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Are medical marijuana, acupuncture alternatives to opioids?

Hillary Talbott, left, of the Art of Acupuncture in St. Petersburg, and Colette Florido, take a whiff of a topical spray created using herbs and Florido's CBD-rich hemp-infused coconut oil as a base, Thursday, June 1, 2017. The women have been experimenting with different pain-relief formulas. Florido started her own cannabis oil company, CR World, in St. Petersburg [CHERIE DIEZ | Times]
Published Mar. 30, 2018

After battling Lyme disease and other ailments for nearly 20 years, Bridgitte Pascale tried "almost everything" to alleviate her pain without relying on opioids.

Though doctors prescribed Percocet and muscle relaxers, she turned to acupuncture and later medical marijuana, which she says are the "only things that help" with the chronic aches and pains she manages daily.

Such alternative treatments are emerging as safe havens for some patients concerned about the dangers of painkillers. But while many swear by the benefit, health insurance generally doesn't cover them.

"It can cost a lot of money," admits Pascale, a 56-year-old registered nurse who lives in Clearwater. "But it's the only thing that helps the pain."

ANYTHING FOR TYLER: How one Florida family risked everything to treat their son with medical marijuana.

As lawmakers grapple with how to address the opioid addiction epidemic that kills thousands annually in Florida alone, some advocates are calling for greater acceptance of non-traditional pain management approaches.

It's an uphill fight.

•••

The road would be longest for medical marijuana.

It won voter approval for use in Florida, but for specific conditions, not pain alone. The federal government still considers it an illegal drug, which all but prevents its study as medicine.

"As long as that's the case, physicians aren't allowed to prescribe it and there's no way health insurance can touch it," said Alex Adams, president of the Compassionate Care Clinics of Pinellas, which employs a state-registered physician to write marijuana recommendations in St. Petersburg.

In Florida, physicians can only "recommend" it, and qualifying patients take that referral to a dispensary to purchase cannabis products. The 13 companies licensed in the state to grow, manufacture and sell medical marijuana dictate the price.

Adams said he sees patients who spend anywhere from $100 to $400 a month on marijuana products.

THE BUZZ: Medical marijuana may be legal, but patients are still limited in Florida.

Pascale paid $165 to see a physician who recommended marijuana, on top of fees to join a state registry. She spent just shy of $200 on cannabis products, from tincture oils to vaporizer pens. She expects her supply to last a little more than a month.

"I take less than the recommended dose to make it last as long as possible," Pascale said.

She's hopeful that the price will come down as more patients turn to cannabis.

•••

Other, more long-standing therapies also have failed to win widespread insurance coverage.

Pascale sees her acupuncturist each month as another way to relieve pain, in addition to her daily doses of marijuana. She drives to St. Pete Community Acupuncture, which offers discounted sessions monthly.

At the Art of Acupuncture in St. Petersburg's historic Kenwood district, practitioners stopped accepting Medicare and other insurance forms some time ago. Owner and operator Christina Bickley Didyk said that it was too much of a hassle because health insurance companies would deny payment requests too frequently or only pay partially for their services.

"We get calls every day asking if we take Medicare and health insurance," she said. "It took chiropractors two decades to convince insurance companies to consider them. I think we'll get there eventually, but it's hard to show in Western medicine physical studies that the benefits are the same for each individual person."

RECENT: Bradley suggests targeting Department of Health funding over medical marijuana delays.

For some patients, the benefits are worth the cost.

After an open heart surgery two years ago, 87-year-old Joan Schory decided to give acupuncture a try to help with lingering physical pain, side effects such as vertigo and even allergy issues.

"I was having all sorts of problems after the surgery and it acupuncture made me feel better in so many ways," said Schory, who lives in Gulfport. "I've always been diligent about seeing a primary physician, but I've also believed that Western medicine isn't always the answer."

Now she goes regularly to the acupuncturist for preventative health measures. She doesn't mind spending $100 an hour for the services.

•••

Even physical therapists, who practice a more "mainstream" form of pain management, battle with health insurance companies sometimes, said Mark Bishop, who has a practice in Gainesville. Physical therapy is used to strengthen the muscles around a particularly painful area, such as a recovering joint or surgical incision, to eliminate acute pain.

"Physical therapy is often considered as a specialty treatment, which means co-pays are a little higher," Bishop said. "Sometimes insurance requires pre-authorization for a patient to see a therapist, which can mean they'll go weeks waiting for the approval and delay treatment."

Studies show that patients are less likely to use prescription drugs to treat acute pain if they see a physical therapist as soon after an injury as possible, he said. Bishop stressed this message to Florida legislators last year as they considered sweeping reforms for opioid use.

"Access to a therapist is important," Bishop said. "In general, it might not work for everyone, but studies show having the access to see a therapist could significantly reduce pain prescriptions."

•••

Health insurance companies differ in how and when they consider covering new treatments, but most rely on U.S. Food and Drug Administration approval and scientific studies, said Sabrina Corlette, a research professor with the Center on Health Insurance Reforms at the Georgetown University Health Policy Institute.

Insurer Humana covers acupuncture and chiropractic services in some of its plans, said spokeswoman Nancy Hanewinckel. She said medical marijuana could be covered one day, if the FDA approved a particular product.

At Florida Blue, a committee led by physicians and other health care professionals constantly review new treatments for coverage, said spokeswoman, Christie DeNave.

"We are always looking at new medical research and listening to what our members are interested in," she said.

Some states, such as California, have passed laws dictating treatments insurers must cover. And some large employers seek extra coverage for such things as acupuncture or vitamin supplements, but most pay the added cost themselves, Corlette said.

"It can be tough with alternative medicine because there's just not the evidence to support it," she said.

Pascale said she doesn't have time to wait around for health insurance to kick in.

"I had terrible bone pain and horrible muscle cramps. My doctors knew that after 20 years of battling Lyme, traditional antibiotics weren't going to work anymore. So I started looking for a more holistic approach," she said.

She admits that she still has a bottle of Percocet, a powerful prescription painkiller with Oxycodone and Acetaminophen components, at home. But she said she has rarely taken any of the pills since starting marijuana.

"I have no desire to be on opioids," Pascale said. "I can always find a less risky way to help control the pain and muscle spasms."

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.

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