Chiropractic Care's Role in Combating the Opioid Epidemic | Podcast Ep. 317

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode we're back at it with the research and this was a special commentary that was released literally just a few weeks ago at the end of last year and it is around. Can chiropractic and spinal manipulation tackle the opioid epidemic? This is a question that has been asked multiple times and there is a ton of take home messages, clinical pearls, you name it. This special commentary in today's episode are going to have some nuggets of truth that you're gonna wanna pay attention to and that you can utilize as you communicate with patients, as you communicate online, as you communicate with other providers in your community. So I'm pumped about this one. Even though it is a tragic tale, it is something that we can make a huge impact on and in. And we'll talk about that on today's episode before we get started. This episode is brought to you by the Smart Chiropractor. The smart chiropractor powers your patient journey to provide you with more qualified leads, more new patients, better retention, consistent reactivations without spending any money on advertising. That's right. If you're on my email list or you follow me on social media, you probably know that I'm a co founder of the Smart Chiropractor. And last year alone we just pulled some of our stats. It was absolutely incredible. 52 million social impressions over 35, excuse me, 350,000 qualified leads, tens of thousands of appointments added to our Smart Chiropractor members calendars as a result of automating, teaching and inviting consistently and tackling those huge, huge hurdles of email marketing, social marketing and video streaming. So check it all out atthe smart chiropractor.com but on today's episode we're talking about a special commentary. It was titled, it is titled increased utilization of spinal manipulation by Chiropractors to tackle the Opioid Epidemic. I'm gonna drop a link to it down in the show notes as always and this is a good one. It came out in quote unquote, medical Care. That's a journal in December of 2021. Now we're gonna talk and tackle a lot of statistics on today's episode. But here is one. These individuals who wrote this paper didn't have the advantage of knowing, and that's I recently saw, when I say recently, I mean in the last 24 hours, that in 2021 there were nearly 100,000 drug overdose deaths in the United States, that is a ton. We also know that that's over a 30% increase from the year before. And those are big numbers. We've talked about it a couple times in this podcast where during the pandemic of the last couple years, all of the gains on the war on opioids have been totally wiped out. And we're seeing the stats start to come in and they're harrowing. When we see 100,000 individuals dying due to drug overdose, a majority of them are in the opioid realm and a majority of them started with prescribed medication from physicians, they. That is a huge issue. How many people are talking about it? Almost nobody to clearly not enough. Because when we were at that level with what's gone on the last couple years, it was red flags, lockdowns, et cetera. And now we're seeing opioids take out tens of thousands of individuals years after, you know, medical guidelines have changed, years after all of these things have changed, and, and it's only gotten worse. So that's the bad news. Now the good news about that is, as we'll discover with this paper, you and I, as chiropractors can make a really, really big difference in our communities. And if all of us make a big difference in our communities, that impacts essentially the country and impacts ultimately the world. But there's a lot of information that needs to be pushed forward. There's a lot of conversations that need to happen, and there's a lot of responsibility that resides with you and I to get out there, to tell the story, to, to consistently communicate with our communities and with other healthcare providers. And without that, nothing's gonna change. So let's dive into this study today. So, you know, in response to what's gone on over the last 10 to 20 years, over half the states in the country have made legislative changes limiting the quantity and duration of opioids for acute pain. Why that's not 100% of states is wildly beyond me, but half of states is certainly better than zero. We've also seen the American College of Physicians, we've seen a lot of these large healthcare organizations recommend spinal manipulation as part of a non pharmacological first line treatment for low back pain that began in 2017 if we trace that back. So it's been almost half a decade. It has been half a decade now, and yet we're still seeing more deaths than ever. So that's an important foundational component, but it's not gonna change things on its own. So we're, we also know that from 2017 to 2018, there's a 13% decrease in prescription opioid involved deaths. Now, as we just talked about a moment ago, that's totally changed, but there was progress being made. There also was a decreased amount dispensed. So we basically had the rate of opioids dispensed decrease from 72.4 to 46.7 per 100 people from 2006 to 2019. So that's a big deal as well. That's almost a halving. But despite that progress, prescription opioids were associated with 28% of opioid related overdose deaths in 2019. So when we look at these numbers and we're seeing, you know, 100,000 deaths just last year, you know, due to drug overdoses, a significant portion