International Chiropractors Association

ICA Presents Comments on FDA Call for Input of Dealing with the National Opioids Crisis

July 10, Falls Church, Virginia:  The International Chiropractors Association (ICA) has submitted extensive comments in response to a call from the federal Food and Drug Administration (FDA) on a national Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioids. In its submission, the ICA told FDA policy makers:  
“As a drugless science focused on natural healing and care pathways, we believe that chiropractic science and practice offers a powerful, clinically effective means of reducing and, for many patients eliminating altogether the need for many prescription pain medication(s).    ICA strongly believes that what is essential to mobilizing and making effective use of non-pharmacological approaches to pain and pain relief is both a serious effort to orient medical and other providers to the importance and effectiveness of those pathways, including chiropractic services, and, providing access through both public and private third-party-payment systems, to those services, as first line interventions, before pharmaceutical applications are considered.  The present document does not adequately provide guidance to practitioners in these areas. The bulk of the current document focuses on non-opioid drug interventions.  ICA’s primary recommendation is that the FDA dedicate a like amount of educational power and authority to teaching practitioners how to begin making this transition to non-pharmacological approaches.
ICA’s comments came in the context of an increasingly tragic and costly national trend of abuse of powerful pain medications.  According to a recent study released by the Centers for Disease Control (CDC):
In 2015, drug overdoses accounted for 52,404 deaths in the United States, 63.1% of which involved an opioid (1). Among opioid-related deaths, approximately 15,000 (approximately half) involved a prescription opioid (2). In addition, an estimated 2.0 million persons in the United States had opioid use disorder (addiction) associated with prescription opioids in 2015 (3). The economic burden of prescription opioid overdose, abuse, and dependence is estimated to be $78.5 billion each year in the United States (4). Prescription opioid-related overdose deaths and admissions for treatment of opioid use disorder have increased in parallel with increases in opioids prescribed in the United States, which quadrupled from 1999 to 2010 (5). This increase was primarily because of an increase in the use of opioids to treat chronic non-cancer pain (7).  
“These alarming statistics clearly demonstrate the need for one truly drugless care pathway such as the chiropractic profession offers patients of all ages” said ICA President Dr. George Curry.  “ICA will continue to advocate for public policy changes that highlight what chiropractic has to offer to consumers and to educate both policy makers and the public on the need to greatly expand access to chiropractic services as a responsible and long overdue part of the solution to the nationwide prescription drug abuse crisis.”
The ICA sees this FDA call for input and other such explorations of non-opioid treatment pathways as a tremendous opportunity to educate policy makers and the public about the powerful, clinically and cost-effective choice chiropractic has to offer.  “As a truly drugless, natural healing science and art, chiropractic’s unique approach to health and healing has never been more urgently needed and the ICA is committed to expanding both awareness of and access to chiropractic care nationwide and worldwide,” Dr. Curry added.
ICA is strongly advocating a major new effort to educate all parties to this crisis to the importance of chiropractic and to take steps to make access to drugless care pathways such as chiropractic far more readily available.  In its comments, the ICA stated:
It is clear that without a major new educational program for primary care providers, now currently focused on drug-based therapies, to fully educate and orient them on the non-pharmacological options available, patients will not be likely be referred to or even made aware of those clinical options, thus eroding both the immediate and long-term effectiveness of the campaign to reduce opioid dangers and abuse.  Likewise, patients must be provided the opportunity to not just be aware of safer, drugless alternative care pathways, but have an effective choice to access those alternatives.   

“Regrettably, the national opioids crisis will be a long time in being resolved and the ICA is committed to playing a major role in any and every way possible to serve the public and the nation,” said Dr. Curry.  “This is the right thing to do.” 
1. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morbidity and Mortality Weekly Rep 2016;65:1445–52. 
2. CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2017. 
3. Substance Abuse and Mental Health Services Administration. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. 
4. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 2016;54:901–6. 
5. Paulozzi LJ, Jones CM, Mack KA, Rudd RA.Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 2011;60:1487–92. PubMed 
6. Boudreau D, Von Korff M, Rutter CM, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf 2009;18:1166–75. 
7. Von Korff M, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain 2008;24:521–7.