512- Chiropractic Adjustments Cut Opioid Addiction Risk by 80 Percent for Low Back Pain Patients

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. On today's episode, we are back with more brand new research. Another fantastic study, this one all about chiropractic adjustments and the decrease in opioid use. A lot of take home messages here, a lot of conversational messages that you probably can and should be having. Social channels email knee to knee with your patients. Gonna dive into this study and highlight all of that and more. Before I get started, I wanna say a few words about Neckcare, the best combination of hardware and software for cervical assessments, bar none. You can check em out@neckcare.com and as a listener to this podcast, gonna hook you up with 10% off. So connect with their team, learn more about how neck care can improve the cervical spine assessments that you are doing in practice today. But as I said at the top, we're talking research today and the title is association between Spinal Manipulative Therapy for Low Back Pain with and Without Sciatica, An Opioid Use Disorder. This is a retrospective cohort study, came out in 2025. I'm gonna kick this one off with a very simple question. What if one of the most simple choices that your patients made when they first heard hurt their lumbar spine, their back could be to cut their risk of developing an opioid addiction by 80%? No, that is not hype. No, that is not hyperbole. That is the real world implications of this study and why I'm breaking it down today. And really the best part of all of this is that this centers on you and it centers on what you do, and it centers on the hallmark of what you do and what you probably are more skilled at than anybody else on planet earth, which is adjusting their spine. So over the next 10, 15 minutes, we're gonna dive into this study showcasing how choosing chiropractic care first doesn't just help back pain. It actually protects patients from something way more dangerous, and that is opioid use disorders. Now, this study, as I said, was published in 2025 in Health Science Reports and the question that the researchers were looking to answer is, is a really critical one. That question was, does receiving spinal manipulative therapy for new low back pain reduce the risk of developing opioid use disorders compared to a first line prescription like ibuprofen. Now this is a really big deal. And why this question? Well, we know opioids are still being prescribed far too often for low back pain. And even though all the evidence shows they don't work any better than exercise or in some cases even a heating pad, yet opioids carry massive risks, as you're also probably aware of. Addiction, overdose, long term dependence, all of this is really critical. And why? Because you probably have heard me say this before, but I'm going to say it again because it's this important. There were strides made in reducing opioid prescriptions prior to the pandemic. Once people were unable to go get conservative care and in some states they weren't. Depending on what state you're listening to is in, you might say, oh, it didn't affect my practice that much. Other of you might be saying, my practice was closed like zero patients for months on end. So it was highly varied. But let me cut to the chase. The bottom line is all studies showcase all of the gains previous to the pandemic in reducing opioids during the pandemic were blown out. It got worse than where we were 10 or 15 years ago. It wasn't even like break even. It's worse now than it ever has been. Now, as you probably have again heard me say, I believe the physicians prescribing this for non cancer related pain and very few other exceptions absolutely should come up against some sort of law, for lack of a better way to say it. Why? Because at the very bare minimum, you're taking a Hippocratic oath of do no harm. So thereby prescribing opioids specifically for spinal related conditions that are non cancer related and non terminal is completely against that oath. Secondarily, the harms are so clear and the results are so A plus B equals C that it's amazing to me that there is absolutely to date, no recourse. The only recourse you see are on these pill mills and they're usually quite frankly taken up on tax evasion charges because they're making so much money they're putting money in other places. It's very rare that they're actually being held up against the coals because of what they're doing in the medical world. So I really think that needs to change. Why? Because of what we talk about over 500 episodes in a decade on this podcast, which is the research showcases that's hurting people. It's not helping them at all in any meaningful way, with almost zero exception. So the Fact that there are doctors literally in your town right now, I don't care where you're listening. People in your town are prescribing opioids for spinal related conditions for people who should be into your practice. That is a massive problem. And hopefully some of the information you gain today can help you start to