Uncover the benefits of integrative chiropractic care in identifying and treating Opioid Use Disorder through comprehensive care.

Abstract

Hello, I am Dr. Alex Jimenez. With my background as a Doctor of Chiropractic (DC), Advanced Practice Registered Nurse (APRN), board-certified Family Nurse Practitioner (FNP-BC), Certified Functional Medicine Practitioner (CFMP), and an Institute for Functional Medicine Certified Practitioner (IFMCP), among other clinical specializations, I have dedicated my career to providing evidence-based, integrative care. In this educational article, we explore Opioid Use Disorder (OUD) through both modern neurobiology and whole-person clinical medicine. We examine the modern diagnostic landscape established by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), evaluate the pharmacology of FDA-approved Medications for Opioid Use Disorder (MOUD)—such as methadone, naltrexone, and buprenorphine—and analyze the public health impact of the 2023 Drug Enforcement Administration (DEA) X-waiver elimination.

Crucially, this expanded guide details how chiropractic care, spinal biomechanics, neurofunctional regulation, and functional medicine directly reduce the burden of OUD. Unmanaged musculoskeletal pain serves as one of the primary drivers of initial opioid exposure, dosage escalation, and relapse. By integrating targeted spinal manipulative therapy (SMT), spinal decompression, functional neurological restoration, and anti-inflammatory lifestyle protocols, clinicians can alleviate persistent nociceptive input, blunt central sensitization, and resolve musculoskeletal comorbidities related to chronic opioid therapy. Working alongside our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD, our team at Injury Medical Clinic PA in El Paso, Texas, demonstrates how bridging manual therapy, internal medicine, harm reduction, and motivational interviewing creates a comprehensive pathway toward lasting functional recovery.

Our Collaborative and Integrative Practice at Injury Medical Clinic PA

At Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, our clinical model is built upon multidisciplinary synergy. Chronic complex disorders such as OUD rarely exist in isolation; they are deeply entangled with persistent physical trauma, neurochemical adaptation, and psychosocial stress. My dual licensure as a Doctor of Chiropractic and Family Nurse Practitioner enables me to evaluate clinical pathology simultaneously through biomechanical, physiological, and functional medicine lenses.

A foundational pillar of our clinic is our direct collaboration with Dr. Maria Guadalupe Cardenas, MD, a board-certified Internist (Texas Medical License #J2933; NPI #1164426749) with more than four decades of dedicated medical experience. As our Medical Director and Collaborative Physician, Dr. Cardenas provides conventional diagnostic insight, manages internal medical comorbidities, and directs pharmacotherapy, including MOUD induction and maintenance protocols.

           +-------------------------------------------------------+
           |       Injury Medical Clinic PA: Integrative Model      |
           +-------------------------------------------------------+
                                      |
         +----------------------------+----------------------------+
         |                                                         |
         v                                                         v
+----------------------------------+     +----------------------------------+
|   Dr. Maria G. Cardenas, MD      |     |    Dr. Alex Jimenez, DC, APRN    |
|   (Internal Medicine Oversight)  |     |   (Chiropractic & Functional Med)|
+----------------------------------+     +----------------------------------+
| • Diagnostic internal workups    |     | • Spinal manipulation & traction |
| • MOUD pharmacological induction |     | • Mechanoreceptor stimulation    |
| • Comorbidity management         |     | • Central sensitization relief   |
| • Toxicological & liver screens  |     | • Functional medicine & rehab    |
+----------------------------------+     +----------------------------------+
         |                                                         |
         +----------------------------+----------------------------+
                                      |
                                      v
                      +--------------------------------+
                      |   Restored Neuro-Mechanics,    |
                      | Reduced Cravings & Sretained   |
                      |       Long-Term Remission      |
                      +--------------------------------+

Our combined team delivers an integrated suite of clinical services:

• Chiropractic Care and Spinal Biomechanics: Correcting spinal subluxations, restoring joint articulation, relieving neural compression, and stimulating mechanoreceptors to downregulate nociceptive signal transmission.

• Internal Medicine Oversight: Delivering comprehensive systemic evaluations, screening for infectious diseases, and monitoring pharmacotherapy safety.

