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)

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. 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.

In collaboration with medical professionals, we 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.

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, is not widespread.

To bridge these gaps, we consulted with an interprofessional advisory panel and partnered with the Centre for Effective Practice (CEP) to create the evidence-based Opioid and Pain Reduction Collaborative, which includes:

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

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 Tool

We partnered with the CEP to develop this evidence-based clinical tool to help primary care professionals (PCP)s navigate manual therapy.

This tool gives PCPs, the information they need to refer patients with back, neck and shoulder pain to chiropractic care. With their pain alleviated through these medication-free therapies, patients can use and depend less on opioids to manage their pain.

In addition, we successfully received inclusion from the Centre for Addiction and Mental Health (CAMH) for its Opioid De-implementation Pathway.

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 PCPs. It works by making the communication pathways easier for all professionals in the circle of care. The Pain Reduction Toolkit includes a Chiropractor Dialogue Map and three pain reduction forms to support collaborative care.

We are also working with the Canadian Memorial Chiropractic College (CMCC) to develop an opioid and pain management learning program. This program will empower chiropractors to collaborate with patients and their prescribing physicians to provide effective solutions.

Access Primary Care Professionals Tool
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 reduced 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.3
  • 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.4

Subsequently, many medical authorities 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 and neck pain, knee osteoarthritis, fibromyalgia and severe headaches or migraines.
  • 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.
  • 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.

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

Chiropractors’ Impact

As the 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… 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] 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.

[3] 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.

[4] Primary Care Low Back Pain Pilot Evaluation: Final Report. Centre for Effective Practice. Toronto: Ontario. March 2017.