Acupuncture: Safety [120]
The World Health Organization (WHO) reports that acupuncture can be considered inherently safe in the hands of well-trained practitioners; however without proper training, acupuncture can lead to serious, sometimes life-threatening complications (as in the case of organ puncture and hepatitis transmission). Large-scale clinical trials of over 2 million acupuncture treatments found only 8.6% adverse events in which less than 1% reported as serious.[3,10] All of the reported infections and 68% of the serious adverse events occurred in village clinics or rural hospitals in China where clinical skill disparities exist between rural and urban hospital acupuncturists because rural acupuncturists rarely receive formal education in acupuncture medical colleges.[10] In the United States, ACCAOM accredited curriculum includes indications and contraindications for acupuncture point selection (single and combination), anatomy and needle insertion depth, as well as evidence-based clean needle technique practice, as necessary to protect the public.
Increased cost of care from Opioid Epidemic.
In contrast to acupuncture’s safety record, deaths related to opioid misuse have reached epidemic levels, the financial impact of the epidemic is at crisis levels, and incurred expenses rise from general pharmacological-care side effects, medical errors, and failed surgical procedures. In fact, two Oklahoma citizens die daily from opioid overdose according to the Center for Disease Control: 725 deaths in 2015, 777 in 2014, and 790 in 2013 which 12 is an increase from 662 deaths in 2010, and 127 deaths in 1999.113 Oklahoma, has the highest prevalence of prescription painkiller abuse in the country and more overdose deaths involve hydrocodone than methamphetamines, heroin, and cocaine combined.113 The national epidemic is costing public and private insurers more than $72 billion annually.13 Additionally 30% of patients with chronic pain conditions also suffer from clinical depression, and nearly 50% of patients who suffer from both anxiety and depression disorders have a co-morbid pain diagnosis, which shows the compounding concerns of opioid use for pain.13 The impact of the epidemic is far reaching, including but not limited to families, incarcerated persons, children, and disabled. See Appendix C, D, F.
Emergency room misuse.
The percentage of emergency department (ED) visits associated with pharmaceutical misuse or abuse increased 114% between 2004 and 2011. Opioid overuse not only increases ED visits but leads to increased avoidable services and costs that may actually harm beneficiaries. In fact, Medicaid recipients have a higher rate of ED visits and hospitalization for poisoning by opioids and related narcotics than individuals with other forms of insurance or the uninsured.13
Acupuncture Regulation Impact
Accepted method of care. Acupuncture is a standardized, licensed and regulated health care profession1 that conducts technical, master’s, and doctoral level training in U.S. Department of Education recognized accredited institutions.2 A Licensed Acupuncturist (or comparable state designated title) provides safe, low cost, and comparatively effective health care services.3,4 Forty seven states and the District of Columbia have developed licensure laws and regulation for acupuncturists. Alabama, Oklahoma, and South Dakota are without acupuncturist regulations. See Appendix B.
Recognized as a distinct occupation.
In 2016, a recommendation to establish a new code for this distinct occupation in 2018, “29-1291 Acupuncturists,” was made by the Bureau of Labor and Statistics (BLS) Standard Occupational Classification Policy Committee (SOCPC).1 Projected growth of the profession through 2024 is greater than average (13%), with 17,700 new job positions predicted.8 Since 2009, “Acupuncturists” have been recognized by the Bureau of Labor and Statistics’ O-Net Online as an emerging profession and assigned a Standard Occupational Code (SOC) of 29-1199.01 under “Health Diagnosing and Treating Practitioners, All Others.”7,8
Congressional Support.
The National Institutes of Health (NIH) affirms the validity and promise of acupuncture by the 1997 NIH Consensus Conference, concluding that there is sufficient evidence to expand its use into conventional medicine, encouraging further studies of its physiology, and urging broader public access through insurance companies, federal and state health insurance programs, including Medicare and Medicaid, and other third party payers.67 For twenty years thereafter, rigorous scientific investigation of acupuncture continues through the NIH National Center for Complementary and Integrative Medicine.68
Acupuncture efficacy.
An expanding body of evidence confirms that acupuncture stimulates the body’s natural healing abilities, promoting physical and emotional well-being.15,18 Through evidence review in 2003, the World Health Organization determined that acupuncture is an effective treatment for 28 named conditions and 79 potential conditions.78 See Appendix A.
Utilization.[120]
Acupuncture utilization is rapidly increasing in the United States. Nearly 100 primary and specialty physician practice guidelines recommend acupuncture as a non-pharmacological approach to patient care. An integral component of the “collaborative
model of care”, thousands of licensed acupuncturists are independently practicing acupuncture in hundreds of clinics, hospitals, universities, military and veterans’ care facilities. An increasing number of insurance companies are reimbursing for acupuncture, Medicaid in some states covers acupuncture for specific conditions, and the military has long utilized acupuncture for conditions from PTSD to brain injury. 61 See Appendix C, D, E, F.
Acupuncture for pain and mental health.[120]
Effective as a non-pharmacological approach to pain management and compounded by a holistic approach to comorbidity care, tens of thousands of licensed acupuncturists effectively treat patients with acute and chronic pain across the nation while now thousands of hospitals and clinics employ acupuncturists to improve outcomes and reduce costs. Acupuncture has recently been found to be as effective as counseling, and both more effective than usual care, for reducing symptoms of depression, a common co-morbid condition found in patients managing chronic pain.50 See Appendix D, E, F.
The opioid epidemic & auricular (ear) acupuncture.
To improve behavioral health program retention, reduce withdrawal symptoms, enhance recovery outcomes, and decrease costs, a standardized auricular (ear) acupuncture protocol has gained favor throughout the nation for use as an adjunctive treatment by a variety of health care and criminal justice workers within a variety of comprehensive programs.28,32,33,36,39,92,94 The National Acupuncture Detoxification Association (NADA) has trained over 25,00029 professionals to use the NADA 5-point auricular acupuncture protocol to treat individuals of all ages recovering from substance use disorder, trauma, and other behavioral health issues.28 Over 628 licensed addiction treatment facilities utilize NADA30 and inclusion within comprehensive criminal justice programs has reduced inmate expense and re-incarceration rates for two decades.33,36,37,39,40,42,103 See Appendix D.
Emergency department savings.
Expanding acupuncture utilization in the ED provides a non-pharmacological option to citizens, reduces drug-seeking behavior, and can reduce costs. A clinically relevant “real-world” 2016 study published in the Journal of Emergency Medicine, finds acupuncture to be more effective than intravenous morphine in the ED, when individualized patient-centered plans are administered by licensed acupuncturists.55 Newly available preliminary statistical outcomes are available from Rhode Island’s state Medicaid Section 1115 Demonstration, a pilot designed to cut costs by reducing member emergency room visits; members with chronic pain receive acupuncture and other complementary services within a comprehensive pain management plan. Outcomes are demonstrating that on average per year, these members have: decreased ER visits by 61%, reduced opioid prescriptions by 86%, lowered prescription totals by 63%, and reduced annual costs per member by 27%. 90,92-94
Other cost benefits.
Overall savings resulting from acupuncture inclusion include decreased requirements for surgical procedures, shorter in-patient hospital stays, reduction in pharmacologic prescriptions, reduction of days lost at work, and reduction of necessary medical review appointments. See Appendix C, D, E, F.
