Doctors and opioids: can chiropractic win the war?

COVID has made the opioid epidemic worse, and the relationship between doctors and opioids are coming under scrutiny

I still remember the morning two years ago when something caught my attention while I was scanning my news feed. “Opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since the epidemic began in the early 1980s.” We are battling a massive crisis in our nation, and it is not the coronavirus. However, the nation’s COVID pandemic has made the nation’s opioid epidemic worse and put doctors and opioids under the spotlight. Opioids are a class of drugs that include the illicit drug heroin, and licit (legal) prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl and others.

Getting worse, not better

In 2015, the number of deaths involving opioids skyrocketed. This growing epidemic is devastating families of all socioeconomic backgrounds and races.

Unfortunately, the opioid epidemic in the U.S. is getting worse, not better. Drug overdose deaths reached more than 81,000 between May 2019-May 2020 (CDC, 2020). Likewise, from March-October 2020, emergency department visits decreased for conditions such as cardiac arrest, but opioid and other drug-related overdose emergencies were higher than the same period in 2019 (Holland, Jones, & Vivolo-Kantor, 2021).

Projections from the Centers for Disease Control and Prevention (CDC) published in July 2021 predict that in 2025, for the first time, more than 100,000 Americans will die from a drug overdose, bringing the total to more than 1 million since 1999 (CDC, 2021). At current rates, by the time of the presidential election in 2028, more Americans will have died in the 21st century of drug overdoses than died in all of America’s wars over its entire history.

Doctors and opioids: prescribing addiction

How has this happened? With MD doctors and opioids, studies show that 99% of medical doctors have prescribed highly addictive opioids, many for longer than the three days recommended by the CDC.

In 1991, doctors wrote 76 million prescriptions. By 2011, that number had nearly tripled to 219 million, according to a National Institute on Drug Abuse report (Volkow, 2014).

In 1996, Purdue pharmaceuticals released OxyContin. This drug was directly marketed to doctors whose prescription patterns showed them to be “over-prescribers.” OxyContin was also provided free of charge to patients for a limited time. As a result, doctors were encouraged to prescribe this new drug which had also been presented as having a very low risk of addiction. Now, we know better (Zee, 2009).

More chiropractic = less opioid use

The silver lining to this onslaught of new data is that the medical community finally acknowledges what we have known for years. Chiropractic care is a non-invasive approach that is effective in treating chronic pain. Not only does chiropractic care have a high level of patient satisfaction, but the cost of treating chronic pain with chiropractic care is significantly lower. Yet, I don’t think the magnitude of this opportunity has been realized by most doctors of chiropractic in this country.

For example, in 2019, researchers found that patients who receive initial treatment for new low-back pain from chiropractors or physical therapists had decreased odds of opioid use compared with those who received initial treatment from non-chiropractic primary care doctors (McAlister, 2021). Similarly, a 2020 study found patients with spinal pain who saw a doctor of chiropractic had half the risk of filling an opioid prescription compared to those who saw a non-chiropractic primary care doctor first (Whedon, et al., 2020).

The American College of Physicians updated its guidelines in 2017 to recommend chiropractic and other non-invasive, non-drug treatments of back pain before turning to prescription opioids (Qaweem, Wilt, & McLean, 2017). That’s a huge win for the chiropractic profession, which had once been the target of elimination by the American Medical Association. This guideline helped open more doors for MD and DC collaboration to manage pain for patients across America without prescription drugs. Yet, the numbers continue to get worse.

Touched by opioid abuse

This crisis weighs heavily on my mind and my heart. Not only because of the potential to save lives in my community but because I know firsthand the effects of opioids on our bodies.

Someone I know and love suffered an injury from prescription opioids that forever changed her life. And it is not just my family that has been affected. While discussing the opioid epidemic during a team meeting, I quickly learned that everyone in my office knew someone whose life had been touched by doctors and opioids and subsequent opioid abuse.

As a doctor of chiropractic and a board member for the Foundation for Chiropractic Progress (F4CP), I have a vested interest in supporting their goal to reach every consumer in the U.S. with the message that chiropractic is a safer alternative to opioids. The F4CP promotes conservative, drug-free care, specifically chiropractic, as a primary option for pain management, yielding improved clinical outcomes, reduced costs and high levels of patient satisfaction. They have published articles, created toolkits, and more, to promote the efficacy of chiropractic for non-pharmacological pain management. All these resources are on their website (f4cp.org) and available to the entire profession. Each tool kit has links to white papers, videos and more.

Promoting chiropractic for pain management

In the documentary Crime of the Century detailing doctors and opioids, you see how the opioid epidemic was born over the last 100 years. Although we can’t change the course of action that led to the battle against opioid addiction, we can do our part to help now.

As a profession, we all have different philosophies and techniques. But, in this fight, we can speak with one voice on the value and efficacy of chiropractic in pain management and help millions of Americans win the war against opioid addiction.

RAY FOXWORTH, DC, FICC, MCS-P, is a certified Medical Compliance Specialist and president of ChiroHealthUSA. A practicing chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, is a former staff chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic.