272- Reducing Opioid Use With Chiropractic

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid and today we are talking about the association between chiropractic use and opioid use. There's going to be some stats here that you can action in practice and things that you should know as a practicing chiropractor and there's going to be more to this story. But let's start the story today talking all about the association between chiropractic use in opioid recipients amongst patients with spinal pain. This is a systematic review and a meta analysis. Before we get started, I want to say a few words about Jane. What's in a name? You ask everything you need to meet Jane. The only name you'll need to remember in the EHR world. Jane is a HIPAA compliant online platform providing clinical management capabilities. Things like online booking, charting, scheduling, secure telehealth, invoicing, you name it. It's all there in one easy to use system with features like smart options, narrative and dictation. It it makes things way easier in your practice. You can learn more and watch a demo by heading to Jane App Cairo. That's Jane App Cairo. Also link that in the show notes and if you want a 30 day grace period I can hook you up. Use the code evidence based2021 evidence based 2021. You'll get a 30 day grace period as you switch over. I know so many people have trouble with your ehr. Check out Jane. It's a fantastic tool, fantastic product. More about relationships than the transactions, which is something we talk about a lot in the Smart Chiropractor. But today on this podcast we're talking all about research. This is a study that came out not too long ago, 2019 in pain medicine. And it is titled association between Chiropractic Use and Opioid Recipient amongst Patients with Spinal A Systematic Review and Meta Analysis. There's sort of some awkward English in that title there, but that is the title one way or the other. And this is about opioids. We know that in 2017 alone, 2017, an average of 115Americans died every single day from opioid overdoses and a majority of those individuals were based in prescribed medicine. I think in 2019, if I'm not mistaken, I think there was a slight dip in 2018 into 2019 into. And now things have come back strong. We've seen this pandemic occur, spinal pains at an all time high. People are isolated, people are stressed out. And we have seen a complete resurgence. The last that I saw, all progress that had been made in the last five years on decrease of opioid overdoses, opioid deaths and opioid addiction have come back and been eliminated. And that's a very scary proposition because the ramifications for that aren't necessarily seen today, but they're seen as the months, as the years go by. And this is a very, very important thing. And I really want to hone this in for chiropractors out there because many of us, we see patients, you know, that come into our practice, we see a lot of people in our community, we care about them, we do our thing. But I don't think that many of us really take into accord the full extent of what's going on out there. And we have over 100 deaths per day, thousands upon thousands of deaths per year. Those are deaths. Now let's talk about the hundreds of thousands of individuals whose family, whose work, they might not pass away, but their lives are forever changed by these medications. And when we drill down in the research, one thing that we see time and time again is a lot of this stems from neuromusculoskeletal issues. And, and that's just a fact that we all need to reckon with. Because many individuals who go down this path, maybe they're taking them post surgically, maybe they're taking them cause they don't want surgery, maybe they're taking them because they have chronic pain. These are things that we have to reckon with, we have to live with and we have to understand so we can continue to tell our message and we can continue to tell the message that this research paper showcases, which is we need to be the centerpiece of this conversation with we need to get out there, we need to have higher utilization. People need to understand who we are and what we do. And that can make a real impact in the lives of millions, if not tens of millions of people each and every year. So let's dive in. Clinical current clinical practice guidelines. We talk about them a lot. And we just released a new blog on the Smart Chiropractor blog all around clinical practice guidelines. And for the management of low back pain, neck pain, you know, and osteoarthritis of the hip, knee and hand, it recommend non pharmacological treatments as the initial considerations ahead of Pharmacological treatment. So a few years back, we saw that sort of shift in that change where it was like, well, opioids should not be a first line treatment, duh. But that was a shift that occurred a few years ago. Well, now we see an additional step where they're saying, hey, before you even go to NSAIDs, I mean, you shouldn't do anything that's drug, medication or pharmacological until you've attempted non pharmacological care. And that's a very, very important thing that most people are totally unaware of. We look at how many people take NSAIDs, you know, 100,000 hospitalizations per year due to NSAID use alone. And we see that day in and day out when we look at the opioids. It's a big problem. Now, chiropractors, we provide many of those non pharmacological treatments recommended by the clinical practice guidelines for spinal issues. We, you know, spinal manipulation, adjustments, patient education, exercise, acupuncture, massage, all of these things are first line and frontline treatments that are recommended by clinical practice guidelines for all physicians. And they are what we do each and every day as chiropractors. That's something powerful. It's something you need to be aware of, and it's something we need to start telling the story more of. So in this study, specifically, they found the prevalence of chiropractic care varied between about 11% and 50%. I don't know where 50% came from. Maybe they asked two people and one person was under chiropractic care. But I think 11% is much more where we're at. I've seen things saying 15 or 20%. Just don't think that's true. Based upon the number of chiropractors and the care that's being delivered, I think it's much closer to 10. 11% is the prevalence. And chiropractic users had a lower percentage of opioid, you know, opioid use than non users. In all studies and in a random effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than non users, a 64% lower odds of receiving an opioid prescription. Imagine if over the next 6, 12, 18, 24, 36, you name it. Imagine if over the next period of time we were able to decrease opioid usage by 64%. Do you think that would make an impact? I think it would make an impact on tens of millions of lives. The main findings of this review was all studies demonstrated a negative association between the use of chiropractic care and, and opioid prescription use. The current study adds to the small but increased body evidence demonstrating the access and utilization to chiropractic services are negatively associated with chiropractic use. This is an important point that we're going to dive into because you might look at this on the surface and say, hey, well, chiropractors can't prescribe opioids. So if they saw a chiropractor, it's less likely they're going to have an opioid prescription. That's true. But what they found is a negative association, meaning those individuals that saw all types of doctors, if a chiropractor was part of their team, they might be seeing other doctors. It still counted. So they might have been seeing a primary care doctor, maybe they