T he opioid problem in the United States is real and the prime culprit is prescription opioid pain relievers. Paulozzi. Jones. Mack, and Rudd. in The Centers for Disease Control and Prevention's (CDC) publication. Morbidity and Mortality Weekly Report, on November 4. 2011. state: "In 2007. nearly 100 persons per day died of dnig overdoses in the United States. The death rate of 11.8 per 100.000 population in 2007 was roughly three times the rate in 1991. Prescription dmgs have accounted for most of the increase in those death rates since 1999. In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse or abuse of pliar-maccuticals. compared with 1.0 million ED visits related to use of illicit dmgs such as heroin and cocaine. Prominent among these prescription drug-related deaths and ED visits arc opioid pain relievers (OPR). also known as narcotic or opioid analgesics, a class of dmgs that includes oxycodonc. mcthadonc. and hydrocodonc. among others. OPR now account for more overdose deaths than heroin and cocaine combined." Paulozzi et al. (2011) continued. "In 2008. dnig overdoses in the United States caused 36.450 deaths. OPR were involved in 14.800 deaths (73.8%) of the 20.044 prescription dnig overdose deaths. Death rates varied fivefold by state. States with lower death rates had lower rates of nonmedical use of OPR and OPR sales. During 1999-2008. overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially .... The epidemic of overdoses of OPR has continued to worsen. Wide variation among states in the nonmedical use of OPR and overdose rates cannot be explained by underlying demographic differences in state populations but is related to wide variations in OPR prescribing . . . Health-care providers should only use OPRs in carefully screened and monitored patients when non-OPR treatments arc insufficient to manage pain. Insurers and prescription dnig monitoring programs can identify and take action to reduce both inappropriate and illegal prescribing. Third-part}' payers can limit reimbursement in ways that reduce inappropriate prescribing, discourage efforts to obtain OPR from multiple health-care providers, and improve clinical care. Changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription dnig abuse and overdoses while still allowing safe and effective pain treatment." Organized medicine is now taking a hard look at this "epidemic type" issue and has reached to chiropractic for possible solutions. In 2012. Dr. William Owens, a chiropractor from Buffalo. New York, was conferred as an adjunct associate clinical professor at the State University of New York at Buffalo School of Medicine and Biomcdical Sciences. Family Medical Practice. After working for five years to position himself within the institution. Dr. Owens began teaching the application of chiropractic (via chiropractic referrals) through clinical rotations to family medical residents as well as lecturing to the entire medical school body. As a result, he has been invited to participate in the research department to consider a formal study showing the benefits of faniih practitioners co-managing cases with chiropractors. Although much of the education surrounds chronic conditions and how chiropractic offers treatment options for acute and chronic musculoskelctal conditions and niobilih issues as solutions for cardiac and diabetes, the primary reason for introducing chiropractic to these students is to offer chiropractic care as an acceptable and proven "first-line" choice of referral and possible solution to the opioid epidemic. Cifucntcs. Willcts. and Wasiak (2011) reported in the Journal of Occupational and Environmental Medicine: "In work-related LBP [nonspecific low back pain], the use of health maintenance care provided by physical therapists or physician sen ices was associated with a higher disability recurrence than in chiropractic services or no treatment" (p. 396). They went on to report. "In general... those cases treated by chiropractors consistently tended to have a lower proportion in each of the categories for severity proxy compared to the other groups: fewer used opiates and had surgery. In additioa people who were mostly treated by chiropractor had. on average, less expensive medical sen ices and shorter initial periods of disability than cases treated by other providers" (Cifucntes ct al.. 2011. p. 396). DeBar ct al. (2011) reported that. ". . . recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain despite their high costs, potential adverse effects, and modest efficacy suggests the need to evaluate real world outcomes associated with promising non-pharmacological/ non-surgical CAM [complementary and altcrnativc|treatmcnts for CMP [chronic musculoskclctal pain], which arc often well accepted by patients and increasingly used in the community" (p. 1). DcBarct al. rate chiropractic as one of the most promising, with the highest acceptance by physician groups and the best evidence to support its use. A study by Lcgorrcta (2004) compared more than 1.7 million insured patients looking for treatment for back pain. The outcomes showed that when chiropractic care was pursued, the cost of treatment was reduced by 28%. hospitalizations were reduced by 41%. back surgery was reduced by 32%. and the cost of medical imaging, including x-rays and MRIs. was reduced by 37%. Furthermore. 