The difficulty in reducing the epidemic addiction to painkillers while still trying to relieve patients’ pain is felt most by doctors such as Michael Spearman. He’s an internist at Myrtle Hilliard Davis Comprehensive Health Centers, federally subsidized health clinics in north St. Louis that care for those with public health insurance or no insurance.
The three clinics see 30,000 patients a year, and nearly 40 percent — 11,700 — are taking prescription painkillers.
Trauma and barriers to health care that are more common among the poor leave many patients suffering from painful, complex and chronic conditions, Spearman said. Other than writing a prescription for a narcotic or sending them to surgery, he has little at his disposal to help.
His patients can’t travel to or pay for nondrug treatments such as physical therapy, acupuncture, electrical stimulation or chiropractic care, which is not covered by Medicaid. They can’t get more imaging tests to better diagnose problems.
Yet he’s faced with the fact that every day in the U.S., 44 people die from overdosing on prescription painkillers, and many more are becoming addicted, according to the Centers for Disease Control and Prevention.
“It is frustrating,” Spearman said. “We have patients who have pain you can’t make go away.”
Desperate for options, administrators at Myrtle Hilliard contacted Logan University chiropractic college, and a unique partnership formed to provide chiropractic care at little or no cost to patients.
After one year, the care has been so successful it inspired another system of subsidized health clinics — Family Care Health Centers in south St. Louis — to start a similar collaboration with Logan.
“Ever single one of us who works here sees a patient touched by the opioid or heroin addiction every week,” said Dr. Mattie White, a family medicine doctor at the Family Care Health Center in the Carondelet neighborhood. “We are trying to figure out what we can do that is best for our patients, and our best hope for the future.”
On Tuesday, the CDC issued the first national guidelines for prescribing painkillers, warning doctors to try other options before prescribing opioids for chronic pain (pain that continues for more than three months or past time of normal healing).
At Myrtle Hilliard, patients are lining up in droves for the chiropractic services and reporting promising results, said chief executive officer Angela Clabon. Initial data after the first year shows that 80 percent of patients receiving the care decreased their reliance on pain medications.
“Many patients are struggling with back problems and all kinds of issues and are highly medicated,” Clabon said.
“We thought we could help them get off their medications and improve their quality of life, and that’s exactly what’s happened.”
Since 1999, federal data shows the amount of painkillers prescribed and sold in the U.S. has nearly quadrupled.
In 2012, the CDC reports, health care providers wrote 259 million prescriptions for opioid pain relievers — enough for every American adult to have a bottle of pills. The state of Missouri ranked 14th in the number of painkiller prescriptions that year, with 95 prescriptions per 100 people.
The greater availability has been accompanied by alarming increases, not only in deaths due to painkiller abuse, but also inpatient and emergency room visits — a 137 percent increase in Missouri alone — over the past 10 years.
Addiction to painkillers is fueling the sale of a much cheaper street opioid: heroin. More than 10,000 people died from heroin-related overdoses in 2012, a rate that had more than quadrupled since 2002. Nearly half of heroin users were addicted to prescription pain relievers, according to the CDC.
Governors, mayors, county executives and physicians groups are working together to raise awareness, prioritize substance abuse treatment, and explore prevention programs and treatment options.
The latest federal data show prescribing rates have leveled off, and painkiller deaths have declined for the first time in decades. The biggest drops have come in states that have instituted monitoring programs that prevent patients from getting prescriptions from multiple doctors; and measures such as regulating pain clinics and requiring physician training.
Missouri is the only state without a prescription drug monitoring program, making it more challenging for doctors trying to write prescriptions when appropriate. “It’s always possible they are getting them from somewhere else, and I don’t know that,” White said.
The collaboration between Logan University and the federally funded clinics, with their closely watched outcomes, creates fertile ground for research in treatment options. Family Care Health Centers is staffed with family medicine residents from St. Louis University, which plans to study their referrals to the chiropractors.
“My entire life in medicine, I have fought with opioid use and pain,” White said. “It will be nice to take part in research to find out what else is available and what else could work.”
Logan’s director of integrated health centers, Barry Wiese, said he knows of no other collaborations in the country to provide chiropractic services in community health clinics. He expects more will follow.
At each of the clinic sites, a doctor of chiropractic oversees Logan students in caring for patients. For Logan, it’s an opportunity for students to receive their clinical training by treating patients with complex problems in a comprehensive health clinic; and make a big impact on the health of residents.
“It’s not profitable, but it is a win-win,” Wiese said. “It gives us some of the best clinical teaching opportunities, and at the same time we get to give back to the community in a way we couldn’t otherwise do.”
100 PATIENTS A WEEK
About two years ago, severe arthritis sidelined Alicia Rockel, 53, of St. Louis, after owning a cleaning company for 25 years. The pain worsened, and she could not stand or sit in one position for more than five minutes.
Family Care Health Center providers feared prescribing her narcotics, she said, because she’s suffered addiction in the past. They referred her to chiropractic care, and she’s gotten better without drugs.
“Before I was not able to drive even to the corner grocery store without screaming in pain, and now I can drive to my brother’s house in Ballwin. I can vacuum my whole house without stopping and do the dishes without stopping,” Rockel said. “It’s given me my life back.”
Family Care began referring patients three months ago to Logan’s private clinic about eight miles away in south St. Louis County, where the staff treats the referrals three days a week based on the patient’s ability to pay.
White said she’s already seen patients get relief from tension headaches, put away their walkers and avoid surgeries. “I know we are seeing decreased pain and increased function in patients,” she said.
Using two exam rooms inside the clinic on Martin Luther King Drive, chiropractic providers at Myrtle Hilliard started out seeing patients three days a week. Because of demand, treatment expanded to five days a week, and they went from caring for 20 patients a week to 100.
“My favorite thing to hear is, ‘I don’t have to take my medication any more,’” said Ross Mattox, the doctor of chiropractic who oversees the clinic’s program.
Chiropractic care is new and different for most patients, Mattox said. They are not used to being touched or assured they will get better. Many become able to exercise and prevent further problems.
Nelson Jackson, 60, of the Glasgow Village area, couldn’t stand up straight or turn his head after falling asleep one night in his recliner. After receiving adjustments from Mattox, the former Marine is now able to play with his grandkids.
“Not only does he treat the physical ailments, he also administers some type of mental confidence in me,” Jackson said. “That also makes a difference, I no longer feel like I’m a broken-down old man.”