OCA and the Centre for Effective Practice (CEP) are developing an evidence-based clinical tool to help reduce opioid use.

This tool will help chiropractors, other musculoskeletal (spine, muscles and joint) experts and physicians collaboratively guide patients with long-term (chronic) back, shoulder or arm pain toward appropriate pain management, without medication.

decrease opioid use infographic

The Issue:

  • Canada is the second highest consumer of prescription opioids in the world, after the U.S.1
  • Across Canada, there were more than 13,900 deaths apparently related to opioid use, between January 2016 and June 2019. 2
  • In Ontario, there were close to 2,000 deaths related to opioid use in 2019 alone. 3
  • Back pain is reported in more than half of all opioid users4 and is one of the most common diagnoses emergency and family physicians cite for prescribing opioids.5
  • 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.6

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.7

The evidence-based opioid clinical tool will equip health care professionals with the information they need to guide patients toward chiropractic care and other manual therapy to help manage their pain, without medication.

Building on Research and Results

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. 8
  • 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 program sites. 9

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. 10
  • 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. 11
  • 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. 12

Chiropractic care is effective for treating a patient’s chronic back, shoulder, arm or other spine, muscle or joint pain. When this care alleviates their pain, these patients are less likely to use or become dependent on opioids. With effective pain management in place, these patients can also successfully move forward with rehabilitation services, including mental health and addiction treatment.

How the Opioid Clinical Tool Will Work

Unfortunately, knowledge of these research-based recommendations to consider the pain management therapies, chiropractors provide, 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 and stay within their scope of practice.13

To bridge this gap, OCA is partnering with the Centre for Effective Practice (CEP) to develop an evidence-based opioid clinical tool for health care professionals, such as physicians and nurse practitioners, as well as chiropractors. This tool will be designed to give them 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.

This clinical tool will also be designed to help:

• Prompt communications between front line health care professionals, such as physicians, and chiropractors

• Educate health care professionals about chronic pain management alternatives

An interprofessional working group, including physicians, chiropractors, a nurse practitioner, a nationally known pain specialist and one patient representative, is developing this evidence-based, clinical tool. It is slated for release in 2020.

How the Opioid Clinical Tool Will Help Ontarians

Over time, this evidence-based clinical tool is expected to contribute to helping:

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

How the Opioid Clinical Tool May Help You

Gradually, this evidence-based clinical tool 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 chiropractic care, instead of opioids for managing their pain.

As knowledge of chiropractic care as treatment for 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

An interprofessional working group that includes chiropractors, among others, is developing this evidence-based clinical tool. Once this tool is implemented, it’s anticipated that chiropractors will help a rising number of patients learn how to manage their chronic back, shoulder or arm 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.”

Pilot 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!”

Pilot Patient

Watch for updates on this page and in the OCA members’ bulletin


[1] International Narcotic Control Board. Narcotic Drugs Technical report: Estimated World Requirements for 2017 – Statistics for 2015. 2017.
[2] Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Opioid-related Harms in Canada Web-based Report. Ottawa: Public Health Agency of Canada; December 2019.
[3] Suspected opioid-related overdoses in jurisdictions across Canada based on Emergency Medical Services data. Government of Canada. September 2019.
[4] Deyo, R.A., Von Korff, M., & Duhrkoop, D. Opioids for low back pain. BMJ. January 2015.
[5] 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.
[6] 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.
[7] 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.
[8] “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis”, Pain Medicine, September 2019.
[9] Primary Care Low Back Pain Pilot Evaluation: Final Report. Centre for Effective Practice. Toronto: Ontario. March 2017.
[10] 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.
[11] 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.
[12] Tepper, J., Dhalla, I. Opioids and Pain Management. Health Quality Ontario February 2018.
[13] 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.