Ninety-five million Americans have used prescription painkillers in the past year, about four times as many as in 1999.1,2
Sadly, these drugs are extremely easy to misuse: More than 1,000 people a day are treated in emergency departments for not using them as directed, according to the U.S. Centers for Disease Control and Prevention (CDC).3
And 91 people die every day from an opioid overdose.4
Even worse, the numbers just keep rising: the CDC reports a 72 percent increase in the number of deaths associated with synthetic opioids (excluding methadone) between 2014 and 2015.5
What is causing the opioid crisis? And what can you, as a chiropractic professional, do to help combat it?
The pain of pain
Pain is a significant health issue in the U.S. More than half (55.7 percent) of U.S. adults—126 million—reported experiencing some kind of pain in the previous three months in the CDC’s 2012 National Health Interview Survey (NHIS). Of those, 11.2 percent (25.3 million adults) reported daily chronic pain and 17.6 percent (40 million adults) reported severe pain, according to an analysis of the data in a 2015 study by the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH).6
The most common type of pain is musculoskeletal, with about half of American adults (126.6 million) having experienced musculoskeletal disorders in 2012, according to the United States Bone and Joint Initiative (USBJI). The most prevalent disorders are arthritis and related conditions; back and neck pain; injuries from falls, work, military service, and sports; and osteoporosis.7-10
Back and neck pain alone affect nearly a third of U.S. adults (75.7 million). More specifically, about 30 percent of American adults reported lower back pain and 16 percent reported neck pain in 2015, according to the CDC. An additional 15 percent reported severe headache or migraine pain.11
To deal with musculoskeletal and other pain, the NHIS study found, patients spent $225 billion per year out of pocket on conventional care, including $54 billion on prescription drugs, compared to $30 billion on complementary care.12
The conventional approach
Those figures reflect conventional practitioners’ preference for relying on pharmacological solutions to pain management. Far too many physicians respond to patients complaining of pain by writing prescriptions and do so for unnecessarily long courses of treatment. According to the National Safety Council (NSC), 99 percent of doctors report prescribing opioids for longer than the three-day period recommended by the CDC. In fact, 23 percent report prescribing 30 days’ worth at a time—long enough for usage to cause changes in a patient’s brain chemistry.13
One reason for this over-prescribing may be that medical doctors don’t know that over-the-counter (OTC) pain relievers such as ibuprofen and acetaminophen are effective for acute pain. In fact, nearly 75 percent of doctors think that those NSAIDs are less effective than opioids such as morphine and oxycodone, when in fact they can be more effective.14
Worse yet, the reliance on medication doesn’t address the underlying issue, according to Sherry McAllister, DC, executive vice president of the Foundation for Chiropractic Progress (F4CP). “Medications are ineffective in addressing the underlying cause [of pain],” she says. “They’re intended for short-term use for acute conditions, or for the terminally ill. There’s a place for opiates, but that place needs to be reviewed.” There’s no question that minimizing the use of opiates would be much better, both for the individual and for society as a whole.
The cost of the crisis
Aside from the human cost of these unnecessary deaths, researchers esti- mate the total economic impact of the opioid crisis at almost $80 billion. This figure includes $28 billion for healthcare and substance abuse treatment—the vast majority of which ($26 billion) is covered by insurance.
The costs associated with reduced productivity (and, in the case of incarcerated addicts, lost productivity) are estimated at about $20 billion. About a quarter of these aggregate costs are funded by public sources. Virtually all of the $8 billion in criminal justice-related costs, however, was spent by local and state governments.15
Obviously, these costs don’t include the emotional toll on the addicts and their friends and families, which is literally incalculable.
Chiropractic can help
“When you look at the chiropractic option, it’s the gold standard of non-pharmacological options,” McAllister says. “It’s the most highly researched and the easiest to access— it’s twice as available as massage therapy.”
In a study published in the New England Journal of Medicine, patients seeking treatment for back pain reported significantly higher levels of satisfaction with the care they receive from chiropractors than patients who saw medical practitioners, with 42 percent versus 26 percent saying that the overall effects of the treatment were “excellent.”16
This doesn’t mean that you can just flip the sign on your office door to “open” and proceed with business as usual. Lori Allen, who is the only non-physician on the Florida Chiropractic Association’s National conference medical errors panel, is deeply concerned about the opioid crisis, both as a concerned citizen and as a consultant for chiropractic practices.
“Practitioners have to look at the need, which is huge,” she says. “Chiropractic—along with acupuncture, massage, and nutrition—all of them are alternative ways to reduce pain without turning our society into an addictive society.”
To be an effective resource for those seeking relief from pain, Allen says, practitioners need to be taking a deeper look at each patient, and be more effective at communicating what they see. “The practitioner needs to be both a good clinician and a good communicator,” she says.
The first step is to look at how appointments are scheduled. “You need to make sure you have enough time to take a complete history,” Allen says, “and also to present a full report of findings, including a discussion of the treatment plan you recommend. This is an area that practitioners can always improve on.”
Patients need to understand the value and benefit of approaching pain relief through chiropractic, and it’s crucial that practitioners do a better job of communicating these factors.
Non-opioid medication alternatives
Chiropractic treatment alone may not bring full relief to some experiencing chronic pain. For those patients, it may be advisable to supplement treatment with non-opioid pain relief medications. Several kinds of non-addictive alternatives are available.
As noted above, NSAIDs are often more effective than opioids for managing pain, but they can also be overused. “You’ll see this in a chiropractic office,” McAllister says, “patients who are taking up to 16 Tylenol a day.”
The use of large dosages of NSAIDs over long periods can bring significant side effects, including stomach problems (pain, heartburn, and ulcers), liver and kidney problems, high blood pressure, and headaches and dizziness. Thus, one of the things to discuss in a patient history should be the use of these OTC pain relievers.
Cannabis is an increasingly popular alternative for pain relief: It is currently legal for medical use in 29 states and the District of Columbia.17 One major problem with cannabis, though, is that it can lead to psychological dependence and, of course, smoking is bad for the lungs.18 In addition, not all patients want to experience the high that comes with the THC in cannabis. These patients need a product that has the cannabinoids that relieve pain but has also been denatured of THC. To meet this need, one company, TruGen3, has developed a bioavailable hemp oil product in soft-gel capsules.
“The primary benefit of our product is relief for chronic pain associated with inflammation,” explains Douglas Lioon, CEO and co-founder of TruGen3. “It has also been effective for treating seizures, and provides gastrointestinal benefits and improvement in sleep patterns, he says.
“This type of product is non-habit-forming and non-harmful,” Lioon says, “and there are no known side effects.” It is available only through healthcare practitioners, who appreciate the standardization of the dosage in the capsules―which is generally an issue with other cannabinoid delivery systems.
A third approach is the use of a topical product. The gate control theory of pain posits that topical applications work by inhibiting the activity of the nociceptors that respond to the sensation of pain. Basically, these products apply a stimulus to the skin so the body doesn’t perceive pain, says Dana Mackison, DC, director of education for Performance Health. Ice is well known for its ability to control pain, but products such as topical analgesics that include menthol can do so as effectively but with more convenience and less mess.
“A topical analgesic serves as good support for treatment in the office,” Mackison says. “I’m not suggesting its use will do away with the need for treatment―instead, it provides good adjunct care.” Topical analgesics can bridge the time between visits, plus provide a good support to the treatment itself, before and after appointments, he explains. “And if a patent is apprehensive about the treatment [potentially causing discomfort], a topical can be effective for that,” he says.
Beyond the chiropractic office
Chiropractic practitioners can do much more to combat the opioid crisis than just treat patients, starting most importantly with education, both of their own patients and of the community as a whole. Toward that end, the Foundation for Chiropractic Progress (F4CP) has named September “Drug Free Pain Management Month.”
“The national campaign initiated out of the constant barrage of information,” McAllister says. “We got involved in responding to the opioid crisis starting in early 2015, even before the national media did, by supporting non-pharmacological options for pain relief.”
One of the primary goals of the initiative is an outreach effort to consumers: “We want our population to understand the risk [of opioid use and misuse] and that chiropractic is a better option” for pain relief, she says.
The foundation is providing an array of materials for practitioners to use in their offices, such as 8×10 posters they can display to educate patients.
Beyond that, the F4CP is asking doctors to get involved with their communities, to share whitepapers, pamphlets, and other forms of information.
