283- The Impact of Chiropractic Care on Opioid Use

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 Langme. This week we are back with the research. This is a fantastic study that came out in 2020. It is all about opioids and how chiropractic care can affect dramatically affect their utilization. This is a study you're gonna want to know about, you're gonna wanna learn about and you're gonna wanna talk about in your community. I'm gonna break down everything you need to know on today's episode. But before we dive in, I wanna say a few words about the smart chiropractor from your chiropractic marketing Hop on a demo at the smart chiropractor we recently added in Google My business auto posting. I was checking out our stats the other day and we had one doc who received 240 phone calls from his Google my business listing over the last 30 days. So if you would like to optimize all of your email marketing, actually get email marketing going. Many docs don't really have any email marketing going on. We'll automate all of that for you. All your automated social posting, video streaming, Facebook, Instagram, YouTube, now Google my business we can help you get more from what you're currently doing. Help your website work better by getting a pop up box on there that ties directly into Cairo emails. Check it all out atthe smart chiropractor.com hop on a demo, see if we can help. But on today's episode we are talking research. Title of this study is impact of Chiropractic care on use of Prescription Opioids in Patients with Spinal Pain. That's a pretty darn good title. Cause that just about says it all. How does chiropractic care impact the use of prescription opioids in people that have spine pain? So you wanna talk about relevance? This is a 10 out of 10. It came out in pain medicine in 2020. There's a host of authors on this including Jay Greenstein. Jay's a friend of mine. I saw him just last week in Austin, Texas for a mastermind group. So I love to see his name getting out there on additional studies. Bottom line is we know opioids are a big deal. They have continued to be. We've talked about it in this podcast in the past. It's estimated over 135 people die each and every day, each and every day due to opioids. And here's the thing, a lot of that comes down to opioids that were originally prescribed for pain relief. So this is not necessarily. It's a minority percentage, by what I've seen, that is illic people looking to get high. A lot of this comes down to people get addicted. The addiction rates on these things are astronomical. Won't belabor the point on it. But 135 deaths per day is a big deal. And this didn't start yesterday. It's been going on for years upon years upon years. And it's something that continues to be a challenge. It's something that has not been solved. And incidentally, it's something that's gotten worse over the last year, if we just call it what it was. I've seen some preliminary research come out that pretty much all of the gains we've seen in the last 2018, 2019, a lot of people are talking about opioids. Oh, a lot of these guidelines are changing. We'll talk about some of those guidelines on today's episode. But there was positive progress being made. Not nearly enough, but there was at least positive progress. Well, let's just wipe the table off, because all of that positive progress was eliminated last year with what's gone on in the pandemic. People were isolated, people were at home. People were not out there getting care. In some states, in some countries, they weren't even able to get conservative healthcare. They had to stay home. This is a big deal. And all of the gains. And I have a feeling that as the numbers trickle out, I'm interested to see how these numbers. One number is a fact and two numbers is a story. So I'm interested to see how much of a story is told around this, because the numbers, I have a feeling when they finally come out, as far as opioid deaths, how that ties, in my opinion, in some ways to suicide deaths. All these things that have gone on over the last year and all of the changes and challenges that have occurred due to this pandemic, we're going to see these things skyrocket up. And the numbers that we see from 2020, they're not going to be pretty and they're not going to go away this year in 2021 unless we make positive changes. How do we start that? By knowing the research, by being able to have great conversations and being able to talk intelligently about the topic. If not, it's difficult to persuade it's difficult to influence, it's difficult to get anybody to pay attention if you're not able to articulate what's actually going on so well, the trouble started even before 2020. So this study cites that drug overdose deaths in 2017 increased by 10% over 2016, with opioids accounting for almost 48,000 deaths. And that was a couple years back. So we also know, as we've touched on, the Institute of Medicine and amongst many other organizations have recommended the use of non pharmacological therapies and as effective alternatives for patients