Chiropractic and the Opioid Epidemic

Unless you have been sleeping through your days ignoring major media, you are well aware that there is an opioid epidemic in the United States. The U.S. Department of Health and Human Services (HHS) has produced Fact Sheets related to the opioid epidemic.¹ The CDC reports the following:

On an average day in the U.S.:^{2, 3}

• More than 650,000 opioid prescriptions dispensed
• 3,900 people initiate nonmedical use of prescription opioids
• 580 people initiate heroin use
• 78 people die from an opioid-related overdose

The rate of drug overdose deaths involving synthetic opioids nearly doubled between 2013 and 2014.² And opioid related deaths are now comprise 61% of drug overdose deaths.² The state of West Virginia has been hardest hit by the epidemic. While the U.S. average death rate was 16.3 cases per 100,000 residents, the rate in West Virginia was at 41.5.⁴ There is a government funded program to help cover funeral and burial expenses in West Virginia that cannot keep up partly due to the opioid epidemic. According to the Charleston Gazette-Mail, drug wholesalers shipped over 780 million doses of opiate painkillers hydrocodone and oxycodone to the state, or roughly “433 pain pills for every man, woman and child in West Virginia.”⁵

Other states are experiencing massive problems with the opioid and resultant heroin epidemics. Most recently, one County in Ohio had to request cold storage containers to serve as overflow for the morgue.⁶ The coroner’s office considered this problem as a direct result of a 20% increase in opioid and heroin overdoses since the previous year.⁶

The underlying problem starts with the prescription patterns of the Medical Doctor’s. Opioid pain reliever prescribing has increased a whopping 400% between 1999 and 2014.³ Due to these irresponsible prescribing patterns, the focus of the state and federal governments has been on correcting this issue, which is obviously important. Other attention is directed at other drugs to help those addicted to opioids end their dependency, again another important avenue for effort.

What has been largely ignored in managing the opioid epidemic is the role of pain management using non-drug treatment methods. Services offered by chiropractors have been shown to be effective for managing many forms of pain. Most recently the American College of Physicians (ACP), in their Clinical Practice Guideline, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians”,7 make recommendations based on the literature that include the use of “spinal manipulation”.7 Chiropractic care including spinal adjusting has been widely accepted and is now recommended in the Clinical Practice Guidelines of one of the largest medical societies in the world.

A 2007 survey showed that 44% of opioid users reported CAM therapy use in the past 12 months.⁸ 17.8% used chiropractic services.⁸ So the utilization is present in this population to a higher degree than the general population.

Recent research is also pointing toward chiropractic care being able to prevent the need for prescription opioids for pain management. It has been known that a higher supply of DC’s results in less visits to the primary MD’s.⁹ Because primary care MD’s do most of the opioid prescribing, it becomes logical to assume that increasing supply of DC’s would also lower the prescription rate of opioids. Weeks and Goertz found that there was indeed an inverse relationship with the volume of DC’s and volume of prescriptions for opioids in a Medicare population.¹⁰ They state, “our findings suggest that, at least in this younger (< 65 y.o.) Medicare population, greater availability and use of an alternative spine pain treatment may be associated with a lower prevalence of opioid users…”¹⁰

As a corrective chiropractic center our goal is to identify the source of pain and work to correct the cause of the problem, not merely hide symptoms. Call us today to schedule a complimentary consultation to see if Modern Chiropractic can benefit you! (208) 629-1904

REFERENCES:

1. https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf Accessed 03/21/2017
2. Rudd RA, Aleshire N; Zibbell JE; Gladden RM. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. CDC Morbidity and Mortality Weekly Report (MMWR) January 1, 2016 / 64(50);1378-82 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm Accessed 03/21/2017
3. Paulozzi LJ, Jones C, Mack K, Rudd R. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. CDC Morbidity and Mortality Weekly Report (MMWR) 2011;60:1487–92. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm Accessed 03/21/2017
4. Drugs are killing so many people in West Virginia that the state can’t keep up with the funerals. Washington Post March 7,2017. https://www.washingtonpost.com/news/wonk/wp/2017/03/07/drugs-are-killing-so-many-people-in-west-virginia-the-state-cant-keep-up-with-the-funerals/?tid=sm_fb&utm_term=.77ff3e782951 Accessed 03/21/2017
5. Eyre E. Drug firms poured 780M painkillers into WV amid rise of overdoses. December 17, 2016. http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amid-rise-of-overdoses#sthash.rBrCtmcT.dpuf Accessed 03/21/2017
6. Phillips K. Drugs are killing so many people in Ohio that cold-storage trailers are being used as morgues. Washington Post March 16, 2017 https://www.washingtonpost.com/news/to-your-health/wp/2017/03/16/drugs-are-killing-so-many-in-this-county-that-cold-storage-trailers-are-being-used-as-morgues/?tid=sm_fb&utm_term=.a74316facd82 Accessed March 21, 2017
7. Qaseem A, Wilt TJ, McLean RM, and Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med published at Annals.org on 14 February 2017.
8. Fleming S, Rabago DP, Mundt MP, Fleming MF. CAM therapies among primary care patients using opioid therapy for chronic pain. BMC Compl Altern Med 2007, 7:15.
9. Davis MA, Yakusheva O, Gottlieb DJ, Bynum JP. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain. J Am Board Fam Med 2015;28:481-90.
10. Weeks WB, Goertz CM. Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries. J Manipulative Physiol Ther. 2016 May;39(4):263-6.