• Functional Medicine: Identifying underlying physiological drivers such as gastrointestinal dysbiosis, systemic inflammation, adrenal/HPA axis dysregulation, and micronutrient deficiencies.

• Rehabilitation and Active Physical Therapy: Prescribing individualized neuromuscular re-education, active core stabilization, and myofascial therapies to restore functional movement patterns.

• Nutritional Counseling and Behavioral Health Coaching: Supporting neurotransmitter synthesis, balancing glycemic stability, and reinforcing patient autonomy through evidence-based behavioral strategies.

How Chiropractic Care Reduces the Burden of Opioid Use Disorder

Opioid stewardship begins with providing viable, non-addictive pain relief. Extensive epidemiological research shows that patients with acute or chronic spinal pain who seek initial chiropractic care are significantly less likely to receive an opioid prescription compared to those managed with conventional pharmacotherapy alone (Kazis et al., 2019; Whedon et al., 2020). Chiropractic care acts on both primary prevention and secondary risk mitigation across several specific biological fronts:

+--------------------------------------------------------------------------+
|                  Nociceptive & Neuroplastic Escalation                   |
|                                                                          |
|  Musculoskeletal Injury / Subluxation                                    |
|      ?                                                                   |
|      ?                                                                   |
|  Aberrant Biomechanics & Sustained Mechanical Compression                |
|      ?                                                                   |
|      ?                                                                   |
|  Substance P, CGRP, Pro-inflammatory Cytokines ("Inflammatory Soup")     |
|      ?                                                                   |
|      ?                                                                   |
|  C-Fiber Nociception & Spinal Cord Wind-Up (NMDA Activation)             |
|      ?                                                                   |
|      ?                                                                   |
|  Central Sensitization & Opioid-Induced Hyperalgesia (OIH)               |
|      ?                                                                   |
|      ?                                                                   |
|  Opioid Dose Escalation, Dependence, and Relapse                         |
+--------------------------------------------------------------------------+
                                     ?
           Chiropractic SMT, Decompression & Functional Protocols
                                     ?
                                     ?
+--------------------------------------------------------------------------+
|                 Neuro-Biomechanical Restoration Pathway                  |
|                                                                          |
|  • High-velocity, low-amplitude (HVLA) adjustments                       |
|  • Rapid firing of low-threshold, large-diameter A-beta mechanoreceptors  |
|  • Presynaptic inhibition of C-fiber inputs in dorsal horn substantia    |
|    gelatinosa (Melzack & Wall Gate Control)                              |
|  • Restoration of physiological joint motion; reduction of localized     |
|    paraspinal muscle spasm and ischemia                                  |
|  • Calming descending pain facilitatory tracts (PAG-RVM axis)            |
|  • Blunting somatic cravings and breaking the neuro-sensory cycle of OUD |
+--------------------------------------------------------------------------+

1. Attenuation of the Neuro-Biomechanical Pain Cycle

Subluxations, facet joint fixations, intervertebral disc herniations, and chronic postural distortions generate continuous, abnormal mechanical stress. This ongoing strain triggers localized cellular injury, leading to the sustained release of substance P, calcitonin gene-related peptide (CGRP), bradykinin, and pro-inflammatory cytokines—often described as an inflammatory soup.

These biochemical mediators sensitize primary afferent nociceptors (A-delta and C fibers). High-velocity, low-amplitude (HVLA) spinal manipulation restores physiological articular glide, reduces intradiscal and transforaminal pressure, alleviates paraspinal muscle splinting, and washes out pro-inflammatory metabolites, addressing the somatic generator of pain directly rather than masking it chemically.

2. Neurological Gating and Central Pain Modulation

The pain gate theory, formulated by Melzack and Wall, shows that non-painful sensory input closes the spinal nerve gates to painful input. Spinal adjustments rapidly stimulate the large-diameter, low-threshold mechanoreceptive afferents (A-alpha and A-beta fibers) located in joint capsules, paraspinal muscles, and intervertebral ligaments.

