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.

Infographic showing 83% of patients rely on opioids after PCLBP pilot treatment and 64% of patients less likely to use opioids after seeing chiropractor

Why We Need to Address the Opioid Crisis:

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 (long-term) 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

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

Research results demonstrate that treatments chiropractors provide can effectively help patients with chronic back, neck and/or shoulder pain. They can also do so without medication and reduce patients’ reliance on opioids.

Unfortunately, evidence-based recommendations considering manual therapy for pain management, and how to introduce and oversee this care, are not widespread.

To bridge these gaps, we consulted with an interprofessional advisory panel and hired the Centre for Effective Practice (CEP) to produce a clinical, knowledge translation tool.

To support chiropractors, we produced the Chiropractor Pain Management Toolkit (for chiropractors to explore opioid management with a patient). A key part of the Chiropractor Pain Management Toolkit is the Chiropractor Dialogue Map. The CCO unanimously endorsed this dialogue map, making it clear that chiropractors using this tool are within their scope of practice.

The Collaborative equips health care professionals with the information they need to work together, helping their patients manage opioid dependency.

How the OCA Opioid and Pain Reduction Collaborative Tools Address the Opioid Crisis

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

We hired the CEP to develop this evidence-based clinical tool to help medical doctors (MD)s and nurse practitioners (NP)s navigate manual therapy.

This tool gives MDs and NPs the best available evidence they need to refer patients with back, neck and shoulder pain to a manual therapist and co-ordinate a plan of care with them. With their pain managed through these medication-free therapies, patients can use and depend less on opioids to manage their pain.

In addition, the Centre for Addiction and Mental Health (CAMH) included this tool in its Opioid De-implementation Pathway for medical doctors.

Part 2 – Chiropractor Pain Management Toolkit

We developed this toolkit to help chiropractors best navigate communication with patients who want help managing their opioid usage, as well as their medical doctors/nurse practitioners. It works by making the communication pathways easier for all health care professionals in the circle of care. The Pain Reduction Toolkit includes a Chiropractor Dialogue Map and three, fillable pain reduction forms to support collaborative care.

Check the following podcast series on addressing the opioid crisis to learn more about this toolkit and how to best use it.:

We are also working with the Canadian Memorial Chiropractic College (CMCC) to develop an opioid and pain management learning program to be launched this fall. The program will help empower chiropractors to collaborate with patients and their medical doctors/nurse practitioners to provide effective solutions.

Access Manual Therapy as an Evidence-Based Referral for Musculoskeletal Pain Clinical Tool (for MDs and NPs)
Access Chiropractor Toolkit and How to Use It

Using Research and Results to Address the Opioid Crisis

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

For example:

  • 83 per cent of patients surveyed at one of Ontario’s Primary Care Low Back Pain (PCLBP) sites now rely less on medication, including opioids, to help manage their low back pain. This survey was conducted after patients received care from a musculoskeletal expert, such as a chiropractor.7
  • A 2019 U.S. study found that 64 per cent of patients who saw a chiropractor were less likely to use opioids.8

Subsequently, many medical authorities recommend health care professionals, such as medical doctors (MD)s and nurse practitioners (NP)s, 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 and 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 number of prescription opioids that people use in harmful ways.11

Chiropractic care can help address the opioid crisis because it’s effective for treating a patient’s chronic back, neck, shoulder pain. When this care treats their pain, chiropractors can collaborate with patients and their MDs/NPs to reduce or manage opioid dependency.

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, neck or shoulder pain
  • Decrease the number of opioid-related fatalities in Ontario
  • Increase the effectiveness of patient-centred care

For a broader perspective on how the Collaborative will help address the opioid crisis, particularly given its tragic rise during the COVID-19 pandemic, please check our CEO blog post: Addressing the Opioid Crisis with Interprofessional Collaboration.

Chiropractors’ Impact

As the OCA Opioid and Pain Reduction Collaborative is implemented, chiropractors will collaborate with medical doctors and nurse practitioners to help 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… taking 6 Percocet per day, along with 6 Tylenol #3… I have (now) eliminated the Percocet and Tylenol #3 and now have no pain.”
Primary Care Low Back Pain 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!”

Primary Care Low Back Pain program patient
[1] Government of Canada. (2019). Suspected opioid-related overdoses in jurisdictions across Canada based on Emergency Medical Services data.
[2] Deyo, R.A., Von Korff, M., Duhrkoop, D. (2015). Opioids for low back painThebmj. (350):g6380.
[3] Borgundvaag, B., McLeod, S., Khuu, W., Varner, C., Tadrous, M. and Gomes, T. (2018). Opioid-naive patients treated by emergency physicians versus family physicians: a population-based cohort studyCMAJ Open. 6(1): E110-E117.
[4] Busse, J., Mahmood, H., Maqbool, B., Maqbool, A., Zahran, A., Alwasabai, A., & Buckley, D. (2015). 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. 3(3).
[5] Shaheed, C.A., Maher, C.G., Williams, K.A., Day, R., McLachlan, A.J. (2016). Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysisJAMA Intern Med. 176(7):958-968.
[6] Riva, J.J., Noor, S.T., Wang, L., Ashoorion, V., Foroutan, F., Sadeghirad, B., Couban, R. (2020). Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults, A Systematic Review and Meta-analysis of Observational Studies. Annals of Internal Medicine. 173 (9). 721-729.
[7] Primary Care Low Back Pain Pilot Evaluation: Final Report. Centre for Effective Practice. Toronto: Ontario. March 2017.
[8] Corcoran, K. L., Bastian, L. A., Gunderson, C. G., Steffens, C., Brackett, A., &; Lisi, A. J. (2019). Association between chiropractic use and opioid receipt among patients with spinal pain: A systematic review and meta-analysis. Pain Medicine, 21(2), February 2020, 139-145.
[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. (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.
[11] Health Quality Ontario. (2018) Opioids and Pain Management.