How will chiropractors address the opioid crisis?

In collaboration with medical professionals, OCA developed the Opioid and Pain Reduction Collaborative. It’s designed to guide patients with long-term (chronic) back, shoulder or neck pain through opioid management.

Chiropractic student with simulation mannikin at the Canadian Memorial Chiropractic College (CMCC)

Endorsed by College of Chiropractors of Ontario

OCA’s Opioid and Pain Reduction Collaborative will equip health care professionals with the information they need to refer patients to chiropractic care and other manual therapy to better manage patients’ pain. The College of Chiropractors on Ontario (CCO) unanimously endorsed our Opioid and Pain Reduction Collaborative tools, making it clear that chiropractors can collaborate with patients and prescribing physicians while remaining within scope of practice.

Why We Need to Address the Opioid Crisis:

  • In Ontario, there were close to 2,000 deaths related to opioid use in 2019 alone. 1
  • Back pain is reported in more than half of all opioid users2 and is one of the most common diagnoses emergency and family physicians cite for prescribing opioids.3
  • A study at the Pain Management Centre at Hamilton General Hospital found eight per cent of patients on long-term opioid therapy for non-cancer pain had chronic back pain.4

And even though many patients are prescribed opioids for pain, a 2016 systematic review and meta-analysis found that opioid medications provide only modest, short-term pain relief for people with chronic back pain.5 Furthermore, in 2020, a systematic review and meta-analysis concluded that avoiding prescribing opioids for acute spine, muscle and joint injuries to patients with past or current substance use disorder, restricting duration to seven days or less and using lower prescribed doses when prescribed, are potentially important goals to reduce rates of persistent opioid use.6

Building on Research and Results to Address the Opioid Crisis

Research demonstrates that treatments chiropractors provide, such as spinal manipulation and therapeutic exercise programs, can effectively treat patients with chronic back, neck or shoulder pain, without medication and reduce their reliance on opioids.

For example:

  • A 2019 U.S. study found that 64 per cent of patients who saw a chiropractor were less likely to use opioids than people who didn’t, as reported in the journal Pain Medicine.7
  • 83 per cent of patients surveyed now rely less on medication, including opioids, to help manage their low back pain, after receiving care from a musculoskeletal (spine, muscle and joint) expert, such as a chiropractor, at one of Ontario’s seven government-funded Primary Care Low Back Pain (PCLBP) program sites. 8

Subsequently, many medical authorities and decision-makers recommend health care professionals consider pain management therapies without medication, including those chiropractors provide, before opioids:

  • 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain recommends therapies without medication, such as spinal or joint manipulation and therapeutic exercise, for treating back pain, as well as neck pain, knee osteoarthritis, fibromyalgia and severe headaches or migraines. 9
  • The American College of Physicians Low Back Pain Systemic Review demonstrated that exercise is effective for reducing long-term (chronic) low back pain and spinal manipulation provided better short-term pain relief than other active interventions. 10
  • Health Quality Ontario suggests that making better use of non-medical treatments to manage both short-term (acute) and long-term (chronic) pain will reduce the number of people who end up using opioids for the long-term. It will also reduce the amount of prescription opioids that people use in harmful ways. 11

Chiropractic care can help solve the opioid crisis because it is effective for treating a patient’s chronic back, shoulder, arm or other spine, muscle or joint pain. When this care addresses their pain, chiropractors can collaborate with patients and their prescribing physicians to avoid, maintain, reduce or eliminate opioid dependency. are less likely to use or become dependent on opioids.

How the OCA Opioid and Pain Reduction Collaborative Works to Address the Opioid Crisis

Unfortunately, knowledge of evidence-based recommendations to consider manual therapy for pain management, as well as how to appropriately introduce and oversee this care, is not widespread. In fact, a study found that health care professionals, including chiropractors, can benefit from guidance in ‘how’ to appropriately talk to patients about opioid use, while staying within their scope of practice.12

To bridge these gaps, OCA implemented an evidence-based initiative in consultation with an advisory panel, which included Dr. Janice Harvey MD, CCFP(SEM), FCFP DIP. SPORT MED, Dr. David Dos Santos, B.Sc., D.C., FCCPOR(C), FCCO(C), Dr. Erica Weinberg, BSc, MSc, MPhil, MD, Dr. Lindsey Rebeiro, BScH, DC and Lynn K. Cooper, BES as a patient with lived experience.

Part 1: Manual Therapy as an Evidence-Based Referral for Musculoskeletal Pain Tool

OCA partnered with the Centre for Effective Practice (CEP) to develop an evidence-based clinical tool that helps primary care professionals navigate evidence-based manual therapy that can reduce opioid use.