of them are opioid related and a significant portion of them are prescription opioids, and many, many more started with prescription opioids. So big deal, chronic pain. And this is no surprise when you just look at the data. We know tens of millions of individuals, like 30 to 50% of the population is dealing with chronic pain. We also know a certain percentage of population has acute injuries. Now, these medications should not be prescribed in many of those cases. But, you know, many of these primary care physicians in our community, we also see it with other types of physicians as well. They're either stuck in their ways, they're late to the party, or they're just a little bit apathetic to really changing who they are and what they do. And it's killing people. And, you know, us getting out there again, telling our story, building those relationships to other healthcare professionals, as we'll talk about later on today's episode, as well as to the public, critically important. So what's the case for spinal manipulation? Systematic reviews and meta analysis of 26 randomized clinical trials. You, you know, and 47 randomized trials for SMT for low back pain specifically found that spinal manipulation performed by chiropractors, physical therapists, other providers is safe and associated with improvements in pain and function. Now, I always look at that and I say, well, when you take studies and it's done by a chiropractor, the adjustment and by physical therapists and other providers, I tend to hedge, and I still say this, there are great adjusters in the chiropractic profession, not so great adjusters, same in the physical therapy realm. But we are the only profession that is really coached up and trained on adjusting the spine and adjusting extremities for that matter. So if these studies only had chiropractors I suspect the improvements in pain and function would even be better due to the fact that we have such a high skill level at it. And that's undeniable. So important to keep in mind. In 2020, there was a study that demonstrated. It was a retrospective cohort study of over 100,000 patients. We talked about this study on this PODC treated by a chiropractor and primary care physician for spinal pain. And it cut in half the risk of filling an opioid prescription compared to those who saw the primary physician alone. It literally cut it in half just by seeing the chiropractor. Why? Well, some of that is improvement in pain and function. Other it's patient education, patient encouragement. You spend 20 seconds with a primary care physician and get the script. The that's a lot different than going to a chiropractor, getting hands on care, perhaps doing some exercise in rehab, feeling as though there is light at the end of the tunnel and that light is not going to the pharmacy to fill a prescription. Incredibly important. Dramatically underestimated. There was also a recent review in Meta analysis found patients treated for spinal back pain with chiropractic services had a 64% lower odds of being treated with opioids than patients not seen by a chiropractor. And to be clear, this is not just because chiropractors don't prescribe medication. This is because when we look at it, it goes out longitudinal. So people that even when they're having issues down the road, they're not going that direction. Why? Because they experience chiropractic care. Maybe they go back to the chiropractor. Perhaps they know there's a great chance that they can get over the pain through movement, not through prescriptions. All of those items play a role and all of these result in the fact that you and I as chiropractors are so needed in this epidemic. So what are some of the challenges in this commentary? They looked at demographics and I just wanted to point this out because it is important. In 2006, it was estimated that 92% of chiropractic patients were white and only 3.7% were black. And I think that that's an important component when, when we look at who's utilizing chiropractic, and especially in your practice, and getting out there potentially to other segments of the population in your community that might not utilize chiropractic is a really good idea. Whether that's donating your time, whether that's making connections, whatever it might be, I'm gonna Encourage you to just think about that stat. I don't have a direct action step that you can take today regarding it, but that's a big deal and it shouldn't be that disproportionate. So think about how you can get out there, maybe to other segments of the population, other demographics in your community that you're not necessarily making an impact with today. I think that's a great thing for all of us to think about as we head through this year. So what are some of the other challenges? Insurance coverage is just an elephant in the room. We know the challenges with Medicare bottom line is that physical therapy is frequently and consistently regarded as medically necessary for low back pain by insurance policies. And yet in a study that was recently done, chiropractic services were determined medically necessary by 50% of healthcare insurance companies. And of course we have our lovely Medicare and Medicaid where you're unable to perform an examination that makes a lot of sense, but you are able to provide care and treatment, although exceptionally limited. And these are big time hindrances. And this stuff just needs to change. Now is it changing a little bit? We see United Healthcare recently brought out a new policy where people who see a