MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

We have discussed the association between chiropractic an opioid use before. But the problem of causality remained unresolved. Perhaps this new paper can help? This retrospective cohort study with new onset back pain patients (2008-20013) examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).

The researchers evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP. The 216 504 patients were aged 18 years or older and had been diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance. The primary independent variable was the type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists). The main outcome measures were short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).

Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).

The authors concluded that initial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids. Incentivising use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.

Like in previous papers, the nature of the association remains unclear. Is it correlation or causation? It is not correct to conclude that initial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids, because this implies a causal relationship. Likewise, it is odd to claim that incentivising the use of chiros or physios may reduce the risk of opioid use. The only thing that reduces opioid use is opioid perscribing. The way to achieve this is to teach and train doctors adequately, I think.

7 Responses to More on chiropractic and opioid use

  • Could you imagine what this study provided if chiropractors were given prescription power. They are anti-pill but would change their tune if given the option. I am not certain, just guessing since they are fighting real hard to become primary care providers.

  • Logic dictates that chiropractors would do best to have rights granted.
    Those chiropractors who are opposed would not be obliged to use the rights – would not have to prescribe!

    Of course, whether their attachment to magnetic therapy (historically) and ‘adjustment of subluxations’ (currently) suggests that logic is not their strong suit and they lack the necessary ability to think critically, use judgement and discretion, act with integrity, cease taking advantage of gullible patients, and are worthy of any reputable professional status is another question.

    First I would ask any chiropractor who wants to prescribe: “Tell me, given your ambition, why did you not become an MD? Are you not just a failed or second class MD?”

    • Richard,

      Good question – it’s alway interesting to hear how people end up on their paths.

      For instance, you studied and practiced the art of deceiving people. Why did you study deception, when there are many other disciplines/arts devoted to clarity of mind, objective observation, etc? If you had studied the latter…maybe chiros would take your question a bit more seriously…

    • “Tell me, given your ambition, why did you not become an MD?”

      I suspect there are several reasons. But re pharms….

      I wonder say most who get into chiropractic do so because it is a drug free profession, a more wholistic and “natural” approach.

      However, once in practice for awhile, many may see that some pharms, such as muscle relaxers, could help in a quicker recovery. Currently they have to flip or work with the medical field to get those scripts. This would cut out “the middleman”.

      Also, too often with MDs, when they get these referrals, send the patient to a PT and not back to the DC.

      That’s just my opinion/view.

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