with chronic musculoskeletal pain. We see this time and time again, but the actions just don't line up. That's that discord between what's being said and what's being done. Among U.S. adults prescribed opioids, 59% reported having back pain. 59%. So people taking op, a majority, let's just say what it is. A majority of individuals taking opioids reported having back pain. That's a high correlation and that's something that we can make an impact in. Imagine making a dent in 5 to 10% of that. I'd love to make a dent in 50 to 100% of that, but imagine a 5 to 10% swing. When we look at 48,000 deaths, that's a 10% swing, is 5,000 less deaths. That should be easily attainable as we get out there and have good conversations. So this research paper goes on to state, as we kind of talked about, hey, American College of Physicians, amongst a host of other, have recommended and recently published clinical guidelines. So not only recommended, but they've published clinical guidelines saying, hey, non pharmacological treatment should be the first line approach to treating back pain. If you are reaching for opioids as a first line treatment, it's borderline malpractice in my opinion. It just should not be happening. There's no guidelines that support it. The effectiveness isn't there, the addiction rate is high. It is if we wanna talk about Hippocratic oath, do no harm. It's about the most harmful thing that can occur. So this is a big deal and it's something that we need to keep an eye on. So there's been a whole bunch of studies around this topic over the last few years, some of which we touched on and here's a couple highlights from of those studies. A retrospective claims study of nearly 170,000 adults diagnosed with low back pain found that utilization of services delivered by DCs was associated with a reduced use of Opioids. So it's great. 170,000 people is no small sample size. And if they saw a chiropractor, they had reduced utilization of opioids. Makes a heck of a lot of sense. There's also a COHORT study. Nearly 2,000 patients with a new episode of neck pain who received DC care had decreased odds of being prescribed opioids within one year. So not only was this, and this is an important point that we're going to dive into further in this study, it lasted, the effects lasted. 2000 people with neck pain that go in to see a chiropractor, they had less reduced usage over a year. So therefore it wasn't just, oh, the chiropractor was great while I was there and three months later the pain came back and I went, no, this has depth to it, it has length to it. When people receive the care that we deliver, this is an important part of breaking the chronic pain cycle as well as that cannot be overstated. They also found a 2018 report study conducted amongst over nearly 15,000, a little bit over 14,000 veterans. And the percentage of patients who received opioid prescriptions was lower after receiving DC care for low back pain as compared with before. Also in 2018, health insurance claims for treatment of low back pain in New Hampshire found a 55% reduction in the likelihood of opioid prescription fill amongst recipients of chiropractic. So people that received chiropractic care, 55% reduction. That is substantial. I talked about at the top, imagine if we could make a 5 to 10% dent. Well, man, we can make a heck of a lot bigger dent than that. But again, we need to know how to utilize these papers. We need to have that information, we need to have that education all around it. So this study, they looked at health claims from the year 2012 to 2017. This study looked at adults between 18 and 84 years old enrolled in a health plan and with they had office visits to a primary career physician and or a dc. So they've kind of broke people down to recipients and non recipients. Recipients of chiropractic services had primary care and chiropractic care. Non recipients received primary care but no chiropractic care. So that was sort of the breakdown of individuals. The total subjects in this study, kind of drum roll please here. Total subjects, over 100,000 charts were analyzed. So there was a ton of data looked at and the data ended up being very favorable to what we do as chiropractors. Here was the conclusion that they found analyzing Claims from over a five year period. Analyzing over 100,000 individuals, this study concluded, quote, among patients with spinal pain disorders for recipients of chiropractic care, the risk of filling a prescription for an opioid analgesic over a six year period was reduced by half as compared with non recipients. Among those who saw a chiropractor within 30 days of being diagnosed with spinal pain disorder, the reduction in risk was greater compared to those who received a chiropractor after the acute phase had passed. Wow, lot to dive into there and a lot of fantastic stuff. So number one, we see a six year period cut in half. So this blows that New Hampshire study of one year out of the water or six months out of the water. This is saying, man, if you received chiropractic care in