The Role of Chiropractic Care in Reducing Opioid Use and Addressing the Opioid Epidemic

Introduction

The opioid epidemic has emerged as a public health crisis of staggering proportions, affecting millions of individuals worldwide and contributing to significant morbidity and mortality. In the United States alone, opioid overdoses claim more than 100,000 lives annually (Centers for Disease Control and Prevention [CDC], 2023). As the healthcare system seeks effective strategies to combat opioid misuse, abuse, and dependence, non-pharmacological approaches to pain management have gained increasing attention. Chiropractic care, known for its conservative, drug-free treatment of musculoskeletal conditions, especially spinal pain, offers a valuable alternative. This paper examines the role of chiropractic care in reducing opioid prescriptions and addiction risk, supported by peer-reviewed evidence and public health guidelines.

The Opioid Epidemic and Overprescription

The overprescription of opioids for acute and chronic pain has been identified as a key driver of opioid misuse and addiction. Traditionally, physicians have relied heavily on opioids for managing musculoskeletal pain, particularly low back pain—a condition that affects nearly 80% of adults at some point in their lives (Hartvigsen et al., 2018). However, opioids are not only ineffective for long-term pain control but also carry significant risks of dependence, tolerance, and overdose (Dowell et al., 2016).

In response, organizations like the CDC and the American College of Physicians (ACP) have revised their pain management guidelines, emphasizing the use of non-pharmacological treatments, including spinal manipulation, as first-line interventions (Qaseem et al., 2017). Chiropractic care aligns with this model, providing a safe, evidence-based, and cost-effective alternative to opioids.

Chiropractic Care as a First-Line Treatment

Chiropractors are trained in the diagnosis and management of neuromusculoskeletal disorders and specialize in non-invasive, manual therapies such as spinal manipulation, mobilization, and therapeutic exercise. These treatments have been shown to provide significant relief for conditions commonly treated with opioids, such as acute and chronic low back pain, neck pain, and tension headaches (Paige et al., 2017).

Research demonstrates that chiropractic care can play a crucial role in preventing the initiation of opioid therapy. A landmark retrospective cohort study by Whedon et al. (2018) found that adults with spinal pain who received chiropractic care had 64% lower odds of receiving an opioid prescription compared to those who did not. This finding suggests that chiropractic intervention may reduce the likelihood of opioid exposure at the outset of treatment, thereby lowering the risk of dependence.

Evidence Supporting Reduced Opioid Use

Several peer-reviewed studies have examined the association between chiropractic utilization and reduced opioid prescribing. A systematic review and meta-analysis by Whedon, Toler, and Kazal (2020) concluded that chiropractic care is consistently associated with decreased opioid use among patients with spinal pain. The study analyzed 62,000 patients and found that those who engaged in chiropractic care had up to 90% reduced odds of early opioid use and were less likely to progress to long-term use.

Similarly, Kazis et al. (2019) evaluated data from over 216,000 patients with low back pain and found that initial visits to non-pharmacological providers such as chiropractors and physical therapists were associated with significantly lower rates of opioid prescriptions. These findings support the incorporation of chiropractors into front-line care for musculoskeletal pain to reduce reliance on opioids.

Alignment With Public Health Guidelines

Leading health authorities have recognized the importance of integrating non-drug therapies into standard care. The ACP’s 2017 guidelines recommend spinal manipulation and other conservative treatments as first-line care for acute and chronic low back pain, citing the risks of pharmacologic options (Qaseem et al., 2017). The CDC’s Guideline for Prescribing Opioids for Chronic Pain (2016) also urges clinicians to consider non-pharmacologic and non-opioid therapies as preferred approaches for managing chronic pain (Dowell et al., 2016).

These recommendations provide a framework for including chiropractors as essential members of interdisciplinary teams aimed at addressing the opioid crisis. Chiropractors can offer early, effective interventions that prevent the cascade from acute pain to chronic opioid dependence.

Public Health and Economic Impact

Beyond individual benefits, integrating chiropractic care has broad implications for public health and healthcare economics. States with greater access to chiropractic care have reported lower per-capita opioid prescription rates and fewer opioid-related deaths (Whedon et al., 2020). By reducing initial exposure to opioids, chiropractic care may decrease the incidence of addiction, reduce the burden on addiction treatment services, and improve overall population health outcomes.

From a cost perspective, chiropractic care is associated with lower overall healthcare expenditures for musculoskeletal conditions. Research has shown that early chiropractic intervention results in fewer imaging studies, surgeries, and hospitalizations—components that are often escalated by long-term opioid therapy (Fritz et al., 2015).

Barriers to Utilization

Despite its benefits, chiropractic care remains underutilized due to stigma, insurance barriers, and lack of integration into mainstream healthcare systems. Historical opposition from organized medicine and misconceptions about chiropractic philosophy have led to professional marginalization. Educating policymakers, expanding insurance coverage, and encouraging interdisciplinary collaboration are essential to fully leverage chiropractic’s role in combating the opioid epidemic.

Conclusion

Chiropractic care offers a powerful, evidence-based strategy to reduce opioid use and prevent addiction. By providing safe, effective, and non-pharmacologic management of musculoskeletal pain, chiropractors serve as essential frontline providers in modern healthcare. Integration of chiropractic into pain management protocols aligns with public health guidelines and presents a meaningful opportunity to address one of the most pressing health crises of our time. As health systems evolve to prioritize prevention and value-based care, the chiropractic profession is uniquely positioned to lead the way toward a safer, drug-free approach to pain relief.

References  

Centers for Disease Control and Prevention. (2023). Understanding the epidemic.

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Fritz, J. M., Childs, J. D., & Wainner, R. S. (2015). Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs. Spine, 40(11), 835–842. 

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., ... & Woolf, A. D. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. 

Kazis, L. E., Ameli, O., Rothendler, J., Garrity, B. M., Murphy, J. E., & Gomes, D. (2019). Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open, 9(9), e028633. 

Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., ... & Shekelle, P. G. (2017). Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: Systematic review and meta-analysis. JAMA, 317(14), 1451–1460. 

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. 

Whedon, J. M., Toler, A. W., Bezdjian, S., Kazal, L. A., & Goehl, J. M. (2018). Association between chiropractic use and opioid receipt among patients with spinal pain: A systematic review and meta-analysis. Journal of Alternative and Complementary Medicine, 24(6), 552–563..

Whedon, J. M., Toler, A. W., & Kazal, L. A. (2020). Impact of chiropractic care on use of prescription opioids in patients with spinal pain. Pain Medicine, 21(11), e121–e132.