The Opioid Epidemic and the Role of Physical Therapy

This past week I had the privilege to attend the 2019 StartUp Health Festival in San Francisco, CA. StartUp Health provides a unique platform in where entrepreneurs, investors, providers and healthcare industry players (like Casamba) can collaborate through innovation to help address some of the most pressing problems we face in healthcare. The Opioid Epidemic in the United States was among one of the hot topics this year. The discussion on the subject not only opened my eyes to the deadly magnitude of this issue, but it also left me pondering of the role that physical therapy plays in this devastating epidemic. 

The Opioid Epidemic fire-chat discussion was led by Dr. Sanjay Gupta, MD (CNN correspondent and practicing neurosurgeon) and Dr. Howard Krein, MD, PhD (Chief Medical Officer of StartUp Health). The statistics surrounding this epidemic are simply staggering. The Centers for Disease Control and Prevention estimate that the total “economic burden” of prescription Opioid misuse in the United States is $78.5 billion a year. Every day, more than 130 people in the US die after overdosing on Opioids (including prescription pain relievers, heroin and synthetic Opioids). In 2015 alone, more than 33,000 Americans died as a result of Opioid overdose. In short, Opioid addiction is killing American citizens at an alarming rate.

The panel addressed various root causes to this problem. Over prescription of Opioid medications for pain control were among the few topics discussed. Both of our panelists were MD’s and it was clear that the medical profession feels a clear sense of accountability in this epidemic. But this is a complex problem and physicians are not to take all of the blame. Many other cultural, socioeconomic, political and psychosocial factors also play a major role.

The discussion around potential solutions was both invigorating while at the same time disappointing. Let’s highlight the positives first. There are clearly many ways in where the healthcare community is tackling the epidemic. For example, new non-narcotic solutions for pain management and drug cravings are starting to look very promising (e.g. Cannabis and CBD); pharmacological agents such as Narcan are very effective in resuscitating victims from an overdose; holistic approaches such as psychotherapy, meditation and lifestyle changes are also gaining traction. Despite these positive developments, I was really discouraged about the fact that physical therapy was never mentioned as a viable solution for pain management and narcotic control.

The United States is by far the largest buyer of legal narcotic drugs in the world. Yet, we are a population plagued with chronic pain. It’s no mystery that narcotic addiction can lead to heavier drug consumption such as heroine. In fact, 21 to 29 percent of patients prescribed Opioids for chronic pain misuse them and between 8 and 12 percent develop an Opioid use disorder as a result. Why then, is a panel full of physicians not talking about the role physical therapy can play in pain management? 

I believe the answer lies in the lack of awareness of our services. Clearly, the need of pain management in this country is such that we have the opportunity to flood every outpatient physical therapy practice in the country with patients. Other professions such as chiropractors and even acupuncturists do a much better job at promoting their skills and attract more patients with pain needs (a quick street survey will confirm that). Patients believe in taking pills rather than proactively taking care of their symptoms through natural means such as exercise, body awareness, posture, body mechanics and life changing habits. There is no doubt physical therapy can help and be part of the solution if we could just do a better job at promoting ourselves. 

Given the magnitude of this epidemic, it is our responsibility to do better. We must continue to educate patients and the general public about the role physical therapy plays in pain management and become the default solution for treating musculoskeletal pain. We need to educate patients about how they can manage their pain without popping a pill. We need to educate primary care physicians (and other medical disciplines) that we are a tremendously effective alternative for treating pain dysfunction. But is not enough to simply raise awareness. We need to be accessible and continue to advocate for direct access. It has to be easy for the general public to find us, book us, work with us. Patients need to engage with their therapy providers outside of the four walls of the clinic so that they can have meaningful conversations with them. 

This is where technology comes into play. If applied correctly, technology reduces the friction between the patient and the provider.  Current technologies geared to the OP therapy market for example, such as BetterPT, Alinea Engage, BlueJay Mobile Health, etc. that help patients find therapists, book appointments and meaningfully engage with providers before, during and post treatment. Technology allows us (physical therapists) to be easy to find, easy to book, easy to do business with, easy to communicate with and easy to engage with. We need to leverage these technologies now more than ever and continue to promote our services. We are an important piece of the Opioid epidemic puzzle; and now more than ever, our communities need to know that. It is our responsibility to let them know.