Chiropractic Care to Reduce Opioid Use?

From 1999-2017, more than 700,000 people died from a drug overdose in the US, which largely resulted from an increased use of prescription opioids for treatment of chronic pain.

The United States (US) is currently at the center of a major opioid epidemic. Opioids are a class of drugs used to treat moderate-to-severe-pain, which commonly follows injury, surgery, cancer, and end-of-life care.

OpioidsFrom 1999-2017, more than 700,000 people died from a drug overdose in the US, which largely resulted from an increased use of prescription opioids for treatment of chronic pain. However, in more recent years, research has shown that the number of overdose deaths involving heroin and other synthetic opioids are rapidly increasing, while opioid prescribing rates and those with high dose opioids are declining. In 2017, the national prevalence of drug overdose deaths increased to its highest value of approximately 21.7 per 100,000 persons, of which 47,600 (67.8%) of these over-dose fatalities were opioid-related.

Among those affected by this epidemic are workers suffering chronic pain due to a workplace injury. A Washington State Department of Labor and Industries study found that receiving more than a one week supply of opioids, or two or more opioid prescriptions soon after an injury, doubles a worker’s risk of disability one year later. In 2011, more than 25% of workers’ compensation prescription drug claim costs were for opioid pain medications.

" "Brian Chin, a former Northwest Center ERC Trainee and current UW Health Services PhD Candidate, works as an Occupational Health Services Fellow at the NIOSH Center for Workers' Compensation Studies, where he is working to understand if chiropractic care services reduce opioid use among workers with back injuries.

During his time at the University of Washington, Brian's dissertation has focused on access, utilization, and outcomes of physical therapy services among injured workers with back pain in WA. He is now focusing his research in Ohio, where the Ohio Bureau of Workers’ Compensation (BWC) recently made changes to their pharmacy management program, resulting in a drop in Opiate doses of 10.9 million dollars between 2010-2014.

" "Brian is examining the prevalence and trends of chiropractic services and prescription opioids among workers with back injuries in Ohio, identifying risk factors of chiropractic services, and looking to understand the impact of chiropractic care services on the use of opioids, cost of care, and duration of work disability.

Within the next year, Brian plans on defending his dissertation at the University of Washington, and expanding NIOSH’s strategic plan to include goals focused on return-to-work and disability management for injured workers. Brian has been offered a full-time position as a 42 U.S.C Associate Service Fellow (Health Scientist) in the NIOSH-CWCS beginning summer of 2019. He currently works in the NIOSH Division of Field Research and Engineering with DEOHS alumna, Dr. Miriam Calkins (2018).



1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017. Available at Seth P, Scholl L, Rudd RA, Bacon S. Increases and Geographic Variations in Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants with Abuse Potential – United States, 2015-2016. MMWR Morb Mortal Wkly Rep. ePub: 29 March 2018.

2. Centers for DiseaseControl and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.

3. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-RelatedRisks and Outcomes — United States. Surveillance Special Report

4. Franklin GM, Stover BD, Turner JA, Fulton-Kehoe D, Wickizer TM. Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk IdentificationStudy Cohort. Spine. 2008 Jan 15;33(2):199-204. 5. “Ohio Workers'Comp Bureau: Prescription Formulary Saves over $20M.” Insurance Journal, 24 Jan. 2014,