Learn about the benefits of integrative OUD care and chiropractic rehabilitation in enhancing treatment and promoting well-being.
Table of Contents
Opioid use disorder (OUD) is one of the most complex, multifaceted public health crises of our era, touching virtually every demographic group and cutting across socioeconomic, geographic, and clinical boundaries. As a clinician who practices at the intersection of chiropractic care, advanced nursing, functional medicine, and integrative health, I have witnessed firsthand how opioid dependency frequently develops from musculoskeletal injuries, chronic pain syndromes, post-surgical pain management, and undertreated mental health conditions. At Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic in El Paso, Texas, our team takes a comprehensive, evidence-based, patient-centered approach to addressing the full spectrum of conditions that intersect with OUD.
This educational post draws from a rich body of current research to explore OUD across special populations, including individuals with co-occurring mental health disorders, pregnant women, adolescents, older adults, and those simultaneously using central nervous system (CNS) depressants. Each population presents unique physiological, psychological, and social challenges that demand individualized, thoughtful clinical strategies.
What follows is a deep, narrative-driven exploration of the clinical science, screening methodologies, pharmacological protocols, psychosocial interventions, and integrative care strategies that apply to each group. I will explain not just what the evidence recommends, but why each approach is used, grounding each strategy in its physiological and psychological rationale. Throughout, I will highlight how our clinic’s multidisciplinary model, combining chiropractic care, internal medicine oversight, functional medicine, rehabilitation, and personal injury care, positions us uniquely to serve patients navigating OUD and its many co-occurring conditions.
Before diving into the clinical content, I want to introduce the framework within which we deliver this care, because the structure of care matters as much as the content.
At Injury Medical Clinic PA, I am privileged to work alongside Dr. Maria Guadalupe Cardenas, MD, our Medical Director and Collaborative Physician. Dr. Cardenas is board-certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933) and brings over 40 years of clinical experience as an internist to our practice. Her depth of knowledge in systemic medicine, pharmacology, and complex disease management provides an invaluable medical foundation that complements and amplifies the integrative care I provide as a chiropractor and advanced practice registered nurse.
This multidisciplinary setup is increasingly recognized in the clinical literature as the gold standard for integrative and injury care clinics. Collaboration between an MD providing medical direction and oversight and a chiropractor providing neuromuscular and functional care allows us to address patients at every level of clinical complexity. In the context of OUD, this means that:
Together, we offer patients a continuum of care that addresses the biological, psychological, social, and structural contributors to OUD, which aligns precisely with the biopsychosocial model that modern evidence demands.
Our clinic’s service model includes:
This structure makes our clinic a uniquely suited environment for patients who may have developed OUD as a consequence of a workplace injury, motor vehicle accident, sports injury, or chronic musculoskeletal pain syndrome, all of which are conditions we treat regularly.
Before exploring the clinical populations, it is worth establishing clearly why integrative chiropractic care belongs in any serious discussion of OUD treatment and prevention.
The opioid epidemic did not arise in a vacuum. A significant proportion of opioid prescriptions were initially written for legitimate, chronic musculoskeletal pain, including low back pain, neck pain, radiculopathy, post-surgical pain, and injury-related pain (Dowell et al., 2022). When non-opioid alternatives are available and effective, the risk of opioid initiation, misuse, and dependency is substantially reduced.
Chiropractic care is one of the most well-studied non-pharmacological interventions for musculoskeletal pain. The clinical evidence supports spinal manipulative therapy (SMT) for:
From a physiological standpoint, spinal manipulation works through multiple mechanisms:
By providing effective non-opioid pain management, chiropractic care actively prevents the initial clinical scenario that leads to opioid prescribing in many patients.
For patients already in OUD recovery, chiropractic care serves a different but equally vital role. Patients on medications for opioid use disorder (MOUD), such as buprenorphine or methadone, often continue to experience the underlying musculoskeletal pain conditions that originally drove their opioid use. Without addressing those underlying pain generators, the recovery process is undermined by ongoing suffering that creates a persistent motivation to return to use.
Integrative chiropractic care in this context includes:
This comprehensive approach supports the patient’s recovery by reducing the physiological and functional impairments that make sobriety difficult to sustain.
The relationship between opioid use disorder and mental health conditions is among the most clinically significant and underappreciated dimensions of addiction medicine. The 2022 National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA) reveals a striking reality: approximately 21.5 million adults in the United States are living with a co-occurring disorder, meaning they have both a mental health condition and a substance use disorder (SAMHSA, 2023).
Of these 21.5 million individuals:
This treatment gap is clinically consequential. When the substance use disorder is left untreated, the mental health condition is almost certainly more difficult to manage, because the neurobiological effects of opioid use, including dysregulation of the mesolimbic dopamine system, disruption of the hypothalamic-pituitary-adrenal (HPA) axis, and suppression of endogenous opioid signaling, directly worsen mood, anxiety, and stress regulation.
Conversely, when the mental health condition is left untreated, the risk of continued opioid use increases, because opioids are frequently used as a self-medication strategy for emotional pain, anxiety, and traumatic stress. This bidirectional relationship creates a clinical loop that, if not comprehensively interrupted, can perpetuate both conditions indefinitely.