95% of the patients tliat received chiropractic care said they were satisfied with their treatment. These types of studies have given medicine the insight to teach medical school students and family practice residents that chiropractic should be considered as a first-line alternative to opioid utilization. Dr. Owens has also been invited to be part of the process determining how state and federal grant money for research should be utilized in trving to find a solution for opioid issue with chiropractic as a primary solution. He has been able to create a partnership between the State University of New York at Buffalo School of Medicine and Biomcdi-cal Sciences. Family Medical Practice and the University of Bridgeport College of Chiropractic in a joint research project around chiropractic utilization and opioid utilization. While many groups and organizations within chiropractic arc seeking scope changes to include limited prescriptive rights, it is because we offer a non-drug alternative that we arc now considered as the solution to the problem that medicine created. In the past, this author looked at the numbers of possible chiropractors becoming primary care medical providers with the consideration that if we controlled the patients from the access point, we could get considerably more people under chiropractic care. However, with chiropractic being accepted and taught in medical schools as a solution, we now have a voice during the medical educational process and need to let medical doctors do what they arc trained to do. albeit with one exception; chiropractic needs to be considered as the first-line referral for any spinal-related conditions and the effects thereof. With chiropractic being the first-line referral, the doctor of chiropractic gets to educate and treat the patient in a non-drug environment while offering a real solution to both the opioid epidemic and the vast array of solutions to other issues that chiropractic offers. Now that a pilot program for chiropractic to teach medical students and family practice residents has been created and accepted within medical academia. other doctors of chiropractic arc currently being trained to bring chiropractic to medical schools nationally. Over a relatively short amount of time, this program will be taught to the next generation of medical doctors and family practitioners, creating a significantly increased need for chiropractic nationally and a solution for the opioid epidemic. With further research to bolster the studies already available, the concept of it being malpractice for a medical doctor to prescribe an opiate without first considering a course of chiropractic care is no longer deemed unattainable. If chiropractors are able to order prescriptive dnigs. we may ultimately be prevented from inclusion in organized medicine's solution for the opioid epidemic because we will be part of the problem rather than being uniquely positioned as part of the solution. The question we need to ask as a profession is: arc we to become part of the solution or part of the problem? References: Paulozzi. L. J.. Jones. C. M.. Mack. K. A.. & Rudd. R. A. (2011). Vital signs: Overdoses of prescription opioid pain relievers — United States — 1999-2008. Morbidity and Mortality Weekly Report (MMWR). 60(43). Retrieved from htlp:/Avww.cdc.gov/mimvr/pre- vicw/mimvrhlml/ mm6043a4.htm Cifucntcs. M.. Willcts. J.. & Wasiak. R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4). 396-404 DeBar. L. L.. Elder. C. Ritcnbaugh. C. Aickin. M.. Dcyo. R., Mcenan. R.. Dickcrson. J.. Webster. J.A.. & Yarborough. B.J. (2011). Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study. BMC Complementary & Alterna tive Medicine. 11(118). 1-18. Lcgorrcta. A.P. (2004). Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine, 164(18). 1985-1992. Dr. Mark Studin is an adjunct assistant professor in clinical sciences at the University of Bridgeport College of Chiropractic and a clinical presenter for the State of New York at Buffalo, School of Medicine and Biomedical Sciences for post-doctoral education, teach- ing MRI spine interpretation and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the legal community (www.LawyersPIProgram.com) and teaches .\ IRI interpretation and triaging trauma cases to doctors of all disciplines nationally (www. TeachDoctors. com). He can be reached at DrMark(cbJeachDoctors. com or at 631-786-4253.