This barrage of proprioceptive input enters the dorsal horn of the spinal cord and excites inhibitory interneurons in the substantia gelatinosa. This inhibits the synaptic transmission of ascending nociceptive signals along second-order spinothalamic neurons. Furthermore, neuroimaging and neurophysiological studies confirm that spinal manipulation triggers supraspinal changes, activating descending pain-modulatory pathways within the periaqueductal gray (PAG) and rostral ventromedial medulla (RVM). This response supports the release of endogenous opioid peptides (such as endorphins and enkephalins) and suppresses maladaptive neuroplasticity, helping teverse spinal “wind-up””

3. Disruption of Opioid-Induced Hyperalgesia (OIH)

Patients receiving prolonged opioid therapy frequently experience Opioid-Induced Hyperalgesia (OIH). In this neurobiological condition, patients paradoxically become hypersensitive to painful stimuli and develop diffuse allodynia (pain from normally non-painful stimuli). OIH is driven by the activation of central glutamatergic pathways, specifically N-methyl-D-aspartate (NMDA) receptors, neuroinflammation within spinal microglia, and increased spinal dynorphin concentrations.

When clinicians mistake OIH for developing drug tolerance, they often increase the opioid dosage, worsening the hyperalgesic state. Chiropractic manual interventions provide an alternative, non-pharmacological form of neural afferent stimulation. By improving mechanical integrity and reducing afferent nociceptive input, chiropractic therapies assist in resetting hyperactive neuro-sensory networks, allowing patients to decrease their opioid intake without experiencing a surge in rebound pain.

Addressing Musculoskeletal Pain and OUD Comorbidities

Patients presenting with OUD typically carry significant musculoskeletal secondary conditions that complicate medical management and recovery. Understanding these clinical manifestations enables providers to formulate targeted treatment plans:

Clinical Observations by Dr. Alexander Jimenez, DC, APRN, FNP-BC

Drawing upon more than three decades of direct patient care in El Paso, Texas, across chiropractic sciences, advanced practice nursing, and functional medicine, I have recorded several consistent clinical patterns:

1. Persistent Biomechanical Pain as the Primary Trigger: In clinical practice, unmanaged musculoskeletal pathology is among the most common catalysts for initial opioid exposure and the primary driver of relapse for patients in sustained remission. When severe degenerative disc herniations, facet syndrome, or post-traumatic spinal injuries are left uncorrected, chemical analgesia merely masks the underlying dysfunction. Restoring normal joint motion, opening the neural foramina, and decreasing aberrant spindle signaling provides functional pain relief that significantly reduces a patient’s reliance on opioids.

2. The “Broken Bridge” Between Detoxification and Functional Recovery: Patients who complete acute withdrawal stabilization often experience severe rebound musculoskeletal pain within weeks. Without structural spinal correction, physical reconditioning, and nervous system regulation, the physical pain becomes overwhelming, causing many individuals to return to illicit substance use. Integrative chiropractic interventions bridge this transition by giving patients non-narcotic pain relief during early recovery.

3. Targeted Functional Medicine and Metabolic Stabilization: Prolonged opioid use suppresses hypothalamic-pituitary-adrenal (HPA) axis regulation, disrupts gut motility, impairs mucosal integrity, and depletes vital nutritional cofactors. Integrating functional medicine—such as restoring gut microbiome diversity, correcting micronutrient deficiencies (including magnesium, zinc, and B-complex vitamins), and stabilizing blood sugar—reduces neuroinflammation, improves neurotransmitter production (dopamine, GABA, serotonin), and stabilizes mood.

4. Interprofessional Collaboration Provides an Indispensable Safety Net: Comprehensive care requires multidisciplinary teamwork. Working closely with our Medical Director, Dr. Maria Cardenas, MD, ensures that while I address the mechanical, neuromuscular, and functional components, medical safety, toxicological monitoring, and pharmacotherapy (such as buprenorphine management) are maintained at the highest standard.

(Clinical insights, academic publications, and educational articles are documented on Chiropractic Scientist and LinkedIn).