Call for Inclusive Collaborative Action
Abusers of opioids have been found to have total health care costs eight times that of non-abusers, placing a significant economic and resource burden on providers and health systems. Dr. Shellie Keast, from the University of Oklahoma’s College of Pharmacy, which supports SoonerCare pharmacy operations, believes that the Medicaid agency is ideally positioned to leverage collaborative efforts with other state agencies in the development of documents and best practice guidelines for intrastate work.13 Appendix F. Oklahoma’s plan in 2012, Reducing Prescription Drug Abuse in Oklahoma, calls for lowering the states’ unintentional overdose deaths by 15% will aim for “action to ensure the proper and appropriate use of opioids to treat pain and improve patient’s quality of life while reducing the risk of abuse and diversion… through various partnerships…is imperative.”113 Governor Fallin emphasizes: “Immediate action must be taken in order to reverse this rapidly growing epidemic, which has become one of the most serious public health and safety threats to our state… a broad-based coordination between law enforcement, prevention and treatment providers, the Oklahoma Legislature, community organizations, tribes, and health care is required… It is unacceptable for any Oklahoman to lose their life to this preventable problem.”113
Appendix A: Physiological Effects of Acupuncture Attention through research has been focused upon the following modern theories to explore acupuncture’s effects upon the body:
· Stimulation of the hypothalamus and pituitary gland
· Change in secretion of neurotransmitters and neurohormones
· Conduction of electromagnetic signals
· Activation of the body’s natural opioid secretion system
Most recently, twenty first century state-of-the-art technological advances allow observation of physiological effects of acupuncture. For example-
· fMRI scans detect reduction in pain sensation within the brain after acupuncture.19
· Ultrasound Color Doppler Imaging detects increased blood flow of peripheral, mesenteric, and retrobulbar arteries.20
· PET-CT study concludes acupuncture induces different levels of cerebral glucose metabolism in pain-related brain regions.21
· Demonstrated autonomic nerve function control and modulation of neurotransmitters in related brain regions are observed.22
· Blood panels measure immune system regulatory function, increased humoral/cellular immunity, and NK cell activity.23
· Synchrontron radiation based Dark Field Image method finds accumulation of miro-vessels in acupoints.24
· fMRI scans detect bilateral activation of insula and adjacent operculum; correlation to increased saliva production.25
· Synchrontron x-ray fluorescence analysis detects concentrations of Ca, Fe, Cu and Zn in and around acupuncture points.26
· Acupuncture’s role in triggering the release of adenosine, a neuromodulator with anti-nociceptive properties, is confirmed.14
· Tonometery, electrocardiogram, phtoplethysmogram, ultrasonography, and cardiographyconfirm acupuncture effects upon peripheral pulse amplitudes, wave, blood flow velocity, and sympathetic nerve activity.27
A 2013 study of acupuncture effect upon central autonomic regulation concludes: “Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature, muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response.”22
Appendix B: State Licensure and Regulation The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has provided more than 21,000 certificates for acupuncturists applying for licensure in 46 states and the District of Columbia since 1982.6 NCCAOM Diplomates have passed a set of certification examinations which assure that the knowledge, skills, and abilities necessary for safe and effective entry-level practice of acupuncture have been demonstrated. The NCCAOM is the only national organization in the United States whose certification programs are accredited for the purpose of qualifying candidates for state licensure status. The Institute for Credentialing Excellence (ICE)’s National Commission on Certifying Agencies (NCCA) recognizes the NCCAOM national certification programs in Acupuncture, Chinese Herbology, and Oriental Medicine as having achieved national accreditation by meeting the NCCA’s 21 standards.6 When providing services in health system and hospital facilities within the 45 regulated states, licensed acupuncturists are credentialed as “Licensed Independent Practitioners” (L.I.P.) to be in compliance with The Joint Commission quality assurance standard for healthcare system accreditation.5 The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) is recognized by the U.S. Department of Education as the accreditor for Acupuncture and Oriental Medicine (AOM) educational programs in the United States. ACAOM accredited institutions and programs are shaped by a rigorous peer review process. Over sixty institutions throughout the country have achieved the standards of educational excellence by meeting ACAOM’s accreditation requirements.2 The Oklahoma Board of Private Vocational Schools (OBPV) provides licensure and oversight of two acupuncture training schools.9 The existing grass-roots acupuncture education network may contribute to bridge-building collaborations necessary for acupuncturist workforce expansion within the fabric of Oklahoma’s existing infrastructures. Collaboration in the development of innovative tiered apprenticeship programs for life-long career advancement are in alignment with current workforce expansion plans. In addition, to accommodate evolving health care industry workforce requirements, stakeholders are exploring practice scope expansion solutions, such as competency based certifications. Oklahoma appears to be postured for incubating hybrid models that bridge life-long learners from beginner to entry-level and master clinician to doctoral research.
Appendix C: Acupuncture Utilization Examples Forty-seven states regulate the practice of acupuncture and over sixty colleges host accredited acupuncture programs. Hundreds of hospitals and health systems throughout the nation utilize licensed acupuncturist services. Some leading hospitals currently employing licensed acupuncturists include but are not limited to: Massachusetts General, Ohio’s UH MacDonald Women’s Hospital, Stanford Hospitals, Seattle Children’s Hospital, Los Angeles’ Cedar Sinai, Athen’s Regional Medical Center, Lutheran’s Medical Center, NYU Rusk, Beth Israel Medical Center, Columbia Presbyterian Medical Center, Long Island Jewish Medical Center, Mount Sinai Medical Center, Memorial Sloan-Kettering Cancer Center, Gouverneur Healthcare, University of Wisconsin Hospital and Clinics, Mercy Hospital Chicago, Children’s Memorial Hospital Chicago, Chanadaigua VA Medical Center, University Medical Center of AZ, Arizona Center for Integrative Medicine, Midwestern Regional Medical Center, Cancer Treatment Centers of America, University of Colorado Medical Center, University of New Mexico Hospitals, Cleveland Clinic for Integrative Medicine, Beth Israel Medical Center (Continuum Center for Health and Healing), and Duke University Medical Center, George Washington University Hospital, Greenwich Hospital Integrative Medicine Program. Research Hospitals that offer licensed acupuncturists services include but are not limited to: John Hopkins, Ronald Regan Hospital – UCLA, Cleveland Clinic, San Francisco Medical Center, University of California, Hospital of the University of Pennsylvania, Barnes Jewish St. Louis, and Henry Ford Hospital Detroit. An ever growing number of insurance plans throughout the nation include acupuncture as a member benefit102 and acupuncture meets, at minimum, five of the Essential Health Benefit (EHB) criteria and service categories of care: ambulatory patient services, maternity/infertility, mental health and substance use disorders services, rehabilitative services, preventative wellness, and chronic disease management. As a result of acupuncture being designated as an EHB, nearly 54 million Americans in six states (California,69 Alaska,70 Maryland,71 Massachusetts,97 New Mexico,72 Washington73) and four territories (American Samoa,74 Guam,75 North Mariana Island,76 Virgin Islands77) gained