CVS, Opioids, and the Case for Chiropractic: A Turning Point in Pain Policy

Introduction A landmark court ruling in July 2025 ordered CVS Health's Omnicare unit to pay $949 million in penalties for dispensing invalid prescriptions for controlled substances, including opioids. This case has reverberated across the healthcare sector, underscoring the systemic failures of prescription oversight in long-term care. As public trust in pharmaceutical pain management erodes, this moment presents a compelling opportunity to reconsider the role of non-pharmacological alternatives like chiropractic care.

A Crisis of Oversight The ruling, based on violations of the Controlled Substances Act and False Claims Act, exposed how thousands of prescriptions were filled without proper medical authorization. Omnicare, which services nursing homes and elder care facilities, became emblematic of how administrative breakdowns can lead to the overuse of dangerous drugs in vulnerable populations. While regulatory accountability is long overdue, deeper reform is needed to change the treatment paradigm itself.

The Problem with the Current Pain Model Despite the CDC's 2022 Clinical Practice Guideline urging non-opioid therapies as first-line interventions for chronic and subacute pain (Dowell et al., 2022), opioids remain overprescribed. Institutional settings—such as nursing homes, VA hospitals, and rural clinics—often lack the infrastructure or referral systems to provide safe, conservative care options. The result is a cycle of pharmacological dependence, increased morbidity, and rising healthcare costs.

Chiropractic: A Scalable, Evidence-Based Solution Chiropractic care offers a drug-free, manual approach to managing musculoskeletal pain that is supported by decades of research. Studies show that patients who receive chiropractic care for back pain are significantly less likely to receive an opioid prescription (Whedon et al., 2018). In addition, chiropractic care is associated with reduced emergency room visits, fewer surgeries, and greater patient satisfaction (Corcoran et al., 2022).

Benefits of Chiropractic in Opioid Policy Reform

• Safety: Chiropractic interventions avoid the risks of polypharmacy, sedation, and addiction.

• Cost-effectiveness: Lower total treatment costs and reduced healthcare utilization.

• Accessibility: Chiropractors are widely distributed and can serve in underserved and rural communities.

• Integration: Chiropractors can participate in interdisciplinary teams alongside MDs, PTs, and behavioral health providers.

Policy Recommendations

1. Insurance Parity: Require equal reimbursement for non-pharmacological treatments, including chiropractic.

2. Public Health Integration: Include chiropractors in opioid reduction strategies, especially in long-term care settings.

3. Referral Protocols: Encourage primary care providers to refer patients to chiropractors before initiating opioid therapy.

Conclusion The CVS/Omnicare ruling highlights the dangers of systemic reliance on pharmaceuticals without adequate oversight. But more importantly, it opens the door to a broader conversation about rethinking pain management. Chiropractic care represents a proven, underutilized alternative that aligns with public health priorities and patient safety. It's time for policymakers to shift from reactive penalties to proactive solutions that include chiropractic as a cornerstone of national pain strategy.

References Corcoran, K. L., Whedon, J. M., & Kimura, M. N. (2022). Association between chiropractic spinal manipulative therapy and opioid prescription in musculoskeletal pain: A systematic review and meta-analysis. Pain Medicine, 23(1), 54–67. 

Dowell, D., Ragan, K. R., & Jones, C. M. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports, 71(3), 1–95. 

Whedon, J. M., Toler, A. W. J., Goertz, C. M., & Kazal, L. A. (2018). Association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain. Journal of Manipulative and Physiological Therapeutics, 41(3), 160–166.