Within the opioid use disorder population specifically, the literature documents consistently high rates of the following co-occurring conditions:
Importantly, the literature also notes that individuals with co-occurring OUD and mental health disorders are more likely to be female, and this demographic carries an increased risk of both overdose and suicide attempt. This gender-specific vulnerability warrants heightened clinical attention and underscores the importance of gender-sensitive assessment and treatment protocols.
Effective treatment begins with effective identification. In my practice, I strongly advocate for universal screening for mental health conditions in all patients presenting with substance use disorder, regardless of whether they are presenting primarily for addiction treatment. The following are the primary validated tools used in this context:
The PHQ-9 is a nine-item screening tool for major depressive disorder, derived from the nine DSM-5 diagnostic criteria for depression. Each item is scored on a 0 to 3 Likert scale (not at all, several days, more than half the days, nearly every day), yielding a total score ranging from 0 to 27.
Score interpretation:
Clinically, a score of 10 or above is considered the threshold for initiating treatment consideration, though clinical judgment must always integrate the patient’s broader context. The PHQ-9 is not only a diagnostic screener but also a treatment monitoring tool, where a decrease of 5 or more points after treatment initiation is considered a clinically meaningful response.
In the context of OUD, the PHQ-9 is particularly valuable because depressive symptoms may fluctuate significantly with the opioid use cycle, being temporarily suppressed during opioid use and dramatically worsened during withdrawal and early recovery. Screening at the appropriate time, typically during a period of relative stability on MOUD, provides the most clinically reliable picture.
The GAD-7 is a seven-item screening tool derived from the DSM-5 diagnostic criteria for generalized anxiety disorder. Like the PHQ-9, it uses a 0-3 Likert scale, yielding a total score from 0 to 21.
Score interpretation:
A score of 10 or above indicates that further evaluation is warranted. The GAD-7 has also demonstrated good sensitivity for detecting panic disorder, social anxiety disorder, and PTSD, making it a useful general anxiety screener beyond its primary indication.
The PCL-5 is a 20-item self-report measure designed to assess PTSD symptoms as defined in the DSM-5. The name specifically indicates alignment with the fifth edition of the Diagnostic and Statistical Manual, and the tool focuses on the past month of symptom experience, reflecting the DSM-5’s required duration for PTSD diagnosis.
Each item is rated on a 0 to 4 scale (not at all to extremely), yielding a total score from 0 to 80. The symptom domains assessed include:
A score of 31 to 33 or above is generally used as a provisional PTSD diagnosis threshold, warranting clinical follow-up and treatment initiation. A reduction of 10 or more points after treatment is considered a clinically significant response, indicating that the intervention is effective.
The PCL-5 is frequently underutilized in primary care and addiction medicine settings, yet the prevalence of trauma in individuals with OUD makes it an essential component of comprehensive screening. Many patients with OUD have a history of adverse childhood experiences (ACEs), intimate partner violence, sexual assault, community violence, or combat exposure, all of which are recognized risk factors for both PTSD and substance use disorder.
Beyond screening, the manner in which we deliver care to individuals with OUD and co-occurring mental health conditions matters profoundly. Trauma-informed care (TIC) is not simply a philosophical orientation; it is an evidence-based framework shown to improve treatment engagement, retention, and outcomes in this population (SAMHSA, 2014).
The six core principles of trauma-informed care, as articulated by SAMHSA, are:
Creating a safe physical and emotional environment is the foundational principle of trauma-informed care. For individuals with histories of trauma, the healthcare setting itself can be a trigger, particularly if previous interactions with healthcare providers have been judgmental, dismissive, or coercive. In our clinic, this means attending carefully to:
Transparency builds the trust that is foundational to therapeutic engagement. This means being honest and open about treatment recommendations, their rationale, and the potential challenges involved. When clinicians are unclear, evasive, or paternalistic, patients disengage. In a population that has frequently experienced institutional betrayal and systemic failures, clinicians must actively cultivate and consistently demonstrate trustworthiness.
Peer recovery support leverages shared lived experience to build connection, hope, and trust. Individuals who have personal experience with OUD and recovery are uniquely positioned to offer empathy, practical guidance, and motivation that a clinical provider cannot fully replicate. Peer support specialists in addiction treatment settings have been shown to improve treatment engagement and reduce rates of return to use (Eddie et al., 2019). In our integrative model, peer support complements the clinical services provided by our medical and chiropractic team.
Collaborative care means treating the patient as an active partner in their own treatment rather than a passive recipient of clinical decisions. The paternalistic model of healthcare, where the provider dictates and the patient complies, is particularly harmful in addiction treatment, where autonomy, self-efficacy, and internal motivation are critical to sustained recovery. Motivational interviewing (MI), a specific evidence-based communication approach, operationalizes this collaborative spirit and has strong evidence in addiction medicine (Miller & Rollnick, 2013).
Empowerment grows from meaningful choices. When patients with OUD are given options in their treatment, including which MOUD medication to use, which therapy format to pursue, and which goals to prioritize, they develop self-efficacy, the belief in their own ability to manage their condition and drive their recovery. Self-efficacy is one of the strongest predictors of positive outcomes in addiction treatment (Bandura, 1997).
Effective care requires awareness and respect for the cultural contexts, historical experiences, and gender dynamics that shape each patient’s relationship with healthcare, substances, and recovery. For many populations, including Black Americans, Native Americans, Alaska Natives, