how

the FDA is currently trying to combat the issue.

Maroon, J. C., Bost, J. W., & Maroon, A. (2010, December 13). Natural anti-inflammatory

agents for pain relief. Retrieved from

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 25

https://www.ponderapharma.com/wp-content/uploads/2014/06/Natural-anti-inflammatory-

agents-for-pain-relief.pdf

This article lists different herbal medicines and how they reduce pain on a molecular level.

This source is beneficial in providing evidence for the herbalism section of the discussion.

National Institute on Drug Abuse. (n.d.). Increased drug availability is associated with

increased use and overdose. Retrieved November 27, 2018, from

https://www.drugabuse.gov/publications/research-reports/relationship-between-prescriptio

n-drug-abuse-heroin-use/increased-drug-availability-associated-increased-use-overdose

This publication reveals that between 1991 and 2001, Opioid prescription rates in the US have

tripled, and so have overdose related deaths. This statistic helps emphasize the problem of

overprescription in the United States.

National Institute on Drug Abuse. (2018, March 06). Opioid Overdose Crisis. Retrieved from

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

This article reveals the increase in Opioid related overdose deaths from 2016 to modern day.

This proves that the CDC guidelines for opioid prescription in 2016 (source 7) have been

uneffective.

Nilsson, M., Trehn, G., & Asplund, K. (2001, December 20). Use of complementary and

alternative medicine remedies in Sweden. A population-based longitudinal study within

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 26

the northern Sweden MONICA Project. Retrieved from

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00882.x

This source discusses the use of Complementary and Alternative Medicine (CAM) in

Sweden. The article recognizes the adverse effects that modern medicine can have and

then mentions the success of CAM in Sweden. The success is proven by an included case

study about the use of CAM to treat cardiovascular disease in Sweden.

Overprescribing opioids. (2016, April 27). Retrieved from

https://medicine.wustl.edu/news/podcast/overprescribing-opioids/

This medical journal discusses how 65% of heroin users starting using because they became

addicted to prescription painkillers. The article then discusses how opioid painkillers are

overprescribed to patients which leads to misuse and then addiction.

Public Affairs. (2018). What is the U.S. Opioid Epidemic? Retrieved from

https://www.hhs.gov/opioids/about-the-epidemic/index.html

This article gives statistics on Opioid misuse and overdose rates. The article also details

measures that the HHS has taken in attempt to control the crisis. *Includes the HHS

solution propositions.

Renter, E. (2015, March 9). Does Your Health Insurance Cover Alternative Medicine?

Retrieved from
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 27

https://health.usnews.com/health-news/health-insurance/articles/2015/03/09/does-your-hea

lth-insurance-cover-alternative-medicine

This source explains the reluctance of US insurance agencies to cover alternative medicine,

and thus explains why alternative medicine is not as practiced in the US. This source

provides a contrast against the Swedish healthcare system, which will create an important

argument in the paper.

Adamson, J., MD MPH. (2018, November 1). Holistic Medicine as an Alternative to Opioid

Therapy [Personal interview].

In this interview, Dr. Adamson and the author of the paper discussed the issue at hand and the

use of natural medicine for pain management. The interview provided extensive insight

and perspective for the project.

Sweden. (n.d.). Retrieved from http://nafkam-camregulation.uit.no/country/sweden/

This website lists all the information relating to the use of alternative medicine in Sweden.

Alternative medicine such as acupuncture, herbal medicine, and massage therapy is

covered by national health insurance when practiced by a registered physician. In addition

these treatments are available in hospitals and offered to patients with chronic pain.

The National Alliance of Advocates for Buprenorphine Treatment. (2008, December ND).

The National Alliance of Advocates for Buprenorphine Treatment. Retrieved from

https://www.naabt.org/faq_answers.cfm?ID=6
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 28

This source further explains the chemical structure of opioids and how they affect the brain.

This source will help the author explain the biological implications of opioids.

Tsao, J. C., & Zeltzer, L. K. (2005, April 27). ​Complementary and Alternative Medicine

Approaches for Pediatric Pain: A Review of the State-of-the-science​[PDF]. Los Angeles:

University of California at Los Angeles.

This publication discusses the use of alternative medicine for pediatric pain management. The

article discusses methods such as acupuncture and herbal concoctions. The article also

states the success rates of these alternative methods.

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 29

Appendix A

Author Interview with Dr. Josephine Adamson at the Edgar Cayce Association of Research

and Enlightenment on November 1, 2018.

1.) "Can you briefly describe your educational background?”

“I went to college at Duke University and I majored in French Literature. Then, I went to

Duke medical school. Then after medical school, I went to UNC Chapel Hill for Public

Health. I am also a licensed massage therapist., from our massage school.”

- Dr. Josephine Adamson

2.) “Approximately, how many patients are treated here monthly?”

“Approximately 11,000 visits in 2017.”

