• Low back pain is the single leading cause of disability worldwide.
• One-half of all working Americans admit to having back pain symptoms each year.
• In the United States, low back pain is one of the leading reasons why people are prescribed opioids.
• Almost half of all U.S. opioid overdose deaths involve a prescription opioid.

Prescription opioids are not a good strategy for managing low back pain long term. 

• Research shows that opioids do not provide clinically meaningful pain relief for people with chronic back pain.
• As many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction.
• In 2018, about 2 million Americans abused or were dependent on prescription opioids.
• Almost 80 percent of Americans prefer to first use options other than prescription drugs for their pain.

Guidelines published by major healthcare groups encourage patients with common musculoskeletal conditions to try non-drug treatments.  

• In 2017, the American College of Physicians (ACP) updated its guidelines for the treatment of acute and chronic low back pain to recommend first using noninvasive, non-drug treatments—including spinal manipulation—before resorting to over-the-counter and prescription drugs.
• The Joint Commission, which accredits every major U.S. hospital, recognized the value of non-drug approaches in 2015 by adding chiropractic to its pain management standard.
• The Department of Defense/Veterans Administration 2017 guideline for the treatment of low back pain includes spinal manipulation as a non-drug, noninvasive option.
• In its proposed 2022 Clinical Practice Guideline for Prescribing Opioids, the Centers for Disease Control and Prevention promotes “diverse approaches and varied pain management solutions” and specifically encourages use of non-opioid/nonpharmacologic therapies as a first line of treatment against subacute and chronic pain.

Evidence supports the use of non-drug approaches such as chiropractic services to reduce reliance on prescription opioids for pain. 

• A 2018 study focusing on adults with office visits for noncancer low back pain found that the likelihood of filling an opioid prescription was significantly lower (55% lower) for recipients of services delivered by doctors of chiropractic compared with nonrecipients.
• A study published in the journal Pain Medicine found that chiropractic users had 64% lower odds of receiving an opioid prescription than non-users.
• The Department of Veterans Affairs reports that it has reduced opioid prescriptions by 63% using its Whole Health approach, which includes non-drug treatments for pain such as chiropractic care.

Studies show visiting a chiropractor first for treatment may even reduce the likelihood of receiving an opioid prescription later.   

• A 2018 study examining the effect of initial provider selection concluded that seeing a chiropractor first for new back or lower body pain was associated with lower odds of receiving an opiate prescription.
• A 2017 study published by the Mayo Clinic found that people with neck pain initiating care with chiropractic physicians had lower odds of using advanced imaging, injections, and opioid medications.
• A study published in the British Medical Journal found that patients who saw a chiropractor as their initial provider for low back pain had 90% decreased odds of both early and long-term opioid use.