access to acupuncturists’ services in 2014. As of 2017, eight states provide acupuncture coverage through Medicaid (California,79 Maryland,86-88,99 Massachusetts,97 Minnesota,80 New Mexico,81 Ohio,82,83 Oregon84,85 and Rhode Island89,91); New Jersey’s Medicaid plan covers acupuncture anesthesia during surgery;108 and several states, such as Vermont,96 implement temporary innovative Medicaid pilot programs to examine outcomes and savings.90-93 Various programs within the United States Department of Defense medical community have long utilized acupuncturists’ services and provide introductory training for physicians.56 Acupuncturist services are recognized as important and “extremely effective” treatments for non-opioid pain management;57 post-traumatic stress disorder and resilience care;58 mild traumatic brain injury and related insomnia and headaches;59 traumatic brain injuries and psychological disorders,60 and for Gulf War Illness,62 in facilities across the country (e.g., Camp Pendleton, Ft. Hood, Ft. Bliss, Ft. Carson, Walter Reed Army Medical Center). Additionally, the military has provided these services to military families for stress management and post-traumatic stress disorder.61 The United States Department of Veterans Affairs has integrated acupuncture into a number of facilities while expanding outreach into the community; of 125 Veterans Affairs facilities, 58 offered acupuncture services to patients in 2011.34 The 2014 Veteran Choice Program provides acupuncture as a standalone procedure, or within a comprehensive plan, for treating veterans experiencing service-connected low back pain, PTSD, and more. The U.S. Health and Human Services’ Substance Abuse and Mental Health Services Administration identifies acupuncture as a complementary treatment for detoxification in comprehensive addiction treatment programs.31 A 2014 report for the National Association for Medicaid Directors recommends acupuncture as one part of a holistic approach to treating patients suffering from pain and co-morbidities such as substance use disorder (SUD) and behavioral health issues.13 The National Congress of American Indians issued resolution #SD-15-027 in 2015 requesting inclusion of licensed acupuncturist services within Indian Health Services and tribal health facilities. 16 To remove barriers to licensed acupuncturist services, equitable inclusion and expansion of coverage within all payer programs, including state and federally funded programs, is import to industry stakeholders for public health improvement.13,16,17,65,66
Appendix D: NADA and Substance Use Disorder – Utilization, Research & Cost-Saving Information Throughout the United States, comprehensive treatment settings utilizing the NADA protocol are multiple including but not limited to inpatient, outpatient, addiction treatment programs, mental health facilities, jails, prisons, criminal justice and parole, drug-court, prison psychiatric units, street outreach, homeless shelters, half-way houses, harm reduction, natural disaster emergency relief, HMOs, active-duty military programs, and veterans healthcare programs.28,29,33-37,39,64 Although studies now confirm high risk groups have poorer completion rates than non-risk groups, the high risk groups are proving more likely to complete treatment when participating in NADA treatment.32 NADA is used in the acute and chronic phases of substance use treatment and is increasingly integrated into dual diagnosis settings to help patients with substance use disorders with concurrent behavioral health conditions, psychiatric symptoms,32 and other comorbidities, including personality disorders.35 Report benefits from NADA include improvement in depression, anxiety, anger, sleep disturbances, impaired concentration, fatigue, and body aches/headaches as well as reduction in withdrawal symptoms and cravings.28,32,35-39 Referrals for comprehensive programs utilizing NADA typically include a variety of agencies, such as probation and parole, Drug-Court, Department of Social Services, Department of Motor Vehicles, Recovering Professionals Program, employee assistance program, and physician offices, to name a few.32,28,39 U.S. Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) identifies acupuncture as a complementary treatment for detoxification recognizing that it can be included as part of a comprehensive treatment program for addictions;31and, multiple studies support the adjunctive use of NADA for the treatment of nicotine, heroin, alcohol, and cocaine addiction.28,32,35-39 628 licensed addiction treatment programs30 included acupuncture as a therapeutic tool in 2012. Twenty-two states encourage utilization of the NADA protocol through regulation.28 A 2016 study of NADA within a substance abuse treatment program demonstrates long term savings to the state in NADA control group upon discharge: increased employment by 71% of those previously unemployed vs 35% in the control group, and long term abstinence from alcohol, drugs, and tobacco use.32 A study outcome produced expenditures in a non-NADA control group totaling $17,890.00 while NADA control group costs were $15,580.00, equating to a savings of $2,310.00 per patient,37 a savings of 1 million dollars to the state for every 433 participants. Prison and jail inmates are seven times more likely than individuals in the general population to have a SUD.13 Inmates medicated for violent behavior experienced improved behavior ratings and required fewer psycholeptic drugs than controls when receiving NADA three times weekly.36 A model comprehensive homeless and criminal justice incarceration diversion program in Oregon reports 11% recidivism, saving the state $25,000/year for every rehabilitated person.42 A Sacramento Drug Court Cost Study of a model program demonstrates cost-benefit through comprehensive programming with a 17% recidivism rate after two years for graduates compared to 67% in the non-participation control group, and a saving of $6,605 per graduate; ten year program lifetime savings is calculated as more than $20 million.64
Incorporating NADA treatment into Oklahoma’s existing drug-court diversion and rehabilitation programs may further reduce prison populations and drive down crime rates; for example, reducing Oklahoma drug court graduates’ re-incarceration rates by 50% could save the state 2 million dollars for every 100 additional rehabilitated persons. “The average annual cost of incarceration in the Oklahoma Department of Corrections is $19,000 per person, compared with the average annual per person cost for drug court participation of $5,000. Drug court graduate re-incarceration rates of 23.5% when compared with rates of those whom successfully complete standard probation, 38.2%, and released inmates, 54.3%, are further proof that Oklahoma Drug Courts work.”100 Oklahoma’s existing drug-court program has expanded to 73 of the 77 counties,100 increasing rural and underserved population
access throughout the state. However, Oklahoma incarcerates “a greater portion of its population than any state but one, and a greater portion of its women than anyone”118 and the building of three new prisons is being considered. Pregnant women and neonates are one of “three populations with unique risk in the context of the opioid epidemic.”65 NADA has proven to be safe during pregnancy.41 Although specific acupuncture points on the body are contraindicated during pregnancy, NADA has consistently proven safe and effective throughout term and post-partum. For more than 25 years, NADA was incorporated into the Maternal Substance Abuse Services Program, inspiring programming world-wide while continuing the legacy of the innovative award winning Lincoln Recovery Center39 pregnancy program, an award granted to the center in 1991 by the American Hospital Association.28 Between 2000 and 2009, the rate of newborns diagnosed with neonatal abstinence syndrome (NAS) and dependent on narcotics nearly tripled and the number of mothers using or dependent upon drugs more than quadrupled, while costs associated with treating these infants increased by 35%. Medicaid was the primary payer for over 75% of these births.13 New studies on NADA efficacy suggest savings in neonatal intensive care units from shorter hospital stays and decreased withdrawal symptoms resulting in reduced costly interventions.44,45 The CDC reports that over $170 billion dollars annually is spent on treating diseases caused by smoking; 16 million Americans are currently living with a disease caused by smoking. When used in combination with educational programming, auricular acupuncture protocols (including NADA) have demonstrated marked effect upon reducing nicotine withdrawal symptoms and long-term measurable outcomes are comparable to that of pharmacological approaches at greatly reduced cost.109
