Despite increasing public and professional awareness, the numbing numbers still stand out: an estimated 130 deaths a day due to an opioid overdose. Could a lasting solution be as simple as visiting a doctor of chiropractic or other conservative care provider first? You know the answer, but now the research is proving it. Case in point: a new national study comparing first provider choice with early and long-term opioid use in patients with low back pain.
Published in BMJ Open, this study evaluated short- and long-term opioid use based on initial provider type seen: chiropractor, acupuncturist, physical therapist) or primary care medical physician (PCP).* Participants included 215,000+ U.S. adults diagnosed with new-onset low back pain and "opioid naive."
The study defined early opioid use as "an opioid fill within 30 days of the index visit" and long-term use as "an initial opioid fill within 60 days of the index date and either 120 or more days' supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months."
Researchers evaluated inpatient / outpatient claims from patient visits and pharmacy claims to correlate first provider type seen with opioid use, finding that LBP patients whose initial visit was with a DC were a staggering 90 percent less likely to use opioids early compared to patients who saw a PCP first.
Significantly reduced odds for early opioid use were also noted for acupuncture and PT patients (91 percent and 85 percent reduced odds of early opioid use, respectively). LBP patients who first visited a doctor of chiropractic or other conservative provider were also less likely to use opioids long term compared with patients visiting a PCP.
*ER physicians, orthopedic surgeons, neurosurgeons and rehab physicians were also included in the analysis. Patients visiting any of the above first also had lower odds of early opioid use compared to PCPs (although not as significant as visiting a conservative-care provider), with the exception of ER physicians (dramatically higher odds for early use compared with PCPs). However, odds for long-term use were not significantly different compared to PCPs for all of the above, with the exception of rehab physicians (still significantly lower odds).
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