Tim Royan

Cronkite News

The State of Arizona Acupuncture Board of Examiners has
entered the fight against opioid abuse, approving chemical dependency
programs for a form of acupuncture that involves the outer ear.
Supporters say auricular acupuncture helps people break free of
addiction, but a skeptic says there’s zero evidence acupuncture relieves
any condition.

“I don’t think (auricular acupuncture is) the complete answer, but I
think it can really help change the tide,” said Dr. Mario Fontes, clinic
director of Natural Medicine & Detox in central Phoenix, which
offers a board-approved chemical dependency program.

Opioids in Arizona have killed more than 3,000 people in the past two
years alone, and more than 21,000 suspected overdoses have occurred
over the same time, according to data from the Arizona Department of Health Services.

First developed by French physician Paul Nogier in the 1950s,
auricular acupuncture, also known as acu-detox, uses needles placed in
one to five acupuncture points in the outer ear. Proponents say the
practice offers a non-pharmacological approach to managing a range of
issues, from pain to stress to post traumatic stress disorder to opiate
withdrawals.

The acupuncture board has made efforts to make it easier for
auricular acupuncturists to gain certification for the past few years to
help address the opioid crisis, said the board’s executive director,
David Geriminski.

“We are hoping that by providing chemical dependency programs,
auricular acupuncture will become more accessible to more people and
more parts of the state, especially in rural areas,” he said.

The current statute for the program, approved in March last year,
allows certified auricular acupuncturists to apply to operate in
approved chemical dependency programs under the supervision of a
licensed acupuncturist, Geriminski said.

Auricular acupuncturists, who are certified to perform acupuncture
for the purpose of chemical dependency and substance abuse treatment,
are required to take a training course through the National Acupuncture
Detoxification Association, in addition to a course in clean needling
technique.

Like what you’re reading? Support high-quality local journalism and help underwrite independent news without the spin.

They also must be reviewed by the board and fingerprinted. They then
are certified to perform acupuncture only on the five points in the ear
for the purpose of treatment, Geriminski said.

Meanwhile, fully licensed acupuncturists are required to complete
what is essentially a master’s degree program, consisting of 1,850 hours
of training, of which 800 hours must be practiced in a clinical
setting, Geriminski said.

Fontes, who also is a member of the State of Arizona Acupuncture
Board of Examiners, said this rigorous licensing process is there to
protect the public. His clinic was the first to be approved by the
board; since then, two more have been approved as chemical dependency
programs.

Fontes said auricular acupuncture is a powerful tool in all stages of
opiate dependency, and he criticized the medical establishment for its
role in the opiate crisis.

“A lot of addictions starts with the prescription pad at the doctor’s
office,” Fontes said. “You have somebody who comes with a legitimate
medical complaint and are prescribed an addictive substance. There are
non-pharmacological approaches to pain management.”

For Fontes, acupuncture also can assist existing addictions by
shifting a person suffering from withdrawals or craving drugs from what
he calls a sympathetic state, or a “fight or flight” response, to
parasympathetic dominance, or a “rest and digest” response.

Auricular acupuncture “helps stop you from freaking out,” Fontes said. “We don’t heal when we’re running from the tiger.”

He also says studies show patients are more likely to remain in
treatment if they’re also undergoing acupuncture, which increases the
likelihood for better outcomes.

But he acknowledges the limitations of any treatment for opiate dependency.

“I will tell you that, percentage wise, all treatment centers are
pretty low,” Fontes said. “People tend to change when they’re ready.”

Like what you’re reading? Support high-quality local journalism and help underwrite independent news without the spin.

Acupuncture, which the National Center for Biotechnology Information
says arose in China 3,000 years ago and spread to the West beginning in
the 16th century, remains controversial.

“Acupuncture points don’t exist,” said Dr. Steven Novella, assistant
professor of neurology at Yale University. “There’s absolutely no
physiology, not some basic science at all, no clinical evidence, nothing
either theoretically or directly that establishes that they exist.”

Novella founded Science Based Medicine, a website promoting empirically substantiated medicine that is critical of alternative treatments, including acupuncture.

The website’s “About” page says online information about alternative
medicine “is overwhelmingly credulous and uncritical, and even
mainstream media and some medical schools have bought into the hype and
failed to ask the hard questions.”

For Novella, government licensure and certifications for acupuncturists are tantamount to sanctioning a fraudulent practice.

“They’ll say … ‘This is to protect patients from bad acupuncturists,’
but, really, what they’re looking for is legitimacy,” Novella said.
“It’s the Trojan horse getting into the gate.”

Novella said auricular acupuncture in particular “has another layer
of nonsense.” He describes it as “a homunculus kind of thing where they
say that different parts of the ear correspond to different parts of the
body. … There’s no science behind it, it’s just representational
magic.”

Although some individual studies
show some benefits from acupuncture for a variety of conditions,
Novella said meta-analyses – large-scale, systematic reviews of existing
smaller studies – demonstrate acupuncture is little more than a
placebo. This includes analyses of smaller studies purporting to show
benefits for opioid use disorder. He also said many of the small-scale
studies only demonstrate secondary benefits and overstate the benefits
of acupuncture.

“The only thing that seems to affect the patient’s response to the
treatment is their interaction with the acupuncturist,” Novella said.
“If the acupuncturists are instructed to be supportive and friendly,
then people get a better subjective response. All of that strongly
suggests that acupuncture is just a placebo treatment.”

Despite characterizing acupuncture as a placebo, Novella contends the practice is far from harmless.

“Patients think that it works. And then what do acupuncturists do?
They use it to treat cancer,” he said. “They use the legitimacy that
they gain from the subjective placebo effect. And then they say, ‘Yes,
this is real medicine that treats real disease.’”

Fontes said he has faced critics like Novella his entire career, but he remains undeterred.

“Anytime there’s something that’s not mainstream, eventually, it
becomes integrated, and there’s always going to be the people opposed to
that,” he said. “The people who want our help, we’re here for. The
people who don’t, that’s OK.”

Fontes
contends that acupuncture has been practiced for millennia so it must involve something more than a placebo effect, while
medicines we’ve had for only a century, such as antibiotics, already are
failing.

“It’s the predominant belief that the true path to health is drugs,
radiation and surgery,” Fontes said. “I just don’t believe that.”

Looking to the future, Fontes hopes auricular acupuncture will become
more widely accepted, and not just for chemical dependency but for PTSD
and stress management, too.

Ultimately, Fontes would like acupuncture more widely accepted in hospitals, and in jails and prisons.

Thanks for reading TucsonSentinel.com. Tell your friends to follow us on Facebook and Twitter.

“A lot of times, our system is punitive,” Fontes said. “Instead of
being helped with your drug problem, you’re punished for the
consequences of your drug problem. So, if we can use the current
infrastructure to be helpful, rather than just punitive, we may change
the outcomes.”