State legislators promote ineffective NADA auricular acupuncture protocol for substance abuse

Auricular acupuncture is both highly implausible and has no good evidence of effectiveness as a treatment for substance abuse. Yet, state legislators continue to introduce bills pretending this is not the case. When these bills become law, scare resources and efficacious treatments are pushed aside in favor of magical thinking.

Auricular acupuncture, or "acudetox," is promoted by the National Acupuncture Detoxification Association, which claims there is

"strong evidence for the effect of the NADA protocol in improving patient outcomes [in addiction treatment] in terms of program retention, reductions in cravings, anxiety, sleep disturbance and need for pharmaceuticals."

Actually, there's not. This conclusion is based on cherry-picked studies. In fact, studies of auricular acupuncture follow the trajectory of acupuncture studies in general: More robust trials failed to support initial weak evidence in favor of acupuncture. At best, auricular acupuncture is an elaborate placebo.

Of course, there is no reason to suspect auricular acupuncture would be effective for anything, substance abuse included. French neurologist Paul Nogier supposedly "discovered" a fetal homunculus on the human ear and, by analogy to whole-body acupuncture, invented ear acupuncture. In another origin myth, Hong Kong addicts were supposedly relieved of their desire for heroin after electro-acupuncture, but no clinical trials were ever done to support this claim. Neither story offers a credible biological reason why sticking needles in the outer rim of the ear would affect the complex pathophysiology of addiction.

Yet, during the 2017 state legislative sessions, bills were introduced in two states buying into the fantasy that auricular acupuncture is an effective therapy. In Maine, a bill was introduced forcing the state to apply to the federal Center for Medicare and Medicaid Services for authorization of a pilot project to treat substance abuse with the NADA auricular acupuncture protocol. The program will last for two years, must be reimbursable under federal law, and must be cost-neutral or save money for the state's Medicaid program.

Results are to be reported after two years, but there is no definition of just what might be considered a success, other than cost savings. Of course, this means the program could have zero effectiveness in treating addiction, but as long as it saves money, it will have met its goal, even if none of the substance abusers get off drugs.

One legislator testified in favor of the bill, saying:

"Given the horrific price being paid by Maine families as the opioid crisis continues, are we not compelled to embrace every modality that can offer a solution?"

Perhaps, but NADA doesn't "offer a solution." One acupuncturist, who works at a VA acupuncture program, testified in favor of the bill as well, but didn't offer one whit of evidence.

One the other hand, here's what the head of the Office of Substance Abuse and Mental Health Services of the Maine Department of Health and Human Services had to say:

"Acupuncture is considered an alternative treatment for substance use disorders. It has been used in conjunction with other evidence-based treatments but not as a stand-alone treatment. A review of literature from the Substance Abuse Mental Health Services Administration (SAMHSA), the American Psychological Association (APA) and the National Registry of Evidence-Based Programs and Practices (NREPP) does not recognize acupuncture as an evidence-based practice for the treatment of alcohol abuse disorders, substance abuse disorders and co-occurring disorders."

The committee considering the bill was divided on whether the bill should pass.  Unfortunately, it passed in the House and now appears it will pass in the Senate. Should that happen, the Governor should veto it, as he did a similar bill last year. Medicaid is in enough trouble as it is without wasting money on worthless treatments.

In West Virginia, which has one of the worst rates of death from overdose in the country, state law prohibits the practice of acupuncture without a license. A bill was introduced giving those trained in NADA auricular acupuncture an exemption from the licensing requirement. The bill was never heard in committee and appears to have missed a deadline for further consideration by the legislature. That is small comfort: presumably licensed acupuncturists can still use auricular acupuncture on patients in West Virginia.

Laws permitting the use of auricular acupuncture for substance abuse are yet another unfortunate example of Legislative Alchemy, the process by which the state legislatures and Congress incorporate implausible and unproven diagnostic methods and treatments into our healthcare system, sometimes paying for them with public funds. It is a shameful scam on the American public.