Diagnostic Framework: DSM-5-TR Criteria for Opioid Use Disorder

Accurate diagnosis forms the cornerstone of effective clinical management. The American Psychiatric Association’s (2022) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) defines Opioid Use Disorder as a problematic pattern of opioid use that leads to clinically significant impairment or distress, manifested by at least two of the following eleven criteria occurring within 12 months:

+--------------------------------------------------------------------------+
|                  DSM-5-TR Diagnostic Criteria for OUD                    |
+--------------------------------------------------------------------------+
|  1. Opioids taken in larger amounts or over a longer period than intended |
|  2. Persistent desire or unsuccessful efforts to cut down or control use |
|  3. Great deal of time spent obtaining, using, or recovering from opioids|
|  4. Craving, or a strong desire or urge to use opioids                   |
|  5. Recurrent use resulting in failure to fulfill major role obligations |
|  6. Continued use despite persistent social or interpersonal problems    |
|  7. Important social, occupational, or recreational activities given up   |
|  8. Recurrent opioid use in physically hazardous situations              |
|  9. Continued use despite persistent physical or psychological problems  |
| 10. Tolerance (markedly increased dose needed, or diminished effect)*    |
| 11. Withdrawal (characteristic syndrome, or used to relieve symptoms)*   |
+--------------------------------------------------------------------------+
*Note: Criteria 10 and 11 are not considered met for individuals taking opioids
solely under appropriate medical supervision.

Diagnostic Severity

• Mild OUD: Presence of 2 to 3 criteria.

• Moderate OUD: Presence of 4 to 5 criteria.

• Severe OUD: Presence of 6 or more criteria.

Clinical Remission Specifications

• In Early Remission: Full criteria have not been met for at least 3 months but less than 12 months (except Criterion 4: Craving).

• In Sustained Remission: Full criteria have not been met at any time during a period of 12 months or longer (except Criterion 4: Craving).

• On Maintenance Therapy: The individual is receiving a prescribed agonist, partial agonist, or antagonist medication (e.g., buprenorphine, methadone, naltrexone) as part of structured medical management.

• In a Controlled Environment: The individual resides in an access-restricted environment (e.g., specialized medical units, residential rehabilitation facilities, or secure institutions).

Comprehensive Screening and Holistic Assessment

Screening must move beyond isolated questionnaires to evaluate the patient’s entire biopsychosocial state. While validated screening inventories such as the Opioid Risk Tool (ORT), Screener and Opioid Assessment for Patients with Pain (SOAPP-R), and the Addiction Behaviors Checklist (ABC) provide useful baselines, a comprehensive clinical evaluation should incorporate:

1. Biomechanical and Musculoskeletal Structural Assessment: Performing detailed orthopedic testing, spinal palpation, joint range-of-motion assessments, and posture screenings to detect structural pain drivers, muscular asymmetries, and degenerative nerve root pathology.

2. In-Depth Pain History and Central Sensitivity Mapping: Documenting pain duration, intensity, distribution, and signs of central sensitization (such as wide-area hyperalgesia or allodynia) to distinguish mechanical nociception from neuropathic pain or OIH.

3. Trauma History and Adverse Childhood Experiences (ACEs): A significant body of research correlates high ACE scores with substance use disorders. Screening for trauma ensures that clinical recommendations are delivered through a trauma-informed lens.

4. Infectious Disease and Systemic Review: Conducting diagnostic blood work to screen for systemic infections common in intravenous drug use, including Hepatitis B and C, HIV, and infective endocarditis, as well as checking complete blood counts and comprehensive metabolic panels.

5. Psychiatric and Psychosocial Evaluation: Identifying co-occurring psychiatric conditions, such as major depressive disorder, generalized anxiety, and PTSD, which can impair recovery if unaddressed.

Medications for Opioid Use Disorder (MOUD): Pharmacological Foundations

MOUD represents the evidence-based medical standard of care for stabilizing neurochemistry, curbing mortality, and supporting long-term recovery (ASAM, 2020; Kampman & Jarvis, 2015).

