Chiropractors Role in Opioid Use Disorders

Opioid Use Disorder (OUD) has quietly but quickly become the hottest topic in healthcare public policy. More than 1/3 of Americans use opioids and 11.5 million misuse or abuse the drug. (1) Tragically, more than 20,000 people died in 2015 due to an opioid overdose. (2) Over a ten-year period, the opioid death rate quadrupled in direct proportion to the number of prescriptions. (3)
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Currently, almost every governmental and healthcare group on the planet is working to combat this problem. Solutions range from prescription limits to equipping all first responders with Narcan™. However, the underappreciated issue is that opioids are most frequently prescribed for chronic non-cancer pain, primarily spinal pain. The vast majority of spinal pain is mechanical in origin. Prescribing a chemical does not adequately address that problem.  Fortunately, there is abundant research that shows chiropractic spinal manipulation is very effective at resolving mechanical problems. 

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. (4,5) Health plans realize significant savings by incorporating chiropractic care, with some carriers reporting a 2:1 ROI. (6,7)

Not surprisingly, in the past year chiropractic or 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. (8-12) Earlier this week, a Presidential Commission Report on Opioids echoed those recommendations. (13)

References
1. Substance Abuse and Mental Health Services Administration. 2017. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Table 1.28A and 1.28B. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf, accessed on October 26, 2017.
2. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey
3. Paulozzi MD, Jones PharmD, et al. Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United State, 1999-2008. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Center for Disease Control and Prevention. 2011:60:5.
4. 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/
5. 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
6. 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.
7. 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.
8. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
9. 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.
10. 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.
11. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
12. 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
13. 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

Reprinted with Permission from Chiro Up.