Grim statistics support chiropractic non-drug alternatives to opioids

Non-drug practices need to take center stage when it comes to alternatives to opioids

DEATH FROM DRUG OVERDOSE, mainly opioid overdose, is the leading cause of death in adults under age 50, killing 1,000 more people than breast cancer and 18,000 more people than car accidents, and has surpassed the AIDS epidemic.

The opioid epidemic is destroying our communities, and it is only getting worse. The opioid epidemic was declared a public health emergency in 2017, and 66% of overdose deaths involve these addictive drugs. The rate of drug overdose deaths in the U.S. tripled from 1999-2016, when there were 63,600 deaths.

Moreover, life expectancy for U.S. adults has declined for the first time in 20 years. The death rate from synthetic opioids has risen more than 88% per year since 2013, and each day in the U.S., 116 people die from opioids. According to the 2018 World Drug Report, pharmaceutically-produced opioids accounted for more than 75% of all drug overdoses worldwide.

The problem stems from the over-prescription of highly addictive painkilling drugs like oxycodone, hydrocodone, fentanyl and morphine. A recent U.S. Surgeon General Report stated that more Americans use prescription opioids than smoke cigarettes.

An American problem

Surprisingly, 99% of the hydrocodone and 81% of the oxycodone sold in the world is consumed by Americans. This is approximately 30 times more than medically necessary for the entire population of the US.

West Virginia, a state with 1.8 million residents, was shipped 780 million hydrocodone and oxycodone pills between 2007 and 2012. That equals 433 pills for every person in the state, including children. During that same period, more than 1,700 residents died from hydrocodone and oxycodone overdose.

From 2010-2016, BlueCross-BlueShield insurance claims involving opioid dependence increased by 500%. Research shows that more than half of people who use opioids for three months will still be using them five years later. Nearly 80% of heroin addicts reported that they began addiction by using painkillers such as oxycodone and hydrocodone.

Are opioids needed for pain?

Oxycodone (Oxycontin) began selling in the U.S. in 1996. Later that decade the U.S. National Institute on Drug Abuse (NIDA) stated, “Pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and health care providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.”

In 2015, it was estimated that 2 million Americans, due to prescription opioid pain medications, suffered from substance use disorders.

Though non-opioid pain relievers have many risks, the occurrence of death from overdose and addiction is much lower. The Journal of the American Medical Association (JAMA) has published research that suggests that the non-opioid medications ibuprofen and acetaminophen may work just as well.

Government-funded research published in 2018 in JAMA also shows that patients dealing with chronic back pain or osteoarthritic pain in the hip and knee did not experience better pain-related function than those taking non-opioid medications, which are far safer.

Positive change

In West Virginia, Senate Bill 273, “Reducing Use of Certain Prescription Drugs,” was last year signed into law. The purpose of the bill is to reduce the overuse of prescriptions of opioids and create a method to provide other treatment plans rather than prescribing narcotic painkillers. Under the bill, health care practitioners treating a patient “for any of the myriad conditions that cause pain” will be required to refer the patient to alternative treatments before prescribing an opioid. West Virginia’s new law will also require insurance companies operating in the state to cover at least 20 visits to alternative therapy providers for treatment of pain. And, patients will be able to seek treatment from alternative therapy providers without a doctor’s referral.

The American Academy of Neurology has released a new position statement regarding opioid medications. “Whereas there is evidence of short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction.”

CBS News reported on April 19 of this year that new data shows prescriptions for opioid painkillers showed their biggest drop in 25 years — an average nationwide drop of 9% for opioids filled by retail and mail-order pharmacies. All 50 states and the District of Columbia had declines of more than 5%.

Non-drug alternatives

Musculoskeletal care is the number-one cost in American health care today, which means that structural imbalances causing degenerative neurophysiological deficits are costing Americans more than any other condition. The chiropractic profession is positioned to be at the forefront of the solution to this devastating situation.

Chiropractors have a scope of practice that enables them to examine, X-ray and adjust the patient from head to toe. Balancing the body, starting with the pedal foundation utilizing custom, stabilizing orthotics to establish a symmetrical base, is necessary. Most patients develop asymmetrical pronation of the feet, so examining and scanning the feet is the place to start, as custom stabilizing orthotics are clinically proven to reduce low-back pain.

Many supplements, including curcumin, astaxanthin, boswellia, bromelain and ginger, affect pain and inflammation by lowering C-reactive protein and inhibiting both the activity and the synthesis of cyclooxygenase-2 (COX2) and 5-lipooxygenase (5-LOX).

Modifying diet can also help with musculoskeletal symptomatology. Consuming more animal-based omega-3 fats along with reducing intake of processed foods will create less inflammation systemically. Additionally, patients can eliminate or radically reduce consumption of grains and sugars, which will have the same effect.

How to provide additional help

With deaths from opioid overdoses increasing at an alarming rate of nearly 20% per year, all chiropractors can make it a priority to educate fellow health care practitioners and patients on the realities of opioid use.