This tool is designed to give primary care professionals, such as physicians and nurse practitioners, the information they need to guide patients with back, neck and shoulder pain toward chiropractic care and other manual therapy. With their pain alleviated through these medication-free therapies, these patients will use and depend less on opioids to manage their pain.

The OCA successfully received endorsement from the Centre for Addiction and Mental Health (CAMH) and is included in CAMH’s Opioid De-implementation Pathway for physicians.

Part 2 – Chiropractor Pain Management Toolkit to Explore Opioid Management with a Patient

For chiropractors, OCA developed a Pain Management Toolkit to help them best navigate communication in patient-centred care and communicate with patients who may want help managing their opioid usage. This chiropractic toolkit is approved by the College of Chiropractors of Ontario (CCO). The OCA is also developing an Opioid and Pain Management learning program to empower chiropractors to collaborate with patients and their prescribing physicians to provide effective solutions.

See our Tool for Primary Health Professionals Here

View and Download

See our Pain Reduction Toolkit for Chiropractors Here

View and Download

How the OCA Opioid and Pain Reduction Collaborative Will Help Ontarians

Over time, the collaborative is expected to contribute to helping:

  • Reduce the number of Ontarians who depend on opioids to manage their chronic back, shoulder or arm pain
  • Decrease the number of opioid-related fatalities in Ontario
  • Increase the effectiveness of patient-centred care

How OCA Opioid and Pain Reduction Collaborative May Help You

Gradually, this evidence-based clinical collaborative will increase the number of physicians, nurse practitioners and other health care professionals able to guide patients with chronic back, neck and shoulder pain, toward manual therapy provided by a chiropractor, instead of opioids for managing their pain.

As knowledge of using manual therapy for treating these types of pain increases among health care professionals, you are more likely to be offered this effective and non-addictive option, if you suffer from this type of pain.

Chiropractors’ Impact

As OCA Opioid and Pain Reduction Collaborative is implemented, chiropractors will help a rising number of patients learn how to manage their chronic back, shoulder or neck pain, without depending on opioids.

What patients, who are former opioid users, say about chiropractic treatment

“Thank you [to my chiropractor] for helping me with the back pain I have suffered over eleven years… I was taking 6 Percocet per day, along with 6 Tylenol #3… I have (now) eliminated the Percocet and Tylenol #3 and now have no pain.”

PCLBP Program Patient

“I got hit back in 2005 on my bike. I was taking percs [Percocet], buying them off the street, I was taking anything I can get to stop the pain. Now [after chiropractic care] I’m right off the percs!”

PCLBP Program Patient

[1] Suspected opioid-related overdoses in jurisdictions across Canada based on Emergency Medical Services data. Government of Canada. September 2019.
[2] Deyo, R.A., Von Korff, M., & Duhrkoop, D. Opioids for low back pain. BMJ. January 2015.
[3] Borgundvaag B, McLeod S, Khuu W, Varner C, Tadrous M, Gomes T. Opioid prescribing and adverse events in opioid-naive patients treated by emergency physicians versus family physicians: a population-based cohort study. CMAJ Open. March 2018.
[4] Busse, J., Mahmood, H., Maqbool, B., Maqbool, A., Zahran, A., Alwasabai, A., & Buckley, D. Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario. CMAJ OPEN. September 2015.
[5] Abdel Shaheed, C., Maher, C. G., Williams, K. A., Day, R., & McLachlan, A. J. Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-Analysis. JAMA Intern Med, 176(7), 958-968. July 2016.
[6] Riva, J.J., Noor., S.T., Wang, L., Ashoorion, V., Foroutan, F., Sadeghirad, B., Couban, R. & Busse, J. Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults. Annals of Internal Medicine. August 18, 2020.
[7] “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis”, Pain Medicine, September 2019.
[8] Primary Care Low Back Pain Pilot Evaluation: Final Report. Centre for Effective Practice. Toronto: Ontario. March 2017.
[9] Busse, J. W., Craigie, S., Juurlink, D.N., Buckley, D. N., Wang L., Couban R.J., Agoritsas, T., Akl, E.A., Carrasco-Labra, A., Cooper, L., Cull, C., da Costa B.R., Frank, J.W., Grant G., Iorio, A., Persaud, N., Stern, S., Tugwell, P., Vandvik P.O. and Guyatt G.H., Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain, CMAJ, 189 (18), May 2017.
[10] Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline. American College of Physicians Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Annals of Internal Medicine, 166(7), 514-530. April 2017.
[11] Tepper, J., Dhalla, I. Opioids and Pain Management. Health Quality Ontario February 2018.
[12] Corcoran K. L., Bastian L. A., Gunderson C. G., Steffens, C., Brackett, A., Lisi A. J., “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis”, Pain Medicine, September 2019.