                      Mu-Opioid Receptor Signaling
     100% +-------------------------------------------------------+
          |                        Full Agonist (Methadone)       |
          |                                                       |
          |                      * * * * * * * * * *              |
          |                  * *                                  |
          |               *                                       |
      50% |             *  Partial Agonist (Buprenorphine)        |
          |            #----------------------------------------  |  <-- Ceiling Effect
          |           #                                           |      (Lower respiratory
          |          #                                            |       depression risk)
          |         #                                             |
       0% |........+..............................................|
          |        |             Antagonist (Naltrexone)          |
          +--------+----------------------------------------------+
                  Low               Drug Dose                  High

1. Methadone

• Mechanism: Long-acting, full synthetic mu-opioid receptor agonist. It provides steady receptor occupancy, blunting cravings and withdrawal without the sharp peaks associated with short-acting illicit opioids.

• Clinical Access: Federally regulated under 42 CFR Part 8; outpatient dispensing for OUD is restricted to certified Opioid Treatment Programs (OTPs), which often require daily observed dosing.

• Safety Considerations: Requires baseline and follow-up electrocardiograms (ECGs) to monitor for dose-dependent QTc interval prolongation and torsades de pointes. It is an established option for managing OUD during pregnancy.

2. Buprenorphine

• Mechanism: High-affinity, partial mu-opioid receptor agonist and kappa-opioid receptor antagonist.

• The Pharmacological “Ceiling Effect”: Unlike full agonists, buprenorphine reaches a plateau in receptor activation, significantly lowering the risk of life-threatening respiratory depression even at higher doses (Brantley & He, 2024; SAMHSA, 2021).

• High Receptor Affinity and Blockade: Buprenorphine binds to mu-opioid receptors with higher affinity than illicit full agonists like heroin and fentanyl, preventing these drugs from binding and reducing the likelihood of an overdose if a relapse occurs.

• The 2023 DEA X-Waiver Elimination: The Mainstreaming Addiction Treatment (MAT) Act removed the federal requirement for an X-waiver. Any healthcare provider with a standard Schedule III DEA registration can now prescribe buprenorphine for OUD, eliminating arbitrary patient limits and expanding access across outpatient medical and integrative practices.

• Clinical Formulations:

  • Sublingual Tablets/Films: Buprenorphine monotherapy (Subutex) is indicated for patients with documented naloxone sensitivities and remains the standard of care in pregnancy to avoid fetal exposure to naloxone. Buprenorphine/naloxone combination products (Suboxone) deter intravenous tampering because sublingually administered naloxone exhibits poor bioavailability (less than 10%), but precipitates withdrawal if crushed and injected.

  • Long-Acting Injectables: Extended-release subcutaneous injections, such as Sublocade (monthly abdominal depot) and Brixadi (weekly or monthly multi-site depot), maintain therapeutic plasma levels, improve treatment adherence, and eliminate the burden of daily dosing.

3. Naltrexone

• Mechanism: Competitive opioid antagonist with high binding affinity that produces no intrinsic receptor activation.

• Formulations: Oral tablets (50 mg daily) and once-monthly intramuscular depot suspensions (Vivitrol, 380 mg).

• Safety Rules: Requires a verified opioid-free period of 7 to 14 days before initiation to prevent severe precipitated withdrawal. Providers must routinely evaluate hepatic transaminases because of the risk of hepatotoxicity.

Clinical Management: Buprenorphine Induction and Microdosing

                  Managing Induction Protocols
                               |
         +---------------------+---------------------+
         |                                           |
         v                                           v
+----------------------------------+     +----------------------------------+
|   Standard Induction Protocol    |     |   Low-Dose / Bernese Protocol    |
+----------------------------------+     +----------------------------------+
| • Used for: Short-acting opioids |     | • Used for: Fentanyl / high-     |
|   (oxycodone, hydrocodone)       |     |   lipophilic opioids             |
| • Patient abstains until signs   |     | • No mandatory withdrawal period |
|   of withdrawal appear           |     | • Patient continues full agonist |
| • Target COWS score: 12 or more  |     | • Day 1: 0.5 mg buprenorphine    |
| • Initiate first dose: 2 to 4 mg |     | • Incrementally titrate upward   |
| • Titrate up to 8-16 mg as       |     | • Discontinue full agonist on    |
|   withdrawal symptoms resolve    |     |   Day 7-8 as buprenorphine reaches|
|                                  |     |   therapeutic receptor occupancy |
+----------------------------------+     +----------------------------------+

The Challenge of Fentanyl and Lipophilicity

Fentanyl’s high lipid solubility causes it to deposit within systemic adipose tissue, where it is released slowly back into circulation. Consequently, patients who regularly use fentanyl can develop precipitated withdrawal when administered buprenorphine, even 24 to 72 hours after their last use.

