In recent years, there has been a growing demand from the public for acupuncture services in the U.S., leading to increased interest and scientific investigation into its effectiveness, safety, and potential uses within the U.S. health care system. The National Center for Complementary and Integrative Health (NCCIH), formerly known as the National Center for Complementary and Alternative Medicine (NCCAM), has funded the most rigorous acupuncture research to date to evaluate its use to ease the pain of chronic conditions such back and neck pain, osteoarthritis, shoulder pain, and headache (Vickers et al, 2012). Findings of this meta-analysis suggest that acupuncture’s effects on chronic pain are clinically significant, supporting the recommendation by NCCIH of referrals for acupuncture as a reasonable treatment option for people with chronic pain (NIH, 2018).
For most doctors practicing within the biomedical paradigm of the heath care system, these findings along with the growing base of evidence for acupuncture’s effectiveness may not be enough to promulgate regular referrals for acupuncture treatment in the context of standard care. However, amidst a growing concern for the widespread misuse of prescription opioids contributing to over 17,000 deaths in 2016 and $504 billion in economic costs (CEA, 2017), many in the health care system are looking to non-pharmacologic alternatives to manage chronic pain. This response to the Opioid Epidemic has drawn interest towards promoting acupuncture and other integrative therapies and inclusion of them in legislation like the Comprehensive Addiction and Recovery Act (CARA), signed into law in 2016, that mandated the Veterans Administration (VA) to expand acupuncture and other integrative health services as well as related research and education.
In fact, the VA has championed integrative health delivery on a national level through the creation of the Integrative Health Coordinating Center, a branch of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT). The VA offers acupuncture or other integrative services in 93 percent of its nation-wide centers that treat more than six million veterans annually (Reddy, 2018). In addition, the VA’s 2018 policy to establish an occupational qualification standard for employment positions of state-licensed acupuncturists within the VA Health Administration further recognizes the advanced professional education, training, and experience of state-licensed acupuncturists and distinguishes their knowledge and skills from that of a certified acupuncturist physician with less acupuncture-specific training (NCCAOM, 2018). This status for licensed-acupuncturists to be acknowledged by a government standard (GS) rating of GS 9-12 helps to lend credibility to the profession of acupuncture and its perception in the national health care arena.
Similarly in 2018, acupuncturists earned a distinct Standard Occupational Code (SOC) by the Bureau of Labor and now have their own federally recognized labor category based on data that confirmed growth within their profession (NCCAOM, 2018). These developments in understanding on a government-level will undoubtedly help to advance the acupuncture profession as it continues to establish itself as a mainstay in standard medical care and make its way into future public policy initiatives.
Preserving the integrity of the profession of acupuncture by its licensed members has long been a priority within the community as most biomedical physicians are also permitted to practice acupuncture within the scope of their medical practices with little to no additional related training. Only three states (Hawaii, Montana, New Mexico) require that physicians obtain acupuncture licenses by completing an accredited program and two states (Vermont and Rhode Island) decreased their requirements over the past two decades, allowing physicians to deliver acupuncture within their scope of practice where in the past this was prohibited. State regulations for training and competency have been focused on safety, recognizing contraindications and complications, and observing the procedures of clean-needle technique (Lin & Tung, 2017). Licensed acupuncturists, who provide acupuncture according to East Asian medical theories of diagnosis and treatment, often criticize the lack of this holistic basis of understanding by certified acupuncture physicians and cite it as a key motivation in preserving the extent of their scope. Further investigation into the differences in outcomes by the two approaches to acupuncture is necessary to address the associated strengths and weaknesses.
Similar issues regarding preserving scope of practice and safety have recently come into question with regard to the use of acupuncture techniques by practitioners other than acupuncturists, specifically physical therapists, who are using a procedure called intramuscular manual therapy, commonly called “dry needling.†This physical therapy service involves the insertion needles into trigger-points of muscles and is sometimes being sought after in lieu of services by licensed acupuncturists because of its access through insurance coverage of physical therapy and rehabilitative services. State regulations in California, Utah, New York, Idaho, Hawaii, and Florida do not allow dry needling in their states because it involves puncturing the skin (Kinetacore, 2018). The American Academy of Physical Medicine and Rehabilitation (AAPMR) recognizes the risks associated with dry needing, such as bruising, hematoma, pneumothorax, nerve injury, vascular injury, and infection. Despite the legality of physical therapists being able to utilize this controversial procedure in most states, The AAPMR maintains their position that dry needling “should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed acupuncturists or licensed medical physicians†(NCCAOM, 2012).
With the potential of future legislation providing greater access of acupuncture to a vast number of Americans, it is clear that may factors and stakeholders will be taken into consideration when crafting related policies and regulations. Licensed acupuncturists may continue to practice a form of the medicine most true to its origins and traditions but they also may need to share in the delivery of acupuncture with other health care providers to meet growing demand. Their role in shaping what that ultimately becomes will be a critical part in establishing the competencies required to maximize the impact that acupuncture can have within the wider landscape of America’s evolving health care system.
References
Kinetacore. (2018). Scope of practice. Retrieved from:Â <https://www.kinetacore.com/about/scope-of-practice/>
Lin K., Tung C. (2017). The regulation of the practice of acupuncture by physicians in the United States. Medical Acupuncture, 2017, 29(3):121-127. http://doi.org/10.1089/acu.2017.1235
National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). (2012). AAPM&R policy on dry needling. Retrieved from: <http://www.nccaom.org/resource-center/press/press-releases/aapmr-policy-on-dry-needling/>
National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). (2018). Acupuncturists now included in the Veterans Health Administration. Retrieved from: <http://www.nccaom.org/blog/2018/03/01/acupuncturists-in-va/>
National Institutes of Health (NIH). (2018) Acupuncture: In depth. Retrieved from:<https://nccih.nih.gov/health/acupuncture/introduction>
Reddy B. (2018). A model for integrative health in the U.S.. Acupuncture Today, 2018, 19(6):1526-7784
The Council of Economic Advisers (CEA). (2017). The Underestimated cost of the Opioid Crisis. Washington, DC: U.S. Government Printing Office.
Vickers A.J., Cronin A.M., Maschino A.C., Lewith G., Macpherson H., Foster N.E., Sherman K.J., Witt C.M., Linde K. (2012). Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Archives of Internal Medicine, 2012 Oct 22; 172(19):1444-53. http://doi.org/10.1001/archinternmed.2012.3654