were seeing a neurologist. But if you have a chiropractor on your team, 64% lower chance that you are going to receive an opioid prescription. That's powerful. And why is it powerful? Because we know back pain is responsible for it's number one cause of disability worldwide. Just in the United States alone, 100 billion bucks, $100 billion of cost estimated due to back pain. Just in the United States alone, each and every year. Now, in these studies, they analyzed a bunch of studies. In four of the six studies, chiropractors were either the first provider seen or part of the initial treatment strategy. So as the researchers say, quote, ideally non pharma pharmacological therapies, including a multimodal chiropractic care, are utilized as frontline treatments to ultimately avoid the prescription of opioids, which are associated with poor outcomes for low back pain and chronic pain. Now, incidentally, I don't have this reference, but I was reading something the other day and it was, it was either on Mayo Clinic website or it was on Yale or Johns Hopkins. And they were referencing the fact that opioids basically don't work for back pain. It was like a 10% effective rate or something absolutely atrocious. So not only are these medications largely ineffective overall, but they're just straight up deadly. So the researchers in this study also found it is possible that chiropractic care may be a reasonable component of a pain management plan during an opioid taper. Although this has yet to be studied sufficiently. That's a really interesting component as well. Think about how many people are on opioids and trying to get off opioids. It's not hundreds, it's not thousands. We're talking tens of thousands into the hundreds of thousands. We're talking people in your community right now. No matter where you're listening to this, there are people in your community, around the world, people in your community that are attempting to taper or get off opioids. Now when we look at the negative association between chiropractic, we look at the effectiveness and efficacy of chiropractic, we look at the safety, we look at the fact that it's non pharmacological and we look at the fact that it's guideline concordant. We do every single thing under our roof practically that's recommended in those clinical practice guidelines. Being a part of an opioid taper, now that starts to get really, really interesting because it opens up an entirely new market. I'm not saying these patients are gonna be easy to take care of and I'm not saying you're gonna win every time. But what I am saying is it opens up a completely new portal of individuals, a completely new group of people that probably have never even considered chiropractic care in the past. So only one of the studies graded low back pain severity and incorporated severity into their regression models. This study demonstrated that long term opioid use, one or more years was significantly lower for those who saw a chiropractor as a first provider for low back pain compared with individuals who initially saw other provider types after adjusting for severity, baseline pain and function. So does seeing a chiropractor first help in not getting prescribed an opioid? Absolutely. Is it a mandatory to getting the result of not getting an opioid, so to speak? Absolutely not. You can see a variety of different care providers and if chiropractors on your team, there's gonna be a significant negative correlation between your care and between the use of opioids. So these research found. In conclusion, this systematic review demonstrated an inverse association between chiropractic use and opioid receipt amongst patients with spinal pain. Overall, chiropractic users had a 64% lower odds of receiving an opioid prescription than non users who. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use. Now let's break that down one more time. 64%. That's a huge number. That's an impactful and meaningful number. That's something we need to keep in mind. What they say at the end of that last paragraph is especially interesting. This is not only about opioid avoidance, this could be about getting off opioids that is an area where I'm exceptionally interested, keen to see and excited where we as chiropractors can provide a portal not only for people to never get on these dangerous, risky, deadly medications to begin with, but also to be able to offer them hope and to be able to offer those individuals who are struggling with opioid addiction, these individuals that have had chronic pain for years and have taken these medications, escalating from, for year after year after year, being able to be a beacon of hope for those individuals and a real chance at either decreasing or eliminating their use over time is something that I think as chiropractors we should be proud of. We can be proud of and it's something that we should light the torch for in our communities. We should start having conversations with this around and with other healthcare providers in our community now. The story is still yet to be told. We need to see more research, we need to see more results. But what we know to date is unequivocal. Opioids are deadly. It's an epidemic. It's a national and worldwide health crisis in the United States. It's of significant authority and interest. And the secondary component of that is a majority of individuals who end up on these crazy medications are doing so because of neck, mid back, low back pain, radiculopathy and or failed surgery. And that has to be unacceptable for us. Long term clinical guidelines have changed, updated and altered us as chiropractors and the care we provide have become over time, the centerpiece of what's recommended. We need to get out there and have those conversations. We need to get out there and communicate that message to other people in our community. And we need to take action each and every day so we see the results that we're looking for, which is a healthier community, a healthier practice and ultimately, no exaggeration when I say this, saving people's lives. So get out there and have those conversations. One thing to follow up on before we close this out. If you're looking to get factory direct pricing for your braces, tens, units and more, check out shield@supersecretsales.com ebc that's supersecretsales.com ebc Dr. Steven Brown is offering you a compliment. As a listener of this podcast, he's offering you a complimentary shield, tens and E stim unit for free, plus free shipping with your first order. He has fast shipping, they have factory direct pricing and a great selection of products are available right now@supersecretsales.com EBC take advantage of his being super nice to you. He's going to give you free shipping, he's going to give you factory direct pricing, and he's going to hook you up with that TENS and ESDIM unit. As long as you place your first order soon. So be sure to head over there and do so. I'll drop that link in the show notes below and we are super close to 200 reviews of this podcast on itunes. If you would be so kind, scroll on down, leave us some feedback, a rating or a review that helps more and more docs find out about this podcast each and every week. I thank you for tuning in and listening. I love doing this. We are approaching 200 and I don't even know. I think we're over 275 episodes right now. It's been a blast over half a decade, which is completely crazy to think of, but we're going to continue to go strong. Any feedback you have about this podcast, hit me up jeff@the evidencebasechiropractor.com and keep an eye out in the Smart Chiropractor land. We're having open enrollment go on right now with the Smart Chiropractor. 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