addition to primary care, you literally cut your opioid prescription utilization risk or rate of filling one by half over a six, over more than a half a decade period. So you want to talk about longevity of results, about changing behavior ultimately in how people receive their healthcare. I'm sure some of those individuals who received chiropractic care still had pain five and six years on. That's just the facts when you look at 100,000 individuals, but they weren't reaching for the bottle. That's an extremely important point of all of this. And I think us as chiropractors, I know I was biased to this early in my career thinking like, man, if a patient's in 8 out of 10 pain, I don't know if I can get them to a 0 out of 10 or a 1 out of 10 every time. They might still read. You can't think that way. Many times these individuals who are 8 out of 10, if you get them down to a 4 out of 10, they're not gonna need or want or desire to take opioids. The pain is manageable at that point. So not everything needs to go to zero. I talked about this before on this podcast. I work with surgeons and they're like, man, a great result in surgery is reduction of pain by 30%. So that's a 10 out of 10 out of 10. Pain going down to 7, that's a 7 out of 10. Pain going down to like a 5. Like, you know, they're not shooting, you know, they're not exactly shooting for the moon. Many times they're looking for a 30% reduction. Like, that's a huge win in us as chiropractors. I think we outperform that many times, but often we get blinded and biased. I Talked to docs early on that use the evidence based chiropractor program, building relationships and it's like, man, if I'm setting this goal is a, if I only say that I'm expecting a 25% reduction, is the MD going to be upset and pull the patient away from me? It's like, no, you know, you just got to make an impact is the most important point. So bring it back to this study. A six year period, some of these people are still going to have pain, but they're not reaching for opioids. That's a fundamental shift in utilization by over 50%. That is incredible. The other interesting point of this is the second half of what I said. Among those people who saw a chiropractor within 30 days of being diagnosed, they had a greater reduction in the risk. So what does that mean? Let's peel it back to the first two to three minutes of this podcast. That means chiropractors need to be a first line treatment. That means you do not want to wait. That means that based upon the guidelines, these referrals should be being made. And people in your community, even without a referral, should be thinking about coming into your practice first. Because the longer they wait to do so, the more likely they are to fill an opioid prescription. Which makes sense. I mean, it's not rocket science to think that, but it's important to enact habits in your practice that support that. So the question I say to you is, if you're not a member of the Smart chiropractor, what are you doing to get out there and tell that story each and every day? You need to teach and invite consistently. Are you teaching every day across your social channels? Are you teaching weekly through a email newsletter? Are you teaching through Google My business, through Instagram, through Facebook, through YouTube? And are you inviting people your call to action, inviting them to come into the practice, teach and invite consistently? Are you doing it consistently? One post a week, two posts a week, 15 posts a month to one platform ain't gonna do it. So are you getting out there and teaching and inviting consistently? Do people know you are the best, the most recommended, the most highly efficacious way to take care of chronic musculoskeletal pain? I know with the Smart Chiropractor we devote a month, each and every year we have a monthly campaign devoted specifically towards opioids because we know this is a huge pain point, quite literally and figuratively for people out there. But also this is an easy story to tell, but you have to tell it. You can't expect people to find this information out on their own. So I hope this was super valuable. I'll link the paper down below. I want to finish up by talking just for a moment about Cairo Matchmakers. If you are looking for a associate doctor if you are an associate doctor to be if you're looking for a job, we actually have over 100 jobs available right now with salaries that are 80,000, 85,000, $90,000 and above. Yes you did. You heard me correctly. Head over to chiromatchmakers.com we are always looking for talent. We have a ton of demand for chiropractors, which is almost weird to say. Most chiropractors don't believe that's the case, but we have a hundred jobs open, many of them paying close to six figures. Head over to ChiroMatchmakers.com or if you are looking for an associate, if you and or temporary coverage as an owner, we're happy to help you as well. Chiromatchmakers.com, head over there and check it out. I hope you have a fantastic week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.

Sam.