The Ongoing Opioid Crisis in Tennessee and How Chiropractic Can Help

The opioid epidemic is still on the news, in the papers, and all over social media – the discussion continues as we learn more about its impact. While there have been efforts to increase awareness, enact legislation, and even legal implications since 2013, when the U.S. Department of Health and Human Services declared the misuse of prescription opioids an epidemic and since 2017, when the opioid epidemic was declared a national public health emergency, it remains a national crisis.

According to data from GoodRx, an online prescription cost service, Americans fill over 4 BILLION prescriptions a year.  The company assessed the top drugs prescribed in each state from March 2017 to February 2018.  This revealed that in 10 states, 4 of which border Tennessee, the most prescribed drugs are opioid pain pills.  However, for TN, the most prescribed drug is Suboxone, a drug used to treat opioid addiction.  As of November, 2021, Hydrocodone / Acetaminophen remains the 10th most taken prescription drug in the US.

In Tennessee, the publicity, preventative policies and regulations, and educational actions that have been taken by various groups across the state, including the TCA, and the nation have made a significant impact.

The TN Department of Health maintains the Tennessee Drug Overdose Dashboard to make available the most current “state, regional, and county level data on fatal overdoses, nonfatal overdoses and drug prescribing.”  According to this tool, there were 4,330,771 opioid painkiller prescriptions written in 2022.  While this is significantly down from over 6 million in 2018, it is still enough for just over 60% of all Tennesseans (birth to the elderly) to have an opioid prescription.

There are conditions for which the benefits of opioids are greater than the potential risk.  In those cases, the medications can provide pain relief that other medications and treatment cannot.  But for many types of musculoskeletal pain, there are a number of other treatments – including chiropractic care – that can provide safe, effective pain relief without the high risks associated with prescription opioids.

In fact, the American College of Physicians (ACP) published guidelines in April, 2017 regarding the treatment of acute, subacute, or chronic low back pain, recommending nonpharmacologic treatment first.  When medications are needed, they recommend nonsteroidal anti-inflammatory drugs and suggest opioids only be considered when other treatments have failed.   The ACP guidelines state that for patients with acute or subacute low back pain, “clinicians and patients should select nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation” and “for patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.”

While searching for pain management options at federally subsidized clinics in St. Louis, administrators contacted Logan University (an educational institution offering the doctorate of chiropractic degree among others) and formed a partnership to provide chiropractic care to their patients.  One year later, 80% of the patients who had received chiropractic care had been able to DECREASE their reliance on pain medication.

Richard Shmerling, MD, a faculty editor for the Harvard Health Blog, states: “With the backdrop of the opioid crisis, we badly need an effective, safe, and non-opioid alternative to treat low back pain.” He goes on to reference and summarize one of the more recent research studies, published in the JAMA Network Open in May, 2018. This study reported:

After six weeks of treatment, those assigned to receive chiropractic care:

• reported less pain intensity
• experienced less disability and more improvement in function
• reported higher satisfaction with their treatment
• needed less pain medicine

Shmerling continues: This won’t be — and shouldn’t be — the last study of chiropractic care for low back pain. But until we know more, I’ll continue to offer it as one of many treatment options.”

Additionally, in 2019, the World Health Organization published recommendations to manage low back pain initially with non-pharmaceutical interventions, such as spinal manipulation, while avoiding opioids, spinal injections and surgery.

With over 2000 chiropractors currently licensed to practice in Tennessee, these doctors are ready and available to provide care for patients with neuromusculoskeletal conditions and help manage their pain.  By using chiropractic as a first line treatment for conditions causing bone, muscle and joint pain, many patients may be able to avoid the need for prescription pain medications and thereby the risk of developing opioid addiction altogether.  If medications are needed, your chiropractor can work with your other health care providers to provide treatments which may minimize the need for them, helping reduce the chances of side effects and addiction.

If you or a loved one is experiencing low back pain, or other musculoskeletal issues, talk to your doctor about which treatment options fit your health care needs.  If you do not have a chiropractor, find a TCA member doctor near your home or work here.

REFERENCES:

Chiropractic in Health Clinics Provides Decrease in Opioid Usage https://www.tnchiro.com/articles/chiropractic-in-health-clinics-provides-decrease-in-opioid-usage/

“Graphic: Opioid Painkiller Is Top Prescription In 10 States”  By Jenny Gold March 22, 2018 Kaiser Health News (KHN)   https://khn.org/news/graphic-opioid-painkiller-is-top-prescription-in-10-states/ accessed 9/7/23

“The Opioid Epidemic in TN (1 of 3): Key Policy Milestones and Indicators of Progress” by The Sycamore Institute August 3, 2017   https://www.sycamoreinstitutetn.org/2017/08/03/opioid-epidemic-tn-milestones-progress/ accessed 9/7/23

Tennessee Drug Overdose Dashboard https://www.tn.gov/health/health-program-areas/pdo/pdo/data-dashboard.html accessed 9/7/23

GoodRx.  Top 10 Prescription Medications in the U.S. (November 2021).  https://www.goodrx.com/drug-guide accessed 9/7/23

World Health Organization Highlights Spinal Manipulation for Low Back Pain Over Drugs or Surgery https://www.tnchiro.com/articles/addressing-pain/world-health-organization-highlights-spinal-manipulation-for-low-back-pain-over-drugs-or-surgery/ accessed 9/7/23

Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. JAMA Netw Open. Published online May 18, 20181(1):e180105. doi:10.1001/jamanetworkopen.2018.0105

“Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” published at Annals.org on 14 February 2017.  Accessed 9/9/2023

TN Board of Chiropractic Examiners licensure listing 8/15/2023