Low-Dose Induction (The Bernese Method)

To avoid precipitated withdrawal, clinicians increasingly use low-dose initiation protocols (microdosing):

• Concept: Patients continue their regular opioid use while beginning very small, sub-therapeutic doses of buprenorphine.

• Mechanism: Small buprenorphine doses gradually bind to and saturate a small fraction of mu-opioid receptors without displacing enough of the full agonist to trigger withdrawal.

• Titration: Buprenorphine is increased daily (e.g., 0.5 mg daily, progressing to 0.5 mg twice daily, 1 mg twice daily, 2 mg twice daily, 4 mg twice daily, and then 8 to 16 mg daily) while the full agonist is tapered off, resulting in a smooth transition to maintenance therapy.

Practical Harm Reduction: Meeting Patients Where They Are

Harm reduction focuses on saving lives, preserving human dignity, and minimizing the complications associated with drug use (SAMHSA, 2023).

+--------------------------------------------------------------------------+
|                  Cornerstones of Practical Harm Reduction                |
+--------------------------------------------------------------------------+
|  1. Community Naloxone (Narcan) Distribution                             |
|     • Opioid antagonist that restores respiratory drive within 2-5 min   |
|     • Education on shorter half-life (60-90 min) vs. fentanyl            |
|                                                                          |
|  2. Fentanyl and Xylazine Immuno-Assay Test Strips                       |
|     • Identifies high-potency synthetic opioids and adulterants          |
|     • Patient education on the "chocolate chip cookie effect"            |
|                                                                          |
|  3. Syringe Service Programs (SSPs)                                      |
|     • Reduces transmission of HIV, HCV, and bacterial pathogens          |
|     • Community linkage to addiction, medical, and wound care services   |
+--------------------------------------------------------------------------+

1. Overdose Reversal with Naloxone: Naloxone displaces opioids from mu receptors to restore respiration within 2 to 5 minutes. Because naloxone’s half-life (60 to 90 minutes) is substantially shorter than that of long-acting opioids or lipophilic fentanyl, clinical monitoring is essential to prevent secondary overdose. Clinicians should educate patients to keep naloxone readily available and review safety measures, such as the Never Use Alone hotline.

2. Rapid Chemical Testing (Fentanyl & Xylazine Test Strips): Handheld test strips enable patients to detect adulterants before use. Given the risk of the “chocolate chip cookie effect”—where adulterants are unevenly distributed throughout a batch—counseling must emphasize that a single negative test does not guarantee the complete absence of fentanyl.

3. Syringe Service Programs (SSPs): Extensive public health data demonstrate that SSPs decrease the transmission of bloodborne viruses (including HIV and Hepatitis C) without increasing drug consumption rates (Aspinall et al., 2014; CDC, 2022). These facilities also serve as critical connection points for sterile supplies, comprehensive wound care, abscess drainage, and entry into medical treatment.

Motivational Interviewing and the Transtheoretical Model of Change

Sustained recovery requires empathetic, patient-centered communication. Motivational Interviewing (MI) is a collaborative counseling style that strengthens internal motivation for change by resolving ambivalence (Miller & Rollnick, 2013).