Appendix E: Acupuncture, Chronic Pain Efficacy, and Cost-Saving Information 30% of patients with chronic pain conditions also suffer from clinical depression, and nearly 50% of patients who suffer from both anxiety and depression disorders have a comorbid pain diagnosis.13 A study published by the NIH in 2017 documents that “evidence on acupuncture compared with usual care and counseling compared with usual care shows that both treatments are associated with a statistically significant reduction in symptoms of depression in the short to medium term, with no reported serious adverse events related to treatment. Acupuncture is cost-effective compared with counseling or usual care alone, although the ranking of counseling and acupuncture depends on the relative costs of delivering these interventions.” 107 A 2017 study finds that acupuncture rewires the primary somatosensory cortex in patients experiencing carpel tunnel syndrome.18 The research supports previous findings recommending the use of acupuncture as a viable first-line long-term cost-effective approach, prior to consideration of costly surgical procedures. Over one-third of patients avoided surgery (arthroplasty of the knee) when acupuncture was added to the standard treatment protocol – generating a savings of $9,000 per patient.49 When incorporated into pre-surgical care, acupuncture has been found to reduce the amount of post-operative morphine consumption; post-operative pain is a strong predictor of subsequent chronic pain.46 Acupuncture is routinely used to reduce pain in cancer patients, as well as alleviate chemotherapy induced nausea and vomiting.46,51-54 Cancer Treatment Centers of American (CTCA) employs acupuncturists in its five nationwide hospitals, providing acupuncture in an integrative setting.51 Dana Farber Cancer Institute at Harvard University has developed evidence-based acupuncture protocols to provide clinically relevant solutions for clinicians and cancer patients with pain, including: postoperative cancer pain, postoperative nausea and vomiting, postsurgical gastroparesis syndrome, opioid-induced constipation, opioid-induced pruritus, chemotherapy-induced neuropathy, aromatase inhibitor-associated joint pain, and neck dissection-related pain and dysfunction.52-54 The National Cancer Institutes comprehensive cancer database (PDQ) statement on acupuncture indicates usage in a wide range of conditions: hot fashes, xerostomia (dry mouth), neuropathy, and cancer related-fatigue & pain management. A 2008 military study documents how replacing pharmacotherapy with acupuncture care for symptoms of pain can generate a $4,000 savings per patient to the Department of Defense – additional savings of $10,000-$18,000 per patient occur when procedures such as spinal fusion and laminectomy are successfully avoided.47
Appendix F: Medicaid and Acupuncture The 2014 Medicaid report articulates: “In addition to the financial implications of prescription drug abuse and overdose, chronic and severe social implications reverberate through Medicaid and social service programs as well in the areas of homelessness, domestic violence, unemployment, foster care, and others that can burden states for years in service and care needs.”13 “Medicaid is the largest health care safety net program and is responsible for the health care of 73 million Americans, including those with the most complex health care needs. The program covers 50 percent of all U.S. births, promotes children’s achievement of developmental milestones and school readiness and, enables adults to maintain good health in support of work readiness and job retention, and furthers the values, dignity, safety and integration of individuals who require long-term services and supports. States and the federal government jointly finance and operate Medicaid, making an effective federal-state partnership critical to success of the program.”114 “Because rates of prescription drug misuse and overdose are elevated in individuals that have co-occurring mental illness and/or have a history of substance abuse, access to and effective coordination of care is essential… Inclusion of other clinical and support specialists on the treatment team could also be considered and may be amenable to payer support, including case management and promotion of non-pharmacologic therapies such as acupuncture, massage, and health/wellness classes. Together these ancillary providers may help in shifting the focus away from prescribing opioids as a primary or exclusive means of pain relief… By incorporating recommendations across the six strategies, states can reasonably expect to bring about a reduction in prescription drug abuse and overdose, resulting in an overall reduction in healthcare expenses and an improvement in the health outcomes of Medicaid beneficiaries.”13 A Medicaid report in March 2017 articulates that “Medicaid must also be given statutory certainty around its ability to support holistic initiatives addressing the social determinants of health, which may cross federal programmatic and funding silos. These types of initiatives represent the next horizon for health care transformation, and with federal support, states may lead the way.”114 The Oklahoma Health Care Authority is a state government agency responsible for administering the Oklahoma’s Medicaid program known as “SoonerCare.”112 In 2015, approximately 17% of Oklahoma enrollees were categorized as disabled, aged, or blind; 61% of enrollees were children and more than half of children in Oklahoma were enrolled; average monthly enrollment was 820,000; and total Medicaid spending was $5.1 billion (including funding of $3.1 billion from federal government).111 The agency’s mission is to “responsibly purchase state and federally-funded health care in the most efficient and comprehensive manner possible; to analyze and recommend strategies for optimizing the accessibility and quality of health care; and, to cultivate relationships to improve the health outcomes of Oklahomans.”112 As of 2017, eight states provide acupuncture coverage through Medicaid (California,79 Maryland,86-88,99 Massachusetts,97 Minnesota,80 New Mexico,81 Ohio,82-83 Oregon84-85 and Rhode Island89,91); New Jersey’s Medicaid plan covers acupuncture anesthesia during surgery;108 and several states, such as Vermont,96 implement temporary innovative Medicaid pilot programs to examine outcomes and savings.90-93 Oklahoma appears to be poised to lead, saving lives by qualifying for supplemental Medicaid funding through 1115 demonstration pilots.90 Expanding upon current successful programming, replicable demonstrations utilizing licensed acupuncturists, with clearly-defined baseline measures, goals, and evaluation criteria in targeted sub-populations groups, have clear potential to propel Oklahoma into the lead for innovative emerging community-based collaborative approaches addressing the unique challenges that must be overcome to successfully combat the nation-wide opioid epidemic.
References
- Bureau of Labor and Statistics (BLS) Standard Occupational Classification Policy Committee Standard Occupation Code Docket 2018 Response. Retrieved 06/18/2017. https://www.bls.gov/soc/2018/soc_2018_docket_responses.pdf
2. The Accreditation Commission for Acupuncture and Oriental Medicine. (2017). Retrieved 06/18/17. http://acaom.org/
- Witt, Pach, Brinkhaus, et al. Safety of Acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information consent form. ForschKomplementmed. Apr 2009;16(2):91-97.
- Jabbour, Sapko, Miller, Weiss, Gross. Economic Evaluation in Acupuncture: Past and Future. The American Acupuncturist. Fall 2009; 49: 11 – 17.
