Opioids – A Needless Epidemic

Opioids have been front and center in the news recently.  An epidemic of opioid abuse has been declared by the federal government with over 12 million Americans reported to have misused prescription opioids, and tragically, in 2015 over 25,000 deaths resulted from overdoses of prescribed and synthetic opioids.

While I’m no expert on opioids, I have over 35 years of professional insight on the management of mechanical back pain, which is one of the most common conditions for which opioids are prescribed.
Fortunately, there is abundant research that shows chiropractic spinal care is very effective for the treatment of mechanical back pain as well as being cost effective.  Patients who utilize chiropractic co-management have significantly lower rates of opioid use (19% vs 35%) and are 30 times less likely to undergo surgery. (1,2) Health plans realize significant savings by incorporating chiropractic care, with some carriers reporting a 2:1 ROI. (3,4)
Not surprisingly, in the past year the chiropractic primary method of treatment; spinal manipulation, has been endorsed as an alternative to opioids by the FDA, CDC, Joint Commission, American College of Physicians, and 37 State Attorney Generals. (5-9) Earlier this month, a Presidential Commission Report on Opioids echoed those recommendations. (10)
While the opioid crisis is disastrous, there is no greater opportunity for chiropractors to showcase our effectiveness for managing pain. Policy makers from all backgrounds are desperately searching for help in combating this epidemic and chiropractors offer a valuable contribution toward the prevention and management of pain.  My hope is that insurance and governmental policy makers will look to the strong research supporting chiropractic care for the management of pain and take proactive steps to engage chiropractors into medical algorithms for the management of pain.

  1. Whedon J. Association between Utilization of Chiropractic Services and Use of Prescription Opioids among Patients with Low Back Pain. Presented ahead of print at the National Press Club in Washington DC on March 14, 2017. Accessed online at http://c.ymcdn.com/sites/www.cocsa.org/resource/resmgr/docs/NH_Opioids_Whedon.pdf on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/
  2. Benjamin J. Keeney , Ph.D., et al. Early Predictors of Lumbar Spine Surgery After Occupational Back Injury. SPINE Volume 38, Number 11, pp 953–964
  3. Feldman V, Return on investment analysis of Optum offerings — assumes Network/UM/Claims services; Optum Book of Business Analytics 2013. Analysis as of 12/8/2014.
  4. Liliedahl RL, Finch MD, Axene DV, Goertz CM. Cost of care for common back pain conditions initiated with a chiropractic doctor vs medical doctor/ doctor of osteopathy as first line physician: experience of one Tennessee-based general health insurer. J Manipulative Physiol Ther. 2010;33:640–643.
  5. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
  6. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recom Rep 2016;65(No. RR-1):1–49.
  7. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in 2018 Comprehensive Accreditation Manual for Hospitals.
  8. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
  9. Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives. Accessed 9/19/17 from http://www. maine.gov/ag/news/article. shtml?id=766715
  10. The Presidents Commission on Combating Drug Addiction and the Opioid Crisis. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf