Pubdate: Mon, 02 Apr 2018
Source: Tampa Tribune (FL)
Copyright: 2018 The Tribune Co.
Author: Justine Griffin, Times Staff Writer


After battling Lyme disease and other ailments for nearly 20 years,
Bridgitte Pascale tried "almost everything" to alleviate her pain
without relying on opioids.

Though doctors prescribed Percocet and muscle relaxers, she turned to
acupuncture and later medical marijuana, which she says are the "only
things that help" with the chronic aches and pains she manages daily.

Such alternative treatments are emerging as safe havens for some
patients concerned about the dangers of painkillers. But while many
swear by the benefit, health insurance generally doesn't cover them.

"It can cost a lot of money," admits Pascale, a 56-year-old registered
nurse who lives in Clearwater. "But it's the only thing that helps the

As lawmakers grapple with how to address the opioid addiction epidemic
that kills thousands annually in Florida alone, some advocates are
calling for greater acceptance of non-traditional pain management 

It's an uphill fight.

The road would be longest for medical marijuana.

It won voter approval for use in Florida, but for specific conditions,
not pain alone. The federal government still considers it an illegal
drug, which all but prevents its study as medicine.

"As long as that's the case, physicians aren't allowed to prescribe it
and there's no way health insurance can touch it," said Alex Adams,
president of the Compassionate Care Clinics of Pinellas, which employs
a state-registered physician to write marijuana recommendations in St.

In Florida, physicians can only "recommend" it, and qualifying
patients take that referral to a dispensary to purchase cannabis
products. The 13 companies licensed in the state to grow, manufacture
and sell medical marijuana dictate the price.

Adams said he sees patients who spend anywhere from $100 to $400 a
month on marijuana products.

Pascale paid $165 to see a physician who recommended marijuana, on top
of fees to join a state registry. She spent just shy of $200 on
cannabis products, from tincture oils to vaporizer pens. She expects
her supply to last a little more than a month.

"I take less than the recommended dose to make it last as long as
possible," Pascale said.

She's hopeful that the price will come down as more patients turn to

Other, more long-standing therapies also have failed to win widespread
insurance coverage.

Pascale sees her acupuncturist each month as another way to relieve
pain, in addition to her daily doses of marijuana. She drives to St.
Pete Community Acupuncture, which offers discounted sessions monthly.

At the Art of Acupuncture in St. Petersburg's historic Kenwood
district, practitioners stopped accepting Medicare and other insurance
forms some time ago. Owner and operator Christina Bickley Didyk said
that it was too much of a hassle because health insurance companies
would deny payment requests too frequently or only pay partially for
their services.

"We get calls every day asking if we take Medicare and health
insurance," she said. "It took chiropractors two decades to convince
insurance companies to consider them. I think we'll get there
eventually, but it's hard to show in Western medicine physical studies
that the benefits are the same for each individual person."

For some patients, the benefits are worth the cost.

After an open heart surgery two years ago, 87-year-old Joan Schory
decided to give acupuncture a try to help with lingering physical
pain, side effects such as vertigo and even allergy issues.

"I was having all sorts of problems after the surgery and it
acupuncture made me feel better in so many ways," said Schory, who
lives in Gulfport. "I've always been diligent about seeing a primary
physician, but I've also believed that Western medicine isn't always
the answer."

Now she goes regularly to the acupuncturist for preventative health
measures. She doesn't mind spending $100 an hour for the services.

Even physical therapists, who practice a more "mainstream" form of
pain management, battle with health insurance companies sometimes,
said Mark Bishop, who has a practice in Gainesville. Physical therapy
is used to strengthen the muscles around a particularly painful area,
such as a recovering joint or surgical incision, to eliminate acute

"Physical therapy is often considered as a specialty treatment, which
means co-pays are a little higher," Bishop said. "Sometimes insurance
requires pre-authorization for a patient to see a therapist, which can
mean they'll go weeks waiting for the approval and delay treatment."

Studies show that patients are less likely to use prescription drugs
to treat acute pain if they see a physical therapist as soon after an
injury as possible, he said. Bishop stressed this message to Florida
legislators last year as they considered sweeping reforms for opioid

"Access to a therapist is important," Bishop said. "In general, it
might not work for everyone, but studies show having the access to see
a therapist could significantly reduce pain prescriptions."

Health insurance companies differ in how and when they consider
covering new treatments, but most rely on U.S. Food and Drug
Administration approval and scientific studies, said Sabrina Corlette,
a research professor with the Center on Health Insurance Reforms at
the Georgetown University Health Policy Institute.

Insurer Humana covers acupuncture and chiropractic services in some of
its plans, said spokeswoman Nancy Hanewinckel. She said medical
marijuana could be covered one day, if the FDA approved a particular

At Florida Blue, a committee led by physicians and other health care
professionals constantly review new treatments for coverage, said
spokeswoman, Christie DeNave.

"We are always looking at new medical research and listening to what
our members are interested in," she said.

Some states, such as California, have passed laws dictating treatments
insurers must cover. And some large employers seek extra coverage for
such things as acupuncture or vitamin supplements, but most pay the
added cost themselves, Corlette said.

"It can be tough with alternative medicine because there's just not
the evidence to support it," she said.

Pascale said she doesn't have time to wait around for health insurance
to kick in.

"I had terrible bone pain and horrible muscle cramps. My doctors knew
that after 20 years of battling Lyme, traditional antibiotics weren't
going to work anymore. So I started looking for a more holistic
approach," she said.

She admits that she still has a bottle of Percocet, a powerful
prescription painkiller with Oxycodone and Acetaminophen components,
at home. But she said she has rarely taken any of the pills since
starting marijuana.

"I have no desire to be on opioids," Pascale said. "I can always find
a less risky way to help control the pain and muscle spasms."
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