               Stages of the Transtheoretical Model
                                 ?
     ?????????????????????????????????????????????????????????
     ?                                                       ?
     ?                                                       ?
[ Precontemplation ]                                   [ Action ]
(Unaware of need to change)                            (Actively modifying behavior)
     ?                                                       ?
     ?                                                       ?
[ Contemplation ]                                      [ Maintenance ]
(Weighing pros & cons)                                 (Sustaining new habits)
     ?                                                       ?
     ?                                                       ?
[ Preparation ]                                        [ Recurrence / Relapse ]
(Planning small steps)                                 (Normal part of chronic care;
                                                        opportunity to adjust plan)

The OARS Communication Framework

• O — Open-Ended Questions: Encourage patients to share their perspectives (e.g., “How does your back pain affect your day, and where do your medications fit into that routine?”).

• A — Affirmations: Acknowledge personal effort, strengths, and resilience (e.g., “Attending your appointment today while dealing with severe discomfort demonstrates your dedication to feeling better.”).

• R — Reflective Listening: Paraphrase the patient’s concerns to build mutual understanding (e.g., “You are concerned about the side effects of your medication, but you are also worried your back pain might become unmanageable without it.”).

• S — Summaries: Pull together the discussed points to transition toward collaborative planning (e.g., “We have reviewed your structural spinal pain, how it makes work challenging, and your interest in exploring gentle chiropractic care alongside medical therapy. Does that reflect where we stand today?”).

Clinicians can use readiness rulers to explore discrepancy: “On a scale of 0 to 10, how ready do you feel to address your opioid use?” If a patient answers “4,” follow up with: “Why did you choose a 4 instead of a 1 or 2?” This prompts the patient to articulate their internal reasons for wanting change, reinforcing their self-efficacy.

Conclusion: The Path Forward in Integrative Recovery

Managing Opioid Use Disorder requires moving past fragmented, single-modality approaches. Opioid dependence often develops at the intersection of unmanaged physical pain, altered biomechanics, neuroplastic adaptations, and psychosocial strain.

By uniting chiropractic adjustments, spinal rehabilitation, and functional medicine with conventional internal medicine and MOUD, healthcare providers can address both the underlying physical pain and the physiological changes of addiction. Grounded in harm reduction, trauma-informed care, and motivational interviewing, this model offers patients a comprehensive, compassionate path to lasting recovery and long-term health.

References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.

• American Society of Addiction Medicine. (2020). The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. Journal of Addiction Medicine, 14(2S Suppl 1), 1–91.

• Aspinall, E. J., Nambiar, D., Goldberg, D. J., Hickman, M., Weir, A., Van Velzen, E., Palmateer, N., Doyle, J. S., Hellard, M. E., & Hutchinson, S. J. (2014). Are needle and syringe programs associated with a reduction in HIV transmission among people who inject drugs: A systematic review and meta-analysis. International Journal of Epidemiology, 43(1), 235–248.

• Brantley, P. R., & He, S. Y. (2024). Buprenorphine. In StatPearls. StatPearls Publishing.

• Centers for Disease Control and Prevention. (2022). Syringe services programs (SSPs) fact sheet. U.S. Department of Health and Human Services.

• Jimenez, A. (2025). Chiropractic Scientist: Clinical insights in neurology, pain modulation, and biomechanics. Chiropractic Scientist Clinical Repository.

• Jimenez, A. (2026). Dr. Alex Jimenez: Professional overview and integrative practice profiles. LinkedIn Professional Profile.

• Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. Journal of Addiction Medicine, 9(5), 358–367.

• Kazis, L. E., Ameli, O., Rothendler, J., Garrity, B., Cabral, H., McDonough, C., Greer, D., Resnick, M., Vance, R., & Saper, R. (2019). Observational study of recipient and provider characteristics and patterns of care associated with chiropractic use among patients with low back pain. BMJ Open, 9(10), e028633.

• Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971–979.

• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). The Guilford Press.

• Substance Abuse and Mental Health Services Administration. (2021). Buprenorphine. U.S. Department of Health and Human Services.

• Substance Abuse and Mental Health Services Administration. (2023). Harm reduction. U.S. Department of Health and Human Services.

• Whedon, J. M., Toler, A. W. J., Goehl, J. M., & Kazal, L. A. (2020). Association between utilization of chiropractic services for treatment of low-back pain and risk of adverse drug events. Journal of Manipulative and Physiological Therapeutics, 43(6), 569–576.

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