Chiropractic and the Opioid Epidemic

Chiropractors work with patients to relieve pain without the use of prescription opioid pain medication. If doctors worked together to treat patients with chiropractic care and other forms of alternative therapy without prescribing opioids, there would be less exposure to opioids and less addiction.

The CDC defines opioids as a class of drugs used to reduce pain. Prescription opioids include oxycodone, hydrocodone, morphine, and Methadone. These drugs are prescribed by doctors to treat pain usually following surgery. In your experience, are you aware of opioids being commonly prescribed by doctors for other purposes such as chronic pain?

Dr. Gregg Rubinstein: Absolutely. You know, pain following surgery can become chronic so anyone who’s had long-lasting pain for anything more than six months are going to be seeking relief, and I’ve seen doctors prescribe these medications for acute pain as well, so they can even be prescribed for headache sufferers. So, it’s a real issue with prescribing these drugs to treat pain because you know most often they never really fix the problem because no one has a deficiency of pain killers like oxycodone or morphine. They’re, you know, really having other types of issues and the drugs only tend to cover up the symptoms while a chiropractor will try and look at the cause of the problem. They’ll look to see if the problem being caused by pressure building up on the spinal nerves and irritating them, which can lead to chronic pain syndromes like headaches and all these other issues.

Look, I understand that it’s a lot harder to show up at a chiropractor’s office consistently and to get care rather than just popping a few pills, but the long term benefits when you look at chiropractic versus taking opioids, hands down, it’s going to be in favor of chiropractic because there’s really no major side effects to what we do. Chiropractic is non-addictive and if you really look at statistics like 21 to 29% of patients prescribed opioids for chronic pain misuse them. 8 to 12% of the people develop an opioid use disorder, 4 to 6% of the people who misuse prescription opioids transition to heroin, and 32% of the patients with lower back pain that were seen by medical doctors were prescribed opioids according to a 2013 study. So, if you just keep handing out these medications, no one really addresses the real problem. Sure, they work, they’re going to cover up the pain and symptoms, but the problem is still going to be there. So yes, they prescribe them for many different types of pain syndromes, but not acknowledging chiropractic or trying something else before you go to the medication sometimes can lead down a dangerous road.

And now, as a chiropractor, you relieve pain without medication. So, do doctors commonly refer patients for chiropractic care before prescribing opioids for painful conditions? If not, why not?

Dr. Gregg Rubinstein: That’s an interesting question and I can’t speak for every MD out there, but I know that every medical doctor, when they graduate, they take an oath and part of that oath is something called primum non nocere, which is a Latin term which means first do no harm. You would think that, you know, if you didn’t want to have side effects, that you would try the most natural solution to a problem that’s available. When you look at the statistics, again, 25% of the adult population is going to have back pain within the last three months and 80% of adults will experience back pain at some point in their lifetime. So those are really interesting statistics because that’s a lot of people and there are many more studies that show that if a patient starts treatment for an acute or chronic back or neck issue with a chiropractor they’re 75% less likely to end up on a prescription medication.

If they seek care in a medical office for the same condition, most likely they’re going to be walking out of there with a prescription. Now, sometimes the medical doctors like to keep things in-house and they’ll usually send to a physical therapist because once they provide that referral, they have more control. Chiropractors are portal of entry so anyone can walk into my office and seek care for just about any condition that they want to. So, when they come to our office, we’re going to look at the problem. My license doesn’t allow me to prescribe medication so that’s not really an option for me. So, I’m going to look hard at the most natural option that would make sense for that patient first.

There’s some interesting stuff coming out because there’s even a few states now that are trying to mandate in law that chronic pain patients need to try physical therapy, acupuncture, chiropractic, massage, some sort of natural or alternative medicine that doesn’t use drugs or surgery before they can be put on those medications. Which is a great discussion, but it’s not really taking traction in every state and, even if it does get passed into law, I think it’ll be a long time before it’s enacted. So, we’re on that slippery slope. I know that medical doctors aren’t out to harm people, but they do what they do based on what their standards of care are. Chiropractic has a different standard of care and we’re looking at the body from a different point of view. We can help a lot of these people and prevent them from getting prescriptions and hopefully not going down that road towards opioid addiction.

In your experience, what type of pain responds the best to chiropractic care?