5. Gale. Hospital Practice: Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP). Meridians. 2016;3(4): 11-16. Retrieved 06/18/17. http://www.meridiansjaom.com/files/MERIDIANSJAOM_A003.4.pdf
6. National Certification Commission for Acupuncture and Oriental Medicine. 2017.Retrieved: 06/18/2017. http://www.nccaom.org/about-us/history/
7. United States Department of Labor, Bureau of Labor and Statistics. 2009, March 12. Standard Occupational Classification, Response to Comment on 2010 SOC: Multiple Dockets on “Acupuncturists.” Retrieved June 2017. http://www.bls.gov/soc/2010_responses/response_mutliple_docket_5.htm
8. O*Net Online. 2011. Summary Report for: 29-1199.01 – Acupuncturists. Retrieved 06/18/17.http://www.onetonline.org/link/summary/29-1199.01
9. Oklahoma Board of Private Vocation Schools. 2017.Retrieved 6/18/17.https://obpvs.publishpath.com/Websites/obpvs/images/DOCUMENTS/OBPVS_State_Licensed_Schools.pdf
10. Zhang, Shang, Gao, Ernst. Acupuncture-related adverse events: a systematic review of the Chinese literature. Bulletin of the World Health Organization.2010;88:915-921C. doi:10.2571/BLT.10.076737. Retrieved 6/18/2017. http://www.who.int/bulletin/volumes/88/12/10-076737/en/
11. Jabbour, Hobbs, Clay, Miller, Morris, Barrett, Taromina, Kang, Benjamin, Graham, et al. Third Draft Federal Acupuncture Bills, American Association of Acupuncture and Oriental Medicine. November 1, 2013. Retrieved 6/18/17. https://c.ymcdn.com/sites/www.aaaomonline.org/resource/resmgr/Legislation-2013/AAAOMLegislativeBills-110113.pdf
12. Center for Disease Control and Prevention. Increases in Drug and Opioid-Involved Overdose Deaths- United States, 2010-2015.Morbidity and Mortality Weekly Report, December 30, 2016, 65(50-51);1445-1452. Retrieved 6/8/2017. https://www.cdc.gov/drugoverdose/data/statedeaths.htmlhttps://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm 13. Marsh & McLennan Companies. State Medicaid Interventions for Preventing Prescription Drug Abuse and Overdose: A Report for the National Association of Medicaid Directors. National Association of Medicaid Directors.October 1, 2014; p. 5-9, 11-12, 15, 19, 20, 37, 39, 43, 44.
14. Goldman, Chen, Fujita, Xu, Peng, Liu, Nedergaard. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience.2010 Jul;13(7):883-8. Retrieved 6/18/2017. https://www.ncbi.nlm.nih.gov/pubmed/20512135
15. How Does Acupuncture Affect the Body? The University of Chicago Medicine Adult Health Library.Retrieved 6/18/2017. http://healthlibrary.uchospitals.edu/Library/DiseasesConditions/Adult/CompAltMed/85,P00171
16. National Congress of American Indians. Resolution #SD-15-027.Retrieved June 6, 2017.http://www.ncai.org/resources/resolutions/support-of-the-inclusion-of-doctors-of-chiropractic-doctors-of-naturopathic-medicine-and-licensed-acupuncturists-at-indian-health-service-and-tribal-facilities
17. H.R.2839 (115th): Acupuncture for Heroes and Seniors Act of 2017-2018. Retrieved June 18, 2017.https://www.congress.gov/bill/115th-congress/house-bill/2839 18. Maeda, Kim, Kettner, Kim, Cina, Malatesta, Gerber, McManus, Ong-Sutherland, Mezzacappa, Libby, Mawla, Morse, Kaptchuck, Audette, Napadow. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncuture.Oxford Academic Brain A Journal of Neurology. (02 March 2017) 140 (4):914-927.
19. Choi, Gizewski, Elki, Rampp, Dobos, Forsting,Musial. Acupuncture changes brain’s perception and processing of pain, researchers find. ScienceDaily.30 November 2010. Retrieved 06/19/2017. https://www.sciencedaily.com/releases/2010/11/101130100357.htm
20. Takayama, Watanabe, Kusuyama, Nagase, Seki, Nakazawa, Yaegashi. Evaluation of the Effects of Acupuncture on Blood Flow in Humans with Ultrasound Color Doppler Imaging.Evid Based Complement Alternat Med.Vol 2012. Art ID 513638.Retrieved 06/29/2017. https://www.hindawi.com/journals/ecam/2012/513638/
21. Yang, Zeng, Feng, Fang, Qin, Liu, Song, Xie, Chen Liang. A PET-CT study on the specificity of acupoints through acupuncture treatment in migraine patients.BMC Complementary and Alternative Medicine. 2012, 12:123. Retrieved 06/19/2017. http://www.biomedcentral.com/1472-6882/12/123
22. Li, Shi, Xu, Wang, Liu, Wang. Acupuncture Effect and Central Autonomic Regulation. Evid Based Complement Alternat Med.Vol 2013, Art ID 267959. 2013. Retrieved 06/19/2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677642/
23. Yamaguchi, Takahashi, Sakuma, Sugita, Uchikawa, Sakaihara, Knada, Arai, Kawakita. Acupuncture Regulates Leukocyte Subpopulations in Human Peripheral Blood. Evid Based Complement Alternat Med. 2007 December; 4(4): 447-453. Retrieved 06/19/2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2176150/
24. Yan, Zhang, Liu, Dang, ANDO, SUGIYAMA, Chen, Ding. Imaging Study on Acupuncture points. Journal of Physics: Conference Series 186. 2009. Retrieved 06/19/2017. http://adsabs.harvard.edu/abs/2009JPhCS.186a2100Y
25. Deng, Hou, Holodny, Cassileth. Functional magnetic resonance imaging changes and saliva production associated with acupuncture at LI2 acupuncture point: a randomized controlled study. BMC Complement Altern Med, 2008; 8: 37.Retrieved 06/19/2017.https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-8-37
26. Yan, Zhang, Liu, Huang, He, Ding. Do acupuncture points exist? Phys Med Biol. 2009 May 7;54(9). Retrieved 6/19/17.https://www.ncbi.nlm.nih.gov/pubmed/19351976
27. Kim, Ku, Bae, Shin, Jun, Kang, Kim, Lee, Kim. Hemodynamic changes caused by acupuncture in healthy volunteers: a prospective, single-arm exploratory clinical study. BMC Complementary and Alternative.22 May 2017.17:274. Retrieved 6/19/17.https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-017-1787-z
28. National Acupuncture Detoxification Association (NADA). Retrieved 06/19/2017.https://www.acudetox.com 29. Serafini, Bryant, Ikomi, LaPaglia. Training Psychiatry Addiction Fellows in Acupuncture.Acad Psychiatry. 2016 Jun; 40(3):503-506. Retrieved 06/19/2017.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670818/
30. Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2012. Data on Substance Abuse Treatment Facilities.BHSIS Series S-66, HHS Publication No. (SMA) 14-4809. 2013: 57.Retrieved 06/19/2017. http://wwwdasis.samhsa.gov/dasis2/nssats/2012_nssats_rpt.pdf
31. U.S. Dept. of HHS, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Detoxification and substance abuse treatment, treatment improvement protocol (TIP45) series. 2006. Retrieved 6/19/2017. http://www.csam-asam.org/sites/default/files/pdf/misc/TIP_45.pdf
32. Carter, Olshan-Perlmutter, Marx, Martini, Cairns. NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment. Behavioral Sciences.16 June 2017, 7(2), 37.Retrieved 06/19/2017.http://www.mdpi.com/2076-328X/7/2/37/htm
33. U.S. Department of Justice Bureau of Justice Assistance. Frequently Asked Questions Series: Effectiveness of Acupuncture as an Adjunct to Substance Abuse Treatment: Summary of Recent Research Findings. BJA Drug Court Technical Assistance Project;May 24, 2011. Retrieved 6/19/2017. https://jpo.wrlc.org/bitstream/handle/11204/859/FAQ_Effectiveness%20of%20Acupuncture%20as%20an%20Adjunct%20to%20Substance%20Abuse%20Treament.pdf?sequence=4&isAllowed=y
34. U.S. Department of Veterans Affairs. Research Advances. 2014; 5.Retrieved 06/19/2017.http://www.research.va.gov/pubs/docs/VAResearchAdvances2014.pdf
35. Stuyt, E. Ear acupuncture for co-occurring substance abuse and borderline personality disorder: An aid to encourage treatment retention and tobacco cessation. Acupunct. Med. 2014, 32, 318–324. Retrieved 06/19/2017. http://aim.bmj.com/content/32/4/318 36. Berman, Lundberq. Auricular acupuncture in prison psychiatric units: a pilot study. ActaPsychiatrSc and Suppl.2002;(412):152-7. Retrieved 06/19/2017.
