Chiropractic patients have increasing success reducing opioid prescriptions

Since 1999, the opioid epidemic has been prevalent in the United States. From 1999 to 2010, there was a substantial increase in opioid-related deaths, with opioid prescriptions accounting for approximately 50%.

In 2015, there were 33,091 opioid-related deaths. The level of opioid use deaths is escalating. Additionally, there are approximately 2,000,000 people in the United States who have opioid use addiction.¹

Sources of opioids

Emergency rooms are a prime source of opioid use, where 60% of low back pain (LBP) patients will be treated with opioids.² In the primary care setting, the opioid prescriptions rate is 30%, and a large number of patients who saw a primary care physician for LBP received care inconsistent with evidence-based clinical practice guidelines.³

The problem of low back pain

Treating low back pain is one area most doctors of chiropractic have in common globally. No matter the focus of chiropractic practices, neck and low back pain, based on my independent research, is one of the most common maladies treated in chiropractic. When considering outcomes for LBP care paths, patient satisfaction, increased drug use and overdose hospitalizations are prime areas of consideration.

Although LBP remains an epidemic worldwide,⁴ and the cost of managing back pain is increasing substantially⁵ with consistently poor outcomes, medicine has dogmatically held onto the label of “non-specific low back pain.”

Non-specific low back pain is defined as low back pain not attributable to a recognizable, known, specific pathology (e.g., infection, tumor, osteoporosis, fracture, structural deformity, an inflammatory disorder, radicular syndrome (discs) or cauda equina syndrome). It represents approximately 95% of all back pain and is persistently labeled non-specific because medicine cannot define a specific diagnosis.⁶

The core of the issue with low back pain is that medicine cannot diagnose the problem; therefore, it chooses to treat the symptoms and not the cause of the problem, and has only pharmacology as a direct solution. The problem is rooted in biomechanical pathology, where no pharmacological solution exists for a mechanical pathology. Chiropractic is an art, science and philosophy based on biomechanical pathology.

Pharmacological treatment vs. chiropractic approaches

In one 2020 four-year study with a cohort of 8,023,162, researchers found 96% of chiropractic care recipients were satisfied with their outcomes for issues including LBP and other spinal maladies.⁷ Medicine is highly trained in anatomical pathology, but its education lacks chiropractic’s forte, training in diagnosing and treating spinal biomechanical pathology with nonpharmacologic care.

The utilization of pharmacological (opioids, benzodiazepines, gabapentinoids) management of LBP revealed that the incidence of drug-related overdose hospitalization was 200% less for both drug users and those receiving nonpharmacological treatments. For those using only nonpharmacological treatments, there was a 300% reduction in the incidence of drug-related overdose hospitalization.⁸

This study lumps together recipients of chiropractic care and physical therapy, disciplines which deliver care differently and render disparate outcomes. However, with the above study, physical therapy alone using mixed modalities increased opioid prescriptions use by 80% in 89.9% of the patients,⁹ which suggests chiropractic is the better solution.

In 2018, evidence revealed that chiropractic reduced opioid prescription use by 55% and opioid costs by 74%.¹⁰ In 2025, a Veterans Administration study with a cohort of 128,377 patients reported that chiropractic care users were found to have 64% lower odds of receiving opioid prescriptions than non-users.¹¹

Final thoughts

These outcomes offer strong evidence that chiropractic is an effective first-line provider for low back pain, both acute and chronic, and that its use will contribute to lowering opioid overdoses and deaths.

Mark Studin, DC, FPSC, FASBE(C), DAAPM, is an adjunct assistant professor at the University of Bridgeport, School of Chiropractic and an adjunct postdoctoral professor at Cleveland University-Kansas City, College of Chiropractic. He is an Adjunct Associate Clinical Professor at The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Family Medicine. He earned his Fellowship in Primary Spine Care whose courses are certified in joint providership from The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Office of Continuing Medical Education, and Cleveland University-Kansas City, College of Chiropractic. He also runs the Academy of Chiropractic’s Personal Injury Program. He can be reached at 631-786-4253 or DrMark@AcademyOfChiropractic.com.

References

1. Schuchat A, et al. New data on opioid use and prescribing in the United States. JAMA. 2017;318(5):425-426. https://pmc.ncbi.nlm.nih.gov/articles/PMC5703201/. Accessed August 29, 2025.
2. Heard K, et al. Association of emergency department opioid administration with ongoing opioid use: A retrospective cohort study of patients with back pain. Acad Emerg Med. 2020;27(11):1158-1165. https://pubmed.ncbi.nlm.nih.gov/32609923/. Accessed August 29, 2025.
3. Kamper SJ, et al. What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. Pain. 2020;161(4):694-702. https://pubmed.ncbi.nlm.nih.gov/31738226/. Accessed August 29, 2025.
4. Balagué F, et al. Non-specific low back pain. Lancet. 2012;379(9814):482-491. https://pubmed.ncbi.nlm.nih.gov/21982256/. Accessed August 29, 2025.
5. Government Accountability Office. Medicare Part B imaging services: Rapid spending growth and shift to physician offices indicate the need for CMA to consider additional management practices. Washington, DC: Government Accountability, 2008. https://www.gao.gov/products/gao-08-452. Accessed August 29, 2025.
6. Oliveira CB, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-2803. https://pubmed.ncbi.nlm.nih.gov/29971708/. Accessed August 29, 2025.
7. Ndetan H, et al. Chiropractic care for spine conditions: Analysis of National Health Interview Survey.” J Health Care and Research. 2020;1(2):105-18. https://asploro.com/chiropractic-care-for-spine-conditions-analysis-of-national-health-interview-survey/. Accessed August 29, 2025.
8. Dow PM, et al. Association of pharmacologic and nonpharmacologic management of acute low back pain with overdose hospitalizations: A nested case-control study. J Integr Complement Med. 2025;31(7):664-673. https://pubmed.ncbi.nlm.nih.gov/40180434/. Accessed August 29, 2025.
9. Farrokhi S, et al. The influence of active, passive, and manual therapy interventions for low back pain on opioid prescription and health care utilization. Phys Ther. 2024;104(3):173. https://pubmed.ncbi.nlm.nih.gov/38112119/. Accessed August 29, 2025.
10. Whedon JM, et al. Association between utilization of chiropractic services for treatment of low-back pain and use of prescription opioids. J Altern Complement Med. 2018;24(6):552-556. https://pubmed.ncbi.nlm.nih.gov/29470104/. Accessed August 29, 2025.
11. Lisi AJ, et al. The impact of chiropractic care on opioid prescriptions in Veterans Health Administration patients receiving low back pain care. J Gen Intern Med. May 2025. https://pubmed.ncbi.nlm.nih.gov/40394439/. Accessed August 29, 2025.