Dr. Gregg Rubinstein: Well, Liz, that’s an interesting question and I’ve been in practice for over 28 years and I’ve seen just about every type of condition walk through my front door. You know, anything from headaches to hangnails, I got people coming in and seeking care for. When you truly understand how chiropractic works, you start to understand that almost any painful condition can be helped with chiropractic care because chiropractic affects the nerve system directly. Most people will think that I’m a back doctor and, you know, what is really going on is that we use the spine as our avenue of approach. Typically stress, tension, poor posture, accidents, falls will create misalignments, which in chiropractic we call subluxations. When these misalignments occur at the spinal level and are irritating the spinal nerves, that’s going to cause pain. Now on top of that, when there’s irritation to the nerve system, the body has a difficult time healing because the nerve system controls and coordinates that healing process. If you create a lot of static in the line because there’s irritation on those spinal nerves and those messages don’t get through or they get distorted, that’s going to slow down the body’s ability to heal. If your body can’t heal itself faster than we can break it down, then we have more significant issues.

And you touched on this a little bit, but in what ways can different types of doctors, including chiropractors, work together to identify the source of a patient’s pain and find ways to alleviate it without prescribing opioids?

Dr. Gregg Rubinstein: You know, that’s going to take a shift in consciousness. Many people out there won’t look to a chiropractor as a thought leader in health or as a thought leader in pain treatment, which is fine because people seek chiropractic for many different reasons. But really when you think about it, we should be working together and they should be referring more consistently to chiropractors. Any time I get a condition that’s outside of the scope of my practice, I’m sending that patient to an orthopedist or a medical doctor to get checked. They can try the same procedures and since chiropractic again is 100% portal of entry, we manage these cases more autonomously, but the facts remain clear. You know, in managing these patients, I just don’t see drugs as being the answer because taking any amount of opioids can lead to addiction. Limiting the size of an opioid prescription doesn’t stop the increased chances of addiction. It can happen after just five days taking opioids.

80% of Americans that are using heroin misused opioids first. That was their gateway drug. Could these people have been helped in a different way? Absolutely, but it’s just a matter of educating and communicating with medical doctors. Really, as the opioid issue has become way more in the forefront of the news, we’re seeing it and we’re seeing it in the news, that doctors are talking about it.

We’re actually putting on an opioid town hall or a community connect up in Albany and we’re inviting all types of law enforcement, addiction specialists. We want the politicians there and the general population because they need to be made aware of what’s going on. I think now it’s hard pressed to find people who aren’t aware of the opioid problem out there, but, you know, some doctors just view chiropractors as competition. If we’re competing for the same patients, they’re going to want to hold on and maintain control. But as I’ve spoken to more doctors and educated them about what we do, they seem to be more open to it. I do get referrals from medical doctors, but I would have expected after 28 years that we’d be getting more, but there are just some divisive lines out there and people should get to choose whichever approach they want.

So, if are people looking for more natural approaches, they will end up with chiropractors as long as chiropractors keep doing their job and explaining what they do and sharing the information with other medical professions.

If someone has become addicted to opioids, in what ways can a chiropractor help them?

Dr. Gregg Rubinstein: Well, there’s a lot of new research coming out about addiction and chiropractic care. There are a bunch of studies out there that show that chiropractic care, when you apply the corrective adjustments, it can stimulate the nerve system in a way that’s similar to opioid drugs that stimulate that pleasure-reward center of the brain and chiropractic can reduce the vulnerability to addictive behavior before it ever happens.

Chiropractic can help normalize brain function, checking the body and clearing the body of the normal wear and tear and the subluxation patterns that show up in the spine from stress, tension, and poor posture. It can eliminate these problems before they become bigger. Chiropractic care also reduces pharmaceutical use in cost by 85%.

So, there’s a lot of information, but the thing is, once they’re addicted, there are some research studies that show what’s going on out there, but the reality is that for chiropractic, we can only handle everything from the top cervical vertebrae, the atlas, on down. Anything above the atlas, people need to get helped by licensed professionals. Sometimes, you know, therapists can help people through addictive behavior or through painful conditions, they can help them with depression, which often leads to misusing these medications as well.

So, there’s a lot of help out there for addiction. I wouldn’t say chiropractors were in the forefront, but there are some who deal a lot with addictions and work with addiction specialists. There’s lots of research that keeps coming out as we keep studying this problem.

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