- Dr. Josephine Adamson

3.) “What types of treatment do you offer here? What do they treat/help with?”

“Everything from Chiropractic and acupuncture to massage therapy and manual lymph

drainage, which is especially great for patients with Edema and Cancer. We also have

foot reflexology, which has been around for at least 5,000 years. We also have a whole

series of hydrotherapy. We also have services targeted toward mental health, such as
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 30

counseling services, hypnotherapy, energy work, breathwork, meditation. These services

can also help with pain relief.”

- Dr. Josephine Adamson

4.) “How does acupuncture (or other pain relief treatments at the ARE) affect pain receptors

in the brain and allow the patient to feel relief of pain biologically/neurologically?”

“There are all kinds of nerve endings that come off the spine and attach to different

organs. So, these treatments are designed to stimulate nerve endings which can reduce

pain. The therapies are also targeted towards reducing inflammation which is a big factor

in pain.”

- Dr. Josephine Adamson

5.) “What are the most popular treatments at ARE?”

“Massage therapy. The choreography for our massages were created almost 100 years

ago and we have a massage school next door. This is Cayce’s trademarked massage

routine. Everyone gets that massage on their first visit, but as they come back, the

therapist can tailor the treatment to their specific pain.”

- Dr. Josephine Adamson

6.) “Why do you think your patients chose ARE opposed to alternative options?”

“One of the reasons in the location. It is very peaceful here; it is not in a strip mall or in a

crowded place. We are removed and near the ocean, which is a very calm and healing

environment. Also once they get here and experience our treatments, they see how

different we are from other places. We are a lot more health-oriented. After experiencing

this, they almost always come back.”

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 31

- Dr. Josephine Adamson

7.) “What can you tell me about the practice of yoga/meditation for pain relief?”

“I do not specialize in either of those, however, just in the course work that I have done,

so much pain is connected with fear. When you are afraid that something is wrong or you

can not handle the pain, you get anxious and spiral off into fear. If you have a way to

calm yourself inside, then it seems that most people are able to control their pain. These

practices can essentially calm your fight or flight reactions.”

- Dr. Josephine Adamson

8.) “What do you know about the origins of alternative medicine practices such as

acupuncture, yoga, meditation, other treatments at ARE?”

“The journal of the AMA referred to Edgar Cayce as the father of holistic medicine. All

of these practices confers responsibility back to the patient; the patients are responsible

for their healing. They need to create a team of healthcare professionals including

traditional medical doctors to help them heal in the best way, however they patients do

have to help in this process, by quieting their mind, relaxing their body, exercising, and

eating right. Actually, I was a keynote speaker at a European Holistic Health Congress in

2016. Many of the European countries have been using holistic practices for decades and

it is very accepted. In a lot of these countries the holistic treatments are automatically

paid for. So in some ways, we are behind in the United States. I have not had the

opportunity to visit indigenous groups and learn about their practices, but I would love to

someday. However, I have had distant exposure to Asian Holistic medicine, as they teach
HOLISTIC ALTERNATIVES TO OPIOID THERAPY 32

asian philosophy in our massage school. Additionally, all of our acupuncturists are

masters of Chinese medicine.”

- Dr. Josephine Adamson

9.) “Do you believe that alternative methods to pain management/relief, such as those

offered here at the ARE, are more beneficial than prescription painkillers that are

commonly used in hospitals in the United States?”

“I think that when someone is in the hospital, for example, receiving surgery, that

prescription medication is extremely effective. There is definitely a use for these

medications. However, they are not designed for long term pain management. There are

over 2 million people in the US with opioid addiction problems, so I think that we need to

dial back. It came out a long time ago that patients were undermedicated for pain, so the

drug companies pushed for a massive increase in the use of these drugs. So people started

receiving opioids for minor pain. It has gotten out of control. I worry that just handing out

opioids masks pain to the point where if there is a complication after surgery, the patient

would not know to return to the doctor, because the opioids would not allow them to

sense that something is wrong.”

- Dr. Josephine Adamson

10.) “Do you think that alternative medicine, such as the treatments at the ARE, could be

further implemented in the medical community?”

“Yes, I do. I think people are skeptical until they come and try it. It is very rare for

someone to come in here and feel unsatisfied with our treatments.”

- Dr. Josephine Adamson

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 33

11.) “Do you think that spreading alternative medicine as a means for pain management

could decrease the prescription of opioid painkillers over time?”

“Yes. I think it has to be a multi-faceted team approach to this. It can not be just the

pharmaceutical companies coming up with new pills for people to take that are less

addictive. In the companies defense, many patients simply seek the instant gratification of

pills, but it is still important for us to push these other options such as holistic medicine.”

- Dr. Josephine Adamson

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 34

Appendix B

United States Opioid Statistics

HOLISTIC ALTERNATIVES TO OPIOID THERAPY 35

Appendix C

Sweden Opioid Statistics