say, well, maybe, maybe I'll change that just a little bit. Because for every life, every person that comes into your practice, as we're gonna see in this study, you're making a massively meaningful difference in their avoidance of going down that dangerous path. So prior studies have already showed that patients seeing a chiropractor are far less likely to get an opioid prescription. But the big unknown is what is that actually, does it actually translate into lower addiction risk down the road? And that's really what this study set out to answer. So if we're going to dive into key findings and stats, there's a headline, right? And that headline is patients who received chiropractic adjustments for new episodes of low back pain were dramatically, dramatically less likely to develop opioid use disorder compared to patients that were prescribed ibuprofen. Probably not a shocker to you, but let's hit some of these numbers. Opioid use disorders, about a quarter of a percent, 0.24% of patients in the chiropractic group versus over 1.5% of people in the ibuprofen group went on to develop opioid use disorder. So you went from over 1.5% if you took an ibuprofen. If you're taking ibuprofen right off the bat, it is a 1.5% chance you are going to end up with an opioid use disorder down the road. That's not an insignificant percentage. That, that's wild to me. That's like over one out of every 10 people. If you received Chiropractic Care First SMT group, it was literally, you know, less than, less, you know, less than one quarter out of one person out of 10, a quarter percent. So that's a risk ratio of 0.20, meaning chiropractic patients were 80% less likely. Let me say that again. 80%, 80% less likely to develop an opioid use disorder. Does it matter who you see first in this care algorithm? It absolutely does. Now let's talk about long term opioid use. It's different than opioid use disorder, and that's 90 plus days. This was 1.85% of individuals in the ibuprofen group, 0.42% in the chiropractic group. It's again a 77% lower risk for the chiropractic group compared to the ibuprofen group. And if we just go say any opioid prescription, we were looking at 45% of ibuprofen patients got an opioid prescription, less than 31% of SMT patients, chiropractic patients. So it's a 31% relative reduction. That is really, really meaningful. So the mean number of opioid prescriptions will go one step farther. SMT patient, one per person, ibuprofen patient over two per person. So that's more than double, double the number of mean opioid prescriptions. The mean number, I should say, of opioid prescriptions for the non chiropractic group. So to me, these numbers are staggering. We are looking at 80, 80% reduction, 77% reduction, 30% reduction, half the number of prescriptions. This is massive. And this is the, this, these are one of those stats where I just think about literally the individual people that are coming into your practice this week as new patients. And I know we see this so often. Okay, patient coming in with sciatica. What else is new? Right. It's not exactly, probably the most exciting moment of your day, but you're literally changing the life of that individual. Why? Because just the fact that they've walked into your practice, especially if you're the practice that they walked into first, you've just changed their life. You haven't even touched them, spoken with them or done anything yet. The fact that they're gonna receive your career is a dramatic difference. Think of like where the twig of the tree grows, right? Where does that road lead? How does the decision I make today affect where I end up later? And the decision to come into your practice is probably one of the most meaningful decisions that they can make, that they have no clue that they just made such a meaningful decision. And if you're not emphasizing this, I don't mean to go overboard, obviously, but if you're not emphasizing this and letting them know, they're never going to have a clue. And by letting them know, it gives them the opportunity to tell their story. And we'll talk about this more as we get into patient discussion. So what's the big picture here? Well, across the board, of course, the chiropractic pathway meant fewer prescriptions, less long term use, and a far less risk of addiction. So if we unpack this a little bit further, the researchers looked at nearly 25,000 patients in each group after matching them on risk factors like age, you know, prior medication use, mood disorders, socioeconomic factors. So this wasn't like a sloppy comparison. This was really carefully designed study to compare apples to apples. And the risk of opioid use was, it wasn't small, it was massive. And we'll put it this way. For every 100,000 patients that they followed over two years, 122 chiropractic patients developed opioid use disorder. 