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STILL RELEVANT?  |   March 2018
Addressing the Opioid Crisis Through the Teachings of A.T. Still
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Janice Blumer, DO, Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, 200 Mullins Dr, Lebanon, OR 97355-3983. Email: jblumer@westernu.edu
     
Article Information
Addiction Medicine / Pain Management/Palliative Care
STILL RELEVANT?   |   March 2018
Addressing the Opioid Crisis Through the Teachings of A.T. Still
The Journal of the American Osteopathic Association, March 2018, Vol. 118, 139-140. doi:https://doi.org/10.7556/jaoa.2018.032
The Journal of the American Osteopathic Association, March 2018, Vol. 118, 139-140. doi:https://doi.org/10.7556/jaoa.2018.032
In the early 1900s, the founder of osteopathic medicine, Andrew Taylor Still, MD, DO, found himself practicing in an opioid epidemic similar to the epidemic taking place today. After he returned from the Civil War, he discovered that many people had developed terrible habits through medications and drug use. In his autobiography, he wrote: 

[B]y day and night I saw legions of men and women stagger to and fro, all over the land, crying for freedom from habits of drugs and drinks. … I saw men and women dosed with drugs whose poisonous fangs showed the serpent of habit, that was as sure to eat its victim as a stone would return to the earth when cast into the air. … I was convinced there was something surer and stronger with which to fight sickness than drugs, and I vowed to search until I found it.1(pp91-92,373)

 
More than a century later, the United States is in the midst of an opioid epidemic of plague-like proportions. From 1999 to 2010, opioid analgesic sales quadrupled.2 Correspondingly, from 1999 to 2012, opioid-related deaths more than tripled.2 In 2014 alone, nearly 29,000 people in the United States died of an opioid overdose (including heroin).3 According to a 2015 report,4 an estimated 33 million people use opioids worldwide. Fishbain et al5 estimated that abuse develops in nearly 5% of patients with chronic pain who are treated with prescription opioids, though this rate varies across studies. 
To address the current epidemic, the Department of Veterans Affairs6 has taken a 4-pronged approach: education, pain management, risk mitigation, and addiction treatment. In a similar vein, Still's approach was to use osteopathic tenets to find the health of the patient. Abuse of prescribed narcotic elixirs and tonics were met with education of his patients, pain management using the body's inherent abilities to heal, risk management by steering clear of “fallacious tonics,” and addiction treatment through the art of osteopathy: 

So nature applies to you the switch of pain when her mandates are disregarded, and when you feel the smarting of the switch, do not pour drugs into your stomachs, but let a [skillful] engineer adjust your human machine, so that every part works in accordance with nature's requirements.1(p289)

 

I have no desire to make war on doctors themselves, but only strive against their fallacious theories. What does medicine do for you? By temporarily allaying the misery it often begets a worse thing and fills the system with poison.7(p302)

 
The 2017 guidelines from the American Society of Interventional Pain Physicians8 include establishing an appropriate physical diagnosis, as well as a psychological diagnosis, if applicable. Still would have agreed—he taught his students: 

He [the osteopath] should go back to the cause which when corrected results in a disappearance of the effect.9(p10)

 

He [the osteopath] sees cause in a slight anatomical deviation for the beginning of a disease.10(p18)

 
Although Still did prescribe medication and pain killers when necessary, he strove to find the cause of the pain first. He used the inherent wisdom of the body, improvements in structure and function, and the body's capacity to heal as his first-line tools. 

What is osteopathy? It is a scientific knowledge of the anatomy and physiology in the hands of a person of intelligence and skill, who can apply that knowledge to the use of man when sick or wounded by strains, shocks, falls, or mechanical derangement or injury of any kind to the body. … He [the osteopath] finds that in man wonderful chemical changes do all the work.10(pp18,31)

 
The current medical model focuses on disease and symptom control, not always the root cause of the symptoms or the “anatomical deviations” that lead to the effect of pain. It is far easier to prescribe medication that temporarily alleviates the pain. This focus on the result, not the cause, has helped to perpetuate the current opioid epidemic. Still professed osteopathy as the only tool for both alleviating pain and finding the source of the pain for those who choose to practice it. 

Osteopathy is a complete science and is not dependent on allopathy, homeopathy, eclecticism, suggestive therapeutics, [C]hristian science or any system or school of philosophy. But its own philosophy of surgery, midwifery, and general treatment are complete and defy refutation, and pronounces all conglomerates to be traps baited with flatter and deception to deceive the afflicted, to obtain their money.11

 
Today, how we manage pain in our society is in many ways back to where we started in the 1890s. The current medical focus on alleviating the effect of pain has perpetuated the opioid epidemic. The misery that we witness among patients addicted to opioids is real. Osteopathic physicians confronting this epidemic should find Still's teaching still relevant, following his mission and vision to help humankind. 
References
Still AT. Autobiography of A.T. Still. Kirksville, MO: published by the author; 1897.
Frank SM, Porter KS, Paulouzzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief. 2015;189:1-8.
Rudd RA, Aleshire N, Zibbel JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;64(50-51);1378-1382. doi: 10.15585/mmwr.mmr6450a3 [CrossRef] [PubMed]
United Nations Office on Drugs and Crime. World Drug Report 2015. Vienna, Austria: United Nations Office on Drugs and Crime; 2015. http://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf. Accessed January 19, 2018.
Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? a structured evidence-based review. Pain Med. 2008;9(4):444-459. doi: 10.1111/j.1526-4637.2007.00370.x [CrossRef] [PubMed]
Gellad WF, Good CB, Shulkin DJ. Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs. JAMA Intern Med. 2017;177(5):611-612. doi: 10.1001 /jamainternalmed.2017.0147 [CrossRef] [PubMed]
Still AT. Autobiography of A.T. Still. Revised ed. Kirksville, MO: published by the author; 1908.
Manchikanti L, Kaye AM, Knezevic NN, et al.   Responsible, Safe and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2017;20(2S):S3-S92. [PubMed]
Still AT. Osteopathy Research and Practice. Kirksville, MO: published by the author; 1910.
Still AT. The Philosophy and Mechanical Principles of Osteopathy. Kansas City, MO: Hudson-Kimberly Pub Co; 1902.
Still AT. Don't mix. J Osteopath. December 1901:393.