https://www.ncbi.nlm.nih.gov/pubmed/12072149 37. Santasiero, Neussle. Cost-Effectiveness of Auricular Acupuncture For Treating Substance Abuse in An HMO Setting: A Pilot Study. Medical Acupuncture.2005; 16: 39-42.
38. Carter, Olshan-Perlmutter, Norton, Smith. NADA Acupuncture Prospective Trial in Patients with Substance Use Disorders and Seven Common Health Symptoms. Medical Acupuncture. September 2011, 23(3): 131-135. Retrieved 06/19/2017. https://doi.org/10.1089/acu.2010.0784
39. Smith, Michael. Testimony presented by Michael O. Smith, MD, DAc, to the Select Committee on Narcotics of the US House of Representatives July 25, 1989. Acupuncture Treatment For Drug Addiction: Acupuncture Treatment For Drug Addiction – Testimony Presented To The Select Committee On Narcotics Of The US House Of Representatives. Retrieved 07/02/2017. http://www.healthy.net/Health/Article/Acupuncture_Treatment_for_Drug_Addiction/2501/1 40. Wismer B, Amann T, Diaz R, Eisen D, Elder N, Ho C, Hwang S, Johnston M, Joslyn M, Kertesz S, Kushel M, Preston C, Solotoroff R, Thompson L, Silva F, Smith S, Zevin B, Meinbresse M, Post P (Ed.). Adapting Your Practice: Recommendations for the Care of Homeless Adults with Chronic NonMalignant Pain, 128 pages. Nashville: Health Care for the Homeless Clinicians’ Network, National Health Care for the Homeless Council, Inc., 2011; 2,5,45.
41. Nancy Smalls, Honoring 40 Years of Service at Lincoln Recovery Center. Guide points: News from NADA September 2013. Retrieved June 2017. http://nada-danmark.dk/wp-content/uploads/2014/05/Nancys-Guidepoints-Sept.-2013.pdf
42. Blackburn. Invest in Re-entry programs not in prison cells. The Oregonian. November 1, 2011. Retrieved 7/03/2017.http://www.oregonlive.com/opinion/index.ssf/2011/11/invest_in_re-entry_programs_no.html 43. Kailasam, V.K.; Anand, P.; Melyan, Z. Establishing an animal model for National Acupuncture Detoxification Association (NADA) auricular acupuncture protocol. Neurosci.Lett.2016, 624, 29–33.
44. Raith, Schmolzer, Resch, Reiterer, Avian, Koestenberger, Urlesberger. Laser Acupuncture for Neonatal Abstinence Syndrome: A Randomized Controlled Trial. American Academy of Pediatrics; October 2015. Retrieved June 2017. http://pediatrics.aappublications.org/content/early/2015/10/21/peds.2015-0676
45. Janssen, Demorest, Kelly, Thiessen, Abrahams. Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol. Substance Abuse Treatment, Prevention, and Policy.December 2012. 7:48. Retrieved July 2017. https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-7-48
46. Kotani, Hashimoto, Sato, Sessler, Yoshioka, Kitayama, Matsuki. Preoperative intradermal acupuncture reduces postoperativepain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses. Anesthesiology.2001.95(2),349-356.Retrieved July 2017.http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1944615
47. Spira. Acupuncture: A Useful Tool for Health Care in an Operational Medicine Environment. Military Medicine.2008. 173, 7:629-634.Retrieved July 2017. http://militarymedicine.amsus.org/doi/pdf/10.7205/MILMED.173.7.629 48. Allen. How Many Die From Medical Mistakes in U.S. Hospitals? ProPublica.September 19, 2013.Retrieved July 2017.
https://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals
49. Christensen, Luhl, Vilbek, Bulow, Dreijer, Rasmussen. Acupuncture treatment of severe knee osteoarthrosis. A long-term study.ActaAnaesthesiol Scand. 1992 Aug; 36(6):519-25.Retrieved July 2017.https://www.ncbi.nlm.nih.gov/pubmed/1514335
50. Kim, Lee, Chae, Park, Lee. A systematic review of cost-effectiveness analyses alongside randomized controlled trials of acupuncture. Acupunct Med. Dec 2012; 30(4):273-285.Retrieved July 2017.https://www.ncbi.nlm.nih.gov/pubmed/23099289
51. Cancer Treatment Centers of America. Acupuncture. Retrieved July 2017. http://www.cancercenter.com/treatments/acupuncture/
52. Saltus. Can Acupuncture Ease Cancer Symptoms? Dana-Farber Cancer Institute at Harvard University – Insight Information & Inspiration Blog. June 1, 2017. http://blog.dana-farber.org/insight/2013/04/can-acupuncture-ease-cancer-symptoms/?_ga=2.237969927.644040092.1499230548-141910532.1499230548
53. The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute at Harvard University. Retrieved July 2017. http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and-Family-Support/Zakim-Center-for-Integrative-Therapies.aspx
54. Lu, Rosenthal. Acupuncture for cancer pain and related symptoms. Curr Pain Headache Rep. 2013 March; 17(3):321.Retrieved July 2017. https://www.ncbi.nlm.nih.gov/pubmed/23338773
55. Grissa, Baccouche, et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. American Journal of Emergency Medicine. 2016;34(11):2112-2116. Retrieved July 2017. http://www.ajemjournal.com/article/S0735-6757(16)30422-3/fulltext 56. U.S. Department of Defense. (2010, December 10). Doctors Use Acupuncture as Newest Battlefield Tool. Retrieved July 2017.
http://archive.defense.gov/news/newsarticle.aspx?id=62053
57. U.S. Department of Defense. (2011, October 25). Military Medicine Works on Managing Pain. Retrieved July 2017.http://archive.defense.gov/news/newsarticle.aspx?id=65812 58. U.S. Department of Defense. (2008, May 1). Gates Works to Reduce Mental health Stigma. Retrieved July 2017.
http://archive.defense.gov/news/newsarticle.aspx?id=49738 59. U.S. Department of Defense. (2011, January 27). Marines in Afghanistan Test New Concussion Care. Retrieved July 2017.
http://archive.defense.gov/news/newsarticle.aspx?id=62607
60. U.S. Department of Defense. (2011, June 24). Intrepid Center Marks First Anniversary. Retrieved July 2017. http://archive.defense.gov/News/NewsArticle.aspx?ID=64450 61. U.S. Department of Defense. (2011, February 9). Women Learn to Fight Stress from Home Front. Retrieved July 2017.
http://archive.defense.gov/news/newsarticle.aspx?id=62739
62. Conboy. Acupuncture in the Treatment of Gulf War Illness. National Institutes of Health ClinicalTrials.gov. May 2015. Retrieved July 2017. https://clinicaltrials.gov/ct2/show/NCT01305811
63. National Pain Strategy. Interagency Pain Research Coordinating Committee, National Institutes of Health & U.S. Department of Health and Human Services. March 2016. Retrieved July 2017. https://iprcc.nih.gov/National_Pain_Strategy/NPS_Main.htm
64. Carey, Waller, Byrne. California Drug Courts: Costs and Benefits. Phase III: DC-CSET Statewide Launch, Superior Court of Sacramento County, Sacramento Drug Court Site-Specific Report. California Administrative Office of the Courts, December 2008. Retrieved July 2017. http://docplayer.net/8953643-California-drug-courts-costs-and-benefits.html
65. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Board on Health Sciences Policy Health and Medicine Division, National Academies of Sciences, Engineering, Medicine.July 13, 2017. Retrieved 07/13/2017. https://www.nap.edu/resource/24781/Opioids-ReleaseSlides.pdf
66. Center for Disease Control. 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Retrieved January 9, 2017. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm 67. Acupuncture. NIH Consensus Statement 1997 Nov 3-5; 15(5): 1-34.
68. National Center for Complementary and Integrative Health 2016 Strategic Plan. Retrieved July 2017..https://nccih.nih.gov/about/strategic-plans/2016
69. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017.https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/california-ehb-benchmark-plan.pdf
70. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources.Retrieved July 2017.https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/alaska-ehb-benchmark-plan.pdf
71. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017. https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/maryland-ehb-benchmark-plan.pdf
72. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017.https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/new-mexico-ehb-benchmark-plan.pdf
73. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017. https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/washington-ehb-benchmark-plan.pdf
74. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017. https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/american-samoa-ehb-benchmark-plan.pdf
75. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017. https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/guam-ehb-benchmark-plan.pdf
76. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources. Retrieved July 2017. https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/northern-mariana-islands-ehb-benchmark-plan.pdf
77. Center for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight, Data Resources.Retrieved July 2017. https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/virgin-islands-ehb-benchmark-plan.pdf
78. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials, Chapter 3, Diseases and disorders that can be treated with acupuncture. World Health Organization. Retrieved July 2017.https://www.acupuncture.org.uk/public-content/public-traditional-acupuncture/4026-who-list-of-conditions.html
79. California Medi-Cal Update. Acupuncture. August 2016. Retrieved July 2017. https://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/acu201608.asp
80. Minnesota Department of Human Services, Acupuncture Services. Retrieved July 2017. http://www.dhs.mn.gov/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&dDocName=dhs16_166324&RevisionSelectionMethod=LatestReleased 81. New Mexico ABP vs State Plan Comparison Chart. April 2015. Retrieved July 2017.
http://www.hsd.state.nm.us/uploads/files/Looking%20For%20Information/Information%20for%20Recipients/Alternative%20Benefit%20Plan%20vs.%20State%20Plan%20Comparison%20Chart/ABP%20vs%20StatePlan%20comparison%20chart%204%2029%2015.pdf 82. Medicaid Transmittal Letter (MTL) No. 3334-16-18. December 27, 2016. Ohio Department of Medicaid. Retrieved July 2017.
http://www.medicaid.ohio.gov/Portals/0/Resources/Publications/Guidance/MedicaidPolicy/NonInst/MTL-3334-16-18.pdf 83. 2017 Member Handbook, CareSource. 2016. Retrieved July 2017.
https://www.caresource.com/documents/oh-medicaid-member-handbook/ Federal Medicaid Notice. Ohio Department of Medicaid. October 2016.
Click to access MFN_5160-1-60_20161007.pdf
84. OHP fee-for-service coverage of back and spine pain diagnosis and treatment. Oregon Health Authority, Health Systems, Oregon Health Plan. March 6, 2017. Retrieved July 2017.http://www.oregon.gov/oha/HSD/OHP/Announcements/OHP%20fee-for service%20coverage%20of%20back%20and%20spine%20pain%20diagnosis%20and%20treatment.pdf 85. Oregon Health Authority, Health Systems, Oregon Health Plan. Retrieved July 2017.
http://www.oregon.gov/oha/HSD/OHP/Pages/Announcements.aspx 86. The Maryland Medical Assistance Program: Provider Manual for Medicaid Provider Types AC, 13, 16, 17, 18, and 28. January 2015.
Click to access MARYLAND%20EPSDT%20Therapy%20PROVIDER%20MANUAL%20January%202015%20final%20(1)%20(1).pdf
87. Application Checklist for Maryland Medical Assistance Program Application: Individual Provider – Acupuncture. Maryland Department of Health and Mental Hygiene. 11/30/2016. Retrieved July 2017.https://mmcp.dhmh.maryland.gov/pages/Provider-Enrollment.aspx
88. Department of Health and Mental Hygiene: Professional Services Fee Schedule January 2017. Maryland Medical Assistance. Maryland Department of o Health and Mental Hygiene. January 2017. Retrieved July 2017. https://mmcp.dhmh.maryland.gov/Documents/Professional%20Services%20Fee%20Schedule-%20January%202017%20updated223.pdf
89. Rhode Island Medicaid Covered & Non-Covered Services. 4-14-2014. Retrieved July 2017. http://facilityinfo.logisticare.com/Portals/221/Downloads/Covered%20Services%204-14-14.pdf
90. About Section 115 Demonstrations. Center for Medicare & Medicaid. Retrieved July 2017. https://www.medicaid.gov/medicaid/section-1115-demo/about-1115/index.html
91. Neighborhood Health Plan of Rhode Island Clinical Practice Guidelines: Complementary Alternative Medicine (CAM) Ease the Pain Program. December 18, 2014. Retrieved July 2017. https://www.nhpri.org/Portals/0/Uploads/Documents/CPG/Clinical%20Practice%20Guidelines%20CAM%20NHPRI%202014.pdf
92. Redwood. Integrative Health Care for a Medicaid Population: Interview with Alan Post, D.C. Topics in Integraive Health Care 2012, Vol.3(4). December 31, 2012. Retrieved July 2017. https://www.nhpri.org/Portals/0/Uploads/Documents/CPG/Clinical%20Practice%20Guidelines%20CAM%20NHPRI%202014.pdf
93. Inflexxion, Inc., GoMo Health, Rhode Island Hospital, and The Miriam Hospital Launch Study of Mobile Text-Message Program for Patients in Medicaid Chronic Pain Program, GOMOHEALTH. August 18, 2015. Retrieved July 2017. https://gomohealth.com/2015/inflexxion-inc-gomo-health-rhode-island-hospital-and-the-miriam-hospital-launch-study-of-mobile-text-message-program-for-patients-in-medicaid-chronic-pain-program/
94. Clum, Meeker, Carabello, McAllister, Lignos. Chiropractic: A Key to America’s Opioid EXIT Strategy. Foundation for Chiropractic Progress. 2017. Retrieved July 2017.http://www.f4cp.com/files/industry-news/f4cp-opioids-2.0-white-paper-web.pdf
95. Continuing Your Care After You Join Neighborhood INTEGRITY. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/RICOCP.pdf 96. Masterson. Can Acupuncture Offer Pain Relief and Reduce Opioid Use? Vermont Funds Medicaid Study. January 27, 2017. Retrieved July 2017.