chiropractor as their first contact for low back pain are billed 0 bucks out of pocket for the first three visits. Now is that life changing? No. But is that a step in the right direction? Absolutely. So there is a little bit of change going on, There is a little bit of hope on the insurance coverage front, but those things take an eon of time. They are all about compromise and I wouldn't hold your breath for it. It really is the responsibility of I to get out there and have these conversations. So what is one way you can do it? As they point out in this commentary, Give the old drumroll here. Drum roll please. Increasing provider referrals to chiropractors and improving collaboration amongst treating providers. So most of what happens right now, chiropractors rely heavily on patient self referral or patient intra referral, so to speak. One patient refers another patient very few of us. This has been the focus of the evidence based chiropractor for over a decade and we've helped thousands of chiropractors at this point in time generate hundreds of thousands of visits and referrals into their practice by having a very step by step systematic approach. So if you haven't checked out, I'm not gonna pitch you on it, but if you haven't checked out the evidence based chiropractor service and you are interested in building relationships with other healthcare providers, you're gonna waste a ton of time, effort and energy. Literally one patient referred in per year is gonna double your roi. So it's just a system that works and you need a system to get results. So that's a huge area that's continued to talk about. So many chiropractors are not really taking advantage of building referral relationships with other healthcare providers. And it's gonna be one of those things where those docs that do it today are gonna look back five and ten years from now and have a stable practice, referral based, built off of that referral. Those referral systems and those that don't are gonna be on the outside looking in. So just something to throw out there. So what's another great thing that's happening? It's over 150 VA healthcare facilities now offer chiropractic services. So we see more and more chiropractors, you know, in VA systems, in large multidisciplinary systems, in hospital based systems. It's probably, you know, it might be approaching even a thousand chiropractors at this point in time. Ten years ago, when I joined my first multidisciplinary group, I think I was one of 20 chiropractors in the world working in a true multidisciplinary setting in a traditional orthopedic group. Now those opportunities are comparatively abundant and they're out there. So I think there's been a lot of progress made in some of these, you know, American College of Physicians changing their recommendations, you know, seeing what's gone on. While it hasn't changed the tide at the practical patient level, overwhelmingly at this point, you start to see it really taking effect. It in some of these groups. And some of these groups look towards those large healthcare groups and organizations and those recommendations to determine how are we gonna staff, how are we gonna go through our patient journey, how are we going about the business of healthcare? And they're more open to chiropractic now than ever before. And again, clearly you don't need to work in one of those facilities to be able to make an impact and to create revenue and help people. You can be a referral partner of facilities that don't have chiropractic services in house, which are a majority, of course, and that could be a great way to build your practice, to get in there and to make a difference and an impact. So there was a lot of stats on today's episode, so feel free, you know, check out the paper. I'll Drop the link in the show notes, rewind this episode, take a few of those stats and clinical pearls and get out there and start some conversations. Whether that's again shooting a Facebook Live or an Instagram video creating a post. If you want that done automatically, that's what we have a smart chiropractor for. If you are getting out there and building referral relationships and getting out and having having conversations with other healthcare providers about what they do with patients with chronic low back pain with acute low back pain, that's what the evidence based Chiropractor is for. But this podcast is to empower you to have the knowledge. If you wanna get out there and start to do some of it on your own, please do. It's important. It's needed. You can make an impact in your community and people need you now more than ever. There is no question about that. Before we wrap up, I'll say a few words about Cairo Matchmakers. If you are looking to build and grow your team in 2022, visit chiromatchmakers.com whether you are an owner of a practice looking to bring on talent. We go through a completely unique system that's utilized really by large healthcare organizations. Nobody else in chiropractic to do assessments before placements. What does that mean? That means your associates stay longer, less churn, more happy, better results. Now if you are an associate looking for your next career opportunity, we have over 100 open jobs right now paying $85,000 plus base sales salary. So please head over to chirometrymakers.com, look for that next fantastic opportunity. We have literally over 100 jobs available throughout the United States and beyond, so be sure to check that out. And most of all, 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.