Allen agrees about the importance of this. “There’s a tremendous need for outreach,” she says. “I’m always telling chiropractors to be proud of who you are. Community awareness is part of that, though it’s up to individual practitioners what form that might take.” This depends on the options available and what a given doctor of chiropractic might be comfortable with. But community workshops, for example, are an effective form of outreach.
At a wider level, the F4CP has also developed materials suitable for use on media platforms such as radio, TV, and podcasts, as well as resolutions that practitioners can take to their legislators.
“We have to be able to cross boundaries with healthcare professionals,” McAllister says. “Our goal is to educate the consumer, and our job is to work through and with medical providers so we can give them a better option.”
Judy Weightman is a writer and editor based in Philadelphia. In addition to health, she writes on higher education, gardening, and sustainability for both print and the web. She can be contacted at jmweightman@gmail.com or followed on Twitter at @JudyWEdu.
References
1 Katz J. “Drug Deaths in America Are Rising Faster Than Ever.” New York Times. https:// www.nytimes.com/interactive/2017/06/05/ upshot/opioid-epidemic-drug-overdose- deaths-are-rising-faster-than-ever.html.Published June 2017. Accessed Aug. 2017.
2 “Prescription Opioid Overdose Data.” Centers for Disease Control and Prevention. https:// www.cdc.gov/drugoverdose/data/overdose. html. Updated Aug. 2017. Accessed Aug. 2017.
3 Ibid.
4 “Understanding the Epidemic.” Centers for Disease Control and Prevention. https://www. cdc.gov/drugoverdose/epidemic/index.html. Updated Dec. 2016. Accessed Aug. 2017.
5 “Synthetic Opioid Data.” Centers for Disease Control and Prevention. https://www.cdc.gov/ drugoverdose/data/fentanyl.html. Updated Dec. 2016. Accessed Aug. 2017.
6 “Use of Complementary Health Approaches in the U.S.” National Center for Complementary and Integrative Health. https://nccih.nih.gov/ research/statistics/NHIS/2012/key-findings. Updated June. 2016. Accessed Aug. 2017.
7 Bone and Joint Initiative USA. https://www. usbji.org. Updated Aug. 2017. Accessed Aug. 2017.
8 Helmick CG, Watkins-Castillo S. “Arthritis.” http://www.boneandjointburden.org/2013-re- port/iv-arthritis/iv. Published 2014. Accessed Aug. 2017.
9 Andersson G, Watkins-Castillo S. “Spine: Low Back and Neck Pain.” http://www.boneand- jointburden.org/2014-report/ii0/spine-low- back-and-neck-pain. Published 2014. Accessed Aug. 2017.
10 “One in two Americans have a musculo- skeletal condition costing an estimated $213 billion each year in treatment and lost wages” Bone and Joint Initiative USA. https://www. usbji.org/news/releases/one-two-ameri-
cans-have-musculoskeletal-condition-cost- ing-estimated-213-billion-each. Published March 2016. Accessed Aug. 2017.
11 National Center for Health Statistics. “Health, United States, 2016: Table 41.” Centers for Disease Control and Prevention. https://www. cdc.gov/nchs/data/hus/hus16.pdf#glance. Published 2017. Accessed Aug. 2017.
12 “Use of Complementary Health Approaches in the U.S.” National Center for Complementary and Integrative Health. https://nccih.nih.gov/research/statistics/ NHIS/2012/cost. Published Aug. 2016. Accessed Aug. 2017.
13 “NSC Poll: 99% of Doctors Prescribe Highly-addictive Opioids Longer than CDC Recommends.” National Safety Council. http://www.nsc.org/Connect/ NSCNewsReleases/Lists/Posts/Post. aspx?ID=108. Published March 2016. Accessed Aug. 2017.
14 Ibid.
15 Curtis S. Florence, Chao Zhou, Feijun Luo, Likang Xu. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Medical Care. 2016;54(10):901.
16 Carey TS, Garrett J, Jackman A. The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons. [table 4]. N Engl J Med. 1995;333:913-917.
17 “29 Legal Medical Marijuana States and DC.” ProCon.org. http://medicalmarijuana.procon. org/view.resource.php?resourceID=000881. Updated June 2017. Accessed Aug. 2017.
18 “Is marijuana addictive?” National Institute on Drug Abuse. https://www.drugabuse.gov/ publications/research-reports/marijuana/ marijuana-addictive. Updated April 2017. Accessed Aug. 2017.