Chiropractors educating the public and other health care professionals can make a difference in the number and amount of opioid prescriptions in the U.S. A dramatic decrease in the prescribing of these highly-addictive substances must occur, and a grassroots educational effort will surely help. You can join the fight right now by visiting the Foundation for Chiropractic Progress, which has the Opioids 1.0 and 2.0 toolkits that help launch local campaigns for chiropractic as a safe alternative to painkilling drugs. For more information, go to f4cp.org/opioid-toolkits.

MARK CHARRETTE, DC, was a featured presenter on the Foundation for Chiropractic Progress’ Practice Progress Webinar Series for DCs in April. Foot Levelers Inc. sponsored his presentation, “Chiropractic Care: A Solution to the Opioid Crisis.”

REFERENCES

1. Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017.
2. Nadia K. Opioids now kill more people than breast cancer. https://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html. December 21, 2017.
3. Shelia K. C.D.C. Reports a Record Jump in Drug Overdose Deaths Last Year. https://www.nytimes.com/2017/11/03/health/deaths-drug-overdose-cdc.html. November 3, 2017.
4. German L. In one year, drug overdoses killed more Americans than the entire Vietnam War did. https://www.vox.com/policy-and-politics/2017/6/6/15743986/opioid-epidemic-overdose-deaths-2016. June 8, 2017.
5. Niall M. Drugs Are Killing More Americans Than Road Crashes. https://www.forbes.com/sites/niallmccarthy/2016/11/17/drugs-are-killing-more-americans-than-road-crashes-infographic/#72826b43de92. November 11, 2016.
6. Eric E. Drug firms poured 780M painkillers into WV amid rise of overdose. https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-poured-m-painkillers-into-wv-amid-rise-of/article_99026dad-8ed5-5075-90fa-adb906a36214.html. December 17, 2016.
7. Leah S. US life expectancy shortens for first time in decades. https://www.statnews.com/2016/12/08/life-expectancy-shorten-american. December 8, 2016
8. Lenny B. Scott H. We feel like our system was hijacked: DEA agents say a huge opioid case ended in a whimper. https://www.washingtonpost.com/investigations/mckesson-dea-opioids-fine/2017/12/14/ab50ad0e-db5b-11e7-b1a8-62589434a581_story.html?utm_term=.6cb0cd9a9287. December 17, 2017.
9. Charles O. Ryann J. Opioid-Makers Cut Back On Marketing Payments to Doctors. https://www.npr.org/sections/health-shots/2018/06/28/621968053/opioid-makers-cut-back-on-marketing-payments-to-doctors. June 28, 2018.
10. Toni C. Surgeon General Report Tackles Addiction. https://www.scientificamerican.com/article/surgeon-general-report-tackles-addiction.
11. Andrew S. The Poison We Pick. http://nymag.com/daily/intelligencer/2018/02/americas-opioid-epidemic.html. February 20, 2018.
12. Maggie F. Lots of Americans Prescribed Opioids, Insurance Survey Shows. https://www.nbcnews.com/storyline/americas-heroin-epidemic/lots-americans-prescribed-opioids-insurance-survey-shows-n777906. June 29, 2017.
13. EverettWA.gov. City of Everett’s lawsuit against Purdue Pharma. https://everettwa.gov/1681/Purdue-Lawsuit.
14. Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department A Randomized Clinical Trial. JAMA.2017;318(17):1661–1667. doi:10.1001/jama.2017.16190
15. German L. A new study compared opioids and over-the-counter painkillers in ERs. Opioids didn’t do so well. https://www.vox.com/science-and-health/2017/11/9/16622922/opioids-ibuprofen-acetaminophen-acute-pain-study. November 9, 2017.
16. Alexa L. Study: Opioids No More Effective Than Other Pain Medications. https://www.usnews.com/news/health-care-news/articles/2018-03-07/study-opioids-no-more-effective-than-other-pain-medications. March 7, 2018.
17. Fred D. How the opioid epidemic has affected the U.S. labor force, county-by-county. https://www.brookings.edu/blog/brookings-now/2017/09/07/how-the-opioid-epidemic-has-affected-the-u-s-labor-force-county-by-county. September 7, 2017.
18. National Institute of Drug Abuse. (March 2018) Opioid Overdose Crisis. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
19. Bloomberg. Opioids Are No Better Than Common Painkillers, Study Finds. http://fortune.com/2018/03/06/opioids-for-chronic-pain-study. March 6, 2018.
20. America’s Opioid Epidemic. CBS News. https://www.cbsnews.com/opiod-epidemic. Published April 19, 2018.
21. Cambron JA, Dexheimer JM, Duarte M, Freels S. Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2017;93(4):732. doi:10.1016/j.apmr.2012.03.001.   
22. Christopher I. Heroin deaths surpass gun homicides for the first time, CDC data shows. December 8, 2016. National Center for Health Statistics. (September 12, 2018). Provisional Drug Overdose Death Counts. Retrieved from https://www.cdc.gov/nch