http://digital.vpr.net/post/can-acupuncture-offer-pain-relief-and-reduce-opioid-use-vermont-funds-medicaid-study#stream/0
97. Thorn. Letter to Physicians Participating in Mass Health Commonweath of Massachusetts. MassHealth Transmittal Letter PHY-140.MassHealth Provider Manual Series: Physican Manual, 1/1/2014. December 2013. Retrieved July 2017.http://www.mass.gov/eohhs/docs/masshealth/transletters-2013/phy-140.pdf
98. Health Insurance Information Session: RE Essential Health Benefit Benchmark Plan Options for 2017 [May13, 2015], Commonwealth of Massachusetts, Office of Consumer Affairs and Business Regulation, Division of Insurance. May 15, 2015. Retrieved July 2017. http://www.mass.gov/ocabr/docs/doi/essential-health-benefit-benchmark-plan-options-2017.pdf 99. The Maryland Medical Assistance Program: PROVIDER MANUAL For Medicaid Provider Types AC, 13, 16, 17, 18, and 28. January 1, 2015. Retrieved July 2017.
Click to access MARYLAND%20EPSDT%20Therapy%20PROVIDER%20MANUAL%20January%202015%20final%20(1)%20(1).pdf
100. Inflexxion blog. Interview Spotlight: OK Department of Mental Health and Substance Abuse Services. March 28, 2017. Retrieved July 2017. http://blog.inflexxion.com/interview-spotlight-ok-department-mental-health-substance-abuse-services/
101. Schoenfeld, Ochoa, Bader, Belmont, Philip. Risk Factors for Immediate Postoperative Complications and Mortality Following Spine Surgery: A Study of 3475 Patients from the National Surgical Quality Improvement Program. Journal of Bone & Joint Surgery – American Volume: 7 September 2011. 93; 1577-1582. Retrieved July 2017. http://journals.lww.com/jbjsjournal/pages/articleviewer.aspx?year=2011&issue=09070&article=00002&type=abstract
102. Review of Acupuncture Coverage in the USA. 2011. Retrieved July 2017. http://www.gancao.net/acupuncture/review-of-acupuncture-insurance-coverage-in-the-usa-5521
103. A History of Acupuncture in the First Three Drug Courts. Retrieved July 2017. http://www.leg.state.co.us/Clics/Clics2011A/commsumm.nsf/b4a3962433b52fa787256e5f00670a71/f41bd2c5fa219a418725783100646934/$FILE/110208AttachI.pdf
104. Edwards, Brown. Nonpharmacologic Management of Neonatal Abstinence Syndrome: An Integrative Review. Neonatal Network. November 5, 2016. 35:305-313(9) Retrieved July 2017. http://www.ingentaconnect.com/content/springer/jnn/2016/00000035/00000005/art00008#expand/collapse
105. Patrick, Schumacher, Benneyworth, Krans, McAllister, Davis. Neonatal abstinence syndrome and associated health care expenditures: United States, 200-2009. Journal of American Medical Association. May 9, 2012. 307(18):1934-40. Retrieved July 2017. https://www.ncbi.nlm.nih.gov/pubmed/22546608
106. Corr, Hollenbeak. The economic burden of neonatal abstinence syndrome in the United States.Addiction .June 13, 2017. Retrieved July 2017. https://www.ncbi.nlm.nih.gov/pubmed/28612362
107. MackPherson H, Vickers A, Bland M, et al. Chapter 6 Acupuncture, Counseling or Usual Care for Depression: a randomized controlled trial. Acupuncture for chronic pain and depression in primary care: a programme of research. NIHR Journals Library; 2017 January. https://www.ncbi.nlm.nih.gov/books/NBK409485/
108. https://newjersey.wellcare.com/WCAssets/newjersey/assets/nj_medicaid_benefitschart_01_2014.pdf
109. Bier, Wilson, Studt, Shakleton. Auricular Acupuncture, Education, and Smoking Cessation: A Randomized, Sham-Controlled Trial. American Journal of Public Health.2002 October; 92:1642-1647.Retrieved July 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447300/
110. Smoking & Tobacco Use. Center for Disease Control and Prevention.Retrieved July 2017. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
111. Mediaid, What’s That? Oklahoma Policy Institute. Retrieved July 2017. http://okpolicy.org/medicaid
112. Oklahoma Health Care Authority, What’s That? Oklahoma Policy Institute. Retrieved July 2017. http://okpolicy.org/oklahoma-health-care-authority/
113. A STATE PLAN: Reducing Prescription Drug Abuse in Oklahoma. Oklahoma Printing Services Division, Oklahoma Department of Mental Health and Substance Abuse Services. 11/2013. Retrieved July 2017. https://www.ok.gov/odmhsas/documents/Rx%20Abuse%20Prevention%20Plan.pdf 114. Key State Flexibilities for Consideration in Medicaid Reform, National Association of Medicaid Directors.3/23/2017.
http://medicaiddirectors.org/wp-content/uploads/2017/03/NAMD-Key-State-Flexibilities-for-Consideration.pdf 115. Volkow, McLellan. Opioid Abuse in Chronic Pain —Misconceptions and Mitigation Strategies.The New England Journal of Medicine.March 31, 2016. 374;13:1257.
116. Morath. You’re Hired: Trump Plans to Build U.S. Workforce With Apprenticeships. The Wall Street Journal. June 10, 2017.Retrieved July 2017. http://nation.foxnews.com/2017/06/12/youre-hired-trump-plans-build-us-workforce-apprenticeships
117. Gov. Fallin Says President’s Directive on Apprenticeships Aligns with Her OkWorks Initiative. June 15, 2017. Retrieved July 2017. http://services.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=33285#
118. Editorial Roundup: Recent editorials in Oklahoma newspapers. Tulsa World. June 4, 2017. Retrieved June 8, 2017. http://www.sanluisobispo.com/news/business/article154568954.html
119. Governor Fallin- 2017 Legislative Session goals http://altustimes.com/category/news This brief has been prepared by Rhonda K Bathurst, L. Ac., Brandy Valentine-Davis, L. Ac., and Tim Williams, Cert. Ac. with evidence base provided by the American Association of Acupuncture and Oriental Medicine (AAAOM) and the National Acupuncture Detoxification Association (NADA). 9 August 2017.
120. Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JA, Meade L, Pang J. Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management—White Paper 2017. J Integr Med. 2017; 15(6): 411–425.
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冬雪春雨4296952 [中国浙江省杭州市 ]：2016年12月06日 19:04 发表
中国的传统中医医务工作者，中国的中药材质量，中国的中药产品的质量，中国新闻有关中国中医的报道质量，中国的医务工作者，中药材，中药产品检验质量到底怎么样？有多少真实性？有多少被污染了？
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悲欢离合4294282 [中国贵州省黔西南布依族苗族自治州 ]：2016年12月06日 07:55 发表
中国药助中华民族人数众多，人材济济，繁荣昌盛、就是最明显的疗效。
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