The Northwestern Health Advocate
Center for Healthcare Innovation and Policy
Stay current with the latest policy and research news in integrative health care
Healthcare Policy
Urgent Need to Increase Use of Non-Drug Healthcare Recognized
While the public health impact of the opioid abuse epidemic is well recognized, its impact continues to astound. Recent data from the Centers for Disease Control and Prevention indicate that opioid drugs are not only killing 142 Americans each day, but are shortening the overall lifespan of US citizens. Drug overdoses reduce the life expectancy of an American born in 2015 by 3.5 months, compared to someone born 15 years earlier. Opioids specifically account for 2.5 of those months.
The White House Commission on Combating Drug Addiction and the Opioid Crisis recently issued an initial report of recommendations to address the opioid abuse problem, and include:
- Increasing the capacity of treatment facilities for substance abuse
- Mandating prescriber education initiatives in appropriate pain management
- Enhancing data sharing among state-based prescription drug monitoring programs
- Enforcing the Mental Health Parity and Addiction Equity Act, to ensure health plans cannot impose less favorable benefits for those with mental health or substance use diagnoses
Of interest to complementary and integrative health care providers, it also suggests the need for a more thorough examination of the benefit of alternative pain management strategies. This presents an important opportunity for advocating the role of chiropractic, acupuncture, massage and other treatments as effective, safe, non-drug therapies to treat pain.
Just this week, more than three dozen states’ Attorney Generals did exactly that in a letter submitted to the President and CEO of America’s Health Insurance Plans. They asked that plans review payment and coverage policies to ensure they prioritize non-opioid pain management options over opioid prescriptions for chronic, non-cancer pain. Pointedly, they state that opioids provide “no substantial [evidence for] maintenance of pain relief or improved function over long periods of time”, and that if taken for longer than three months, are “ineffective and can be life-threatening”. Specifically, the letter advocates the use of physical therapy, acupuncture, massage and chiropractic care.
Finally, the newest Gallup-Palmer College of Chiropractic study reports that 8 in 10 Americans prefer to use drug-free alternatives to pain management, before taking prescription painkillers. The nation’s focus on opioid abuse has finally seemed shift the dialogue toward drug-free pain treatment, and is appropriately pointing toward complementary and integrative care therapies as part of the solution. We find ourselves with a window of unprecedented opportunity to partner with others, and solve one of the most pressing healthcare crises in a generation. Join your local, state, and national professional and public health associations in bringing our voice to the conversation.
Research
Small Association Found between Antidepressants and Autism
The most conclusive study to date investigating the relationship between use of antidepressants during pregnancy and the incidence of autism spectrum disorder (ASD) was published this summer. Basic science has shown that exposure to selective serotonin reuptake inhibitors (commonly referred to as SSRIs, which are commonly prescribed antidepressants) can lead to autism-like behavior in animal models. It is also known that antidepressants cross the placental barrier. Therefore, theoretically, there is biological plausibility that antidepressants may be associated with ASD in humans.
Despite several observational studies, research up to this point been conflicting and largely inconclusive. This is a difficult topic to study because depression and other conditions commonly treated with antidepressant medication may have genetic causes also associated with ASD. This is a confounding variable that has not been adequately controlled in previous research, creating uncertainty and a lack of confidence in previous studies’ results.
A prospective observational cohort study by Rai, et al studied a quarter of a million children in Sweden. It compared groups of children who were born to (1) mothers who did not take antidepressants and did not have any psychiatric disorders, (2) mothers who took antidepressants during pregnancy, (3) mothers with psychiatric disorders who did not take antidepressants during pregnancy. Birth registers, prescription drug registers and antenatal interviews were linked to measure association between prenatal exposure and ASD, and to match cases with controls to minimize the potential of confounding.
Results showed that children exposed to antidepressants during pregnancy were at a slightly higher risk of autism than those of mothers with psychiatric disorders who were not treated (OR 1.45, 95% confidence interval 1.13 to 1.85). This points to a potential effect of antidepressants on the risk of autism beyond the confounding effect of maternal depression. The absolute risk was small: 4.1% of children exposed to antidepressants in utero had ASD, compared to 2.9% in those whose mothers had a history of psychiatric disorder but did not take antidepressants. Therefore, in theory, only about 2% of autism cases would be prevented if pregnant women did not take antidepressants.
It is important to note that maternal depression itself carries risks for the lives of fetuses and infants. As with any intervention, the risks versus benefits of taking SSRI by pregnant women to treat depression should be weighed carefully against this small, but perhaps important, increased risk of ASD in their offspring.
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Center for Healthcare Innovation and Policy
Executive Director of Research and Innovation
Email: mmaiers@nwhealth.edu
Website: https://www.nwhealth.edu/president/center-healthcare-policy/
Location: 2501 W 84th St, Bloomington, MN, United States
Phone: 952-888-4777 158
Twitter: @michele_maiers