Opioids may have been the first path many of Dr. Benjamin Algiere’s patients took for pain relief, but he hopes it’s not their last.
A practicing chiropractor, and owner of 8-month-old Algiere Chiropractic Inc. in Richmond, Algiere discourages continued opioid use for pain management, knowing it may lead to addiction. He said many of his patients believe they’ve “built up a tolerance” to opioids and are now “terrified” of becoming addicted.
“They read the news,” he said, “they know [opioids are] bad for them … and they’re trying to get off them,” he said.
One of nine opioid-crisis-related bills signed into law by Gov. Gina M. Raimondo on Aug. 7 will mandate insurance coverage for “medically necessary” chiropractic care for patients with “substance-use disorders” when it goes into effect next April.
Algiere said one in three male patients he sees aged 25-plus previously relied on opioids and saw “no relief.” Women, he added, tend to prefer over-the-counter medications and “shy away from taking narcotics.”
Sen. Donna M. Nesselbush, D-Pawtucket, a co-sponsor of the bill, said she supports the nonopioid pain relief provided by caregivers that include chiropractors and acupuncturists and believes such treatment shouldn’t be hindered by limited insurance coverage.
“So many Americans want a pill to fix everything,” she said, “these are great people to turn to before pharmaceuticals.”
James McDonald holds multiple roles in the R.I. Department of Health, including co-leader of the governor’s Overdose Prevention and Intervention Task Force. He said 5 percent of patients prescribed opioids for any surgery remain on the medication 90 days later, “and it’s not treating the pain … they’ve become addicted.”
Opioids are “one of the worst tools we have … for treating chronic pain,” he added.
According to the task force, approximately 1,000 Rhode Islanders have died from drug overdoses since 2012. To counter these effects, the governor aims to decrease future opioid-related overdose deaths by one-third before 2020.
By mandating insurance coverage, McDonald hopes the bill will encourage physicians to prescribe chiropractic care for pain relief rather than continued use of opioids. “There shouldn’t be a stigma about chiropractic care,” he said, adding insurance coverage will make it more accessible for those whom it is deemed “medically necessary,” he said, citing language in the bill.
Sen. Louis DiPalma, D-Little Compton, is one of the representatives who introduced the bill. The only opposition he heard was from insurance companies, which he said were concerned with the added cost of coverage.
‘A lot of insurance policies put arbitrary limits on chiropractic [care].’
DR. DAVID DWYER, Toll Gate Chiropractic owner
Dr. David Dwyer, owner of Toll Gate Chiropractic in Warwick and current president of the Chiropractic Society of Rhode Island, said “a lot of insurance policies put arbitrary limits on chiropractic [care].” Those limits, he said, lead patients to prematurely end their prescribed treatment at six or 12 visits when more are recommended – a side effect Algiere said he grapples with as well.
The new law, said Dwyer, includes “language that says [insurance companies] will cover [chiropractic care]” for as many visits as medically needed. He hopes the language will encourage patients to complete the full round of chiropractic treatment prescribed by their physician.
As of mid-August, Dwyer said he was unsure how the bill would impact his relationship with insurance companies. “Time will tell,” he said.
Like Algiere, Dwyer said “a fair number” of his patients are “interested in [other forms of pain management] and anxious about [possible opioid addiction]” after prolonged use. He estimated half of his patient pool previously relied on pain medication, including opioids.
“We believe what we do is [medically] effective and cost-effective [and] through the years we’ve been trying to demonstrate that,” he said, adding he hopes to see more chiropractic-care referrals due to the new law.
“[I’m] always interested in … becoming more integrated into the health care delivery system,” he said, adding mandated coverage “is a step in that direction” for the chiropractic-care community.
