The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care.

Background: Key nonpharmacologic therapies, including those routinely provided by chiropractors, are recommended first-line treatments for low back pain (LBP). Little is known on whether such care provided in the Veterans Health Administration (VA) has a downstream effect on the use of other healthcare services, including opioid prescriptions.

Objective: To evaluate the impact of chiropractic care on receipt of opioid prescriptions within 365 days of an incident primary care provider (PCP) visit for LBP among opioid-naïve VA patients.

Design: Cross-sectional analysis with longitudinal follow-up.

Participants: Patients had an LBP visit with a VA PCP between 10/1/2015 and 9/30/2020, without any VA LBP visit in the preceding 18 months, and then 2 subsequent VA LBP visits in the following 12 months.

Main measures: VA electronic health record data including outpatient visits, prescriptions, and comorbid diagnoses.

Key results: A total of 128,377 patients met study criteria. The hazard ratio for opioid prescription in a propensity-matched sample was 0.77 (95% CI 0.71-0.83), indicating a significantly lower risk for receipt of an opioid prescription among chiropractic care users in the 365-day follow-up adjusting for potential confounders. The cumulative incidence of opioid prescriptions was 13.0% for chiropractic care users and 16.8% for non-users and the number needed to treat was 27.

Conclusions: The results of this study show that nonpharmacologic chiropractic care can be an important component of opioid sparing strategies for VHA patients with LBP.