Here's How The Opioid Crisis Keeps Going……

Recently, a parent on my daughter’s basketball team asked for some advice regarding injuries she sustained in a motor vehicle accident.  She was involved in a collision three weeks earlier and was continuing to have headaches and neck pain despite having massage and physiotherapy.  She wanted to know what I thought about chiropractic treatment.  She also explained why she had avoided it thus far.  Immediately after the accident, she went to a hospital where she was diagnosed with a concussion and whiplash injury.  Two things were striking about the recommendations she was given there.  First, she was told that under no circumstances was she to see a chiropractor.  When she asked why, no answer was given, just a stern warning.  Second, she was prescribed opioid medication for her pain.  A closer look at this case reveals the all-too-common clinical scenario that, in my opinion, has contributed to the current opioid crisis that is plaguing North America.  First, the recommendation to avoid chiropractic care is simply inappropriate given the clinical presentation.  There are some situations where chiropractic treatment of the neck must be avoided.  These include things like neck fracture, underlying bone disease, rheumatoid arthritis, and vascular disease among others.   According the patient, none of these contraindications were present.  Perhaps concussion may have been a concern, but there is little if any evidence to suggest chiropractic treatment would be contraindicated.  In fact, I have seen quite the opposite in clinical practice.  The mechanism of injury of concussion often involves some type of sudden neck movement that usually injures the muscles and joints of the cervical spine.  While chiropractic adjustments may not treat the concussion itself, they can absolutely address the neck pain, and perhaps even headaches, that accompany concussions.  In addition, recent guidelines published by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration confirm the use of spinal manipulation for the treatment of whiplash type injuries.  The OPTIMa Collaboration conducted one of the most exhaustive reviews of the literature in order to arrive at these recommendations.  Yet despite these facts, the patient was told to avoid chiropractic at all costs.  Instead, opioid drugs were prescribed.  Opioid drugs are a class of pain medications that include morphine, oxycodene (often sold as oxycontin or percocet) and codeine.  There are many situations where these types of drugs can be helpful such as post-surgical care.  But opioids are also being prescribed for conditions that are usually very responsive to other types of treatment.  Mortality rates associated with opioid addiction have soared in recent years.  In 2017, almost 4000 Canadians died because of opioid use.  That number is expected to rise.  In this particular case, the patient’s pain did not seem to be severe enough to warrant such a prescription.  Maybe a simple non-steroidal anti-inflammatory like Advil might have worked just fine.  Why prescribe a potent drug that is driving an epidemic of addiction while advising against an alternative treatment that has been shown to be safe and effective?  It is a sad fact that this story plays out over and over again in hospitals and doctor’s offices all over this country.  We need to do better to ensure more people don’t fall into the cycle of addiction.  All stakeholders have a role to play.  Health professionals have a responsibility to be informed of the risks and also be knowledgeable about alternative forms of care.  Patients need to be aware of the risks as well, making every effort to avoid these medications where possible.  Hopefully the coming months and years will see a new awareness that makes cases like the one described above a rare occurrence.  Until that happens however, the opioid crisis is likely to continue.