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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Two-Way: Participation Lacking As Missouri Pushes Alternatives To Opioids

The Javorac

The opioid crisis has driven states to look for ways of providing alternative treatments for chronic pain, to reduce people’s exposure to the potentially addictive pain-killers. Here in Missouri, the state’s Medicaid programs offer a range of alternatives, but their reach seems limited so far. Kaiser Health News Midwest Correspondent Lauren Weber has been covering the story and she sat down to talk about some of the reasons the state's efforts haven't yielded significant results. 

Lauren Weber: So since April, the state of Missouri began offering chiropractic care, acupuncture, physical therapy, and cognitive behavioral therapy for Medicaid patients. And Missouri's latest state in a slew of many to try these alternatives to opioids for those battling chronic pain. But what I found out in reporting is that even though they've been offering these options since April, only 500 of the state's roughly 330,000 adult Medicaid users had actually utilized the services. And Josh Moore, who's Missouri's Medicaid pharmacy director put it pretty clearly, like, "Look, at the end of the day, the opioid crisis, we didn't get into it in just a year. So it's not really a surprise that we're going to get out of it in a year." And I think that's a good way of looking at it. Turning the tide and turning the ship on the opioid crisis is going to take more than offering essential alternate therapies. It also takes getting buy-in, it takes provider interest, it takes people showing up to appointments, it takes a lot more.

Health and Wealth: And in terms of getting people to use these alternative treatments, are there any particular barriers, or is it just a lack of information? 

LW: I think it's a combination of both and a few other things. I mean, at the end of the day, it is easier to take pills than it is to show up to multiple rounds of acupuncture or physical therapy that requires a coordinating care schedule, that requires buy-in from your initial provider prescribing you and alternative therapy and then you finding another provider that is offering it under Medicaid currently, which has been kind of slower on the rollout. That requires you driving to find somewhere that offers this, which in rural areas might be harder to find. And also there's a question about cost, you know, some of the acupuncturists I spoke to highlighted that they were afraid to open their practice to Medicaid patients because they didn't think it would be worth what the reimbursement rate would be.

HW: Have you talked to any state officials or any anyone who's concerned about the low participation rates over the course of almost a year now?

LW: The state officials I talked to, like I said, Josh Moore, other folks, you know, they highlighted the fact that look, it's been a slower start, but, the lag could be in part due to claims data being a little bit behind. The data on the efficacy of the programs is also a little bit scattershot. Some data supported it, some isn't as clear on how helpful they can be. That said, the Department of Health and Human Services put it out as a good option in their pain management report this past summer. But like you said, this is a component of turning the tide on the opioid crisis. And one of the experts I spoke to put it pretty wisely. He discussed how it's not necessarily just an opioid crisis, is a chronic pain crisis and to fix chronic pain, you have to address a lot of other issues, you have to address obesity or rural healthcare deserts or how manual labor leads to more chronic pain and all of those structural barriers. All those are structural barriers to fixing the opioid crisis as it stands today.

Sebastián Martínez Valdivia was a health reporter at KBIA and is documentary filmmaker who focuses on access to care in rural and immigrant communities. A native Spanish speaker and lifelong Missouri resident, Sebastián is interested in the often overlooked and under-covered world of immigrant life in the rural midwest. He has a bachelor's degree in broadcast journalism from the University of Missouri and a master's degree in documentary journalism at the same institution. Aside from public health, his other interests include conservation, climate change and ecology.