756 ibuprofen patients developed opioid use disorder. Two. That is literally hundreds of people spared from what I'll safely say are devastating and life altering effects. And it's just by starting with the adjustment that you deliver instead of a pill like ibuprofen. So it, you know, now obviously we don't prescribe opioids, so part of this effect is our ability to steer patients into a drug free care pathway. Massively important by the way. But the researchers suggest it's not just avoiding it, it's that what you do works. We provide meaningful relief and it reduces the need for patients to seek medications in the first place. So how does this impact your practice? In a few different ways. One, public health impact. Opioid use disorder is a big time chronic and it's a relapsing disease and it devastates the lives of those individuals and the families around them. So if what you do, if chiropractic can play a role in that prevention, I think it's huge. Not just for our profession, but for your community. Secondarily, we talk about clinical confidence. You can and should feel super confident telling your patients and other providers and payers that chiropractic care isn't just safe and effective for back pain. It may literally save the lives of individuals in your community by lowering the risk of opioids and then practice differentiation. Healthcare marketplace super crowded. And this gives you a really powerful way to differentiate yourself. You're not just taking care of pain, you are providing an opioid sparing guideline, recommended first line solution. So if we pull this out and say, okay, what are some one liners to use with patients? I think it's just again, keeping it simple. Hey, you know, starting with chiropractic care for back pain can reduce the chance of needing a strong medication down the road. Really simple, hey, research shows the people who see a chiropractor first are 80% less likely to ever develop an opioid issue. That's powerful. That's a great headline for Real, by the way. And a great headline for a subject line. For an email. We might be using that one internally with Patient Pilot. And additionally, hey, our goal is to help your back heal naturally without those devastating risks that come with opioid prescriptions. And by coming into our practice you are making a meaningful step in that direction. So you can keep this stuff like really simple, keep it really relatable and focus on the benefits to your patients. They don't necessarily need to know the risk ratios. I still have difficulty reading those. But hey, 80% lower chance that is something that is meaningful. So you can talk about this in your report of findings. You know, when you're discussing care plans, highlighting that chiropractic care isn't just about pain relief, it's about avoiding medication use down the road. You can use this of course, as we've discussed in your marketing and education, sharing this on social media, using it in your email newsletters, letting people know chiropractic care has been shown to cut the opioid addiction risk by 80%. That is a massively powerful headline. Referral Conversations of course this is going to go in with MD Connection. So those docs out there that are on MD Connection building other referral relationships with healthcare providers in the community. If you're not, hop on board. What are you doing out there? It's amazing to me the amount of docs that listen to this podcast each and every week that have never joined MD Connection and MD Connection. To be clear, it's about other healthcare providers. I don't care whether it's an md, a do, a midwife, a doula, sports medicine doc, whatever it might be. From a credential perspective, if you want to build referral relationships with other healthcare providers and stop doing all the heavy lifting on getting every new patient into your practice on your own by MD Connection is the best program out there. I'll just say it and then reactivation campaigns as well. So reminding your inactive patients that staying consistent with their care is not just about their back, they it's about protecting their overall health and reducing long term risk. So I loved this study. I thought it was massively powerful. The headlines are super strong and this is something that is a great story to tell not only on this podcast, but hopefully for you to take it and run with it in your community. Now before we wrap up, I also wanna say a few words about Leander Tables. They're hook you up with $1,000 off their series 950, which is awesome. By being a listener to this podcast save $1,000 off a brand new flexion extension table. You can grab that over at Leander Tables and I'll drop a link down in the show notes, connect to the team, ask them questions I know they're happy to answer, and by mentioning you are a listener of this podcast, they're happy to hook you up with that discount. So thank you. Whether it's your first week or whether you've been along for the 10 year 500 episode plus journey, thank you so much for tuning into this podcast. If you'd leave a rating or review, that's my big ask today. Leave a rating or review. That would help us reach more and more people. Deeply appreciate it. Thank you so much for being a chiropractor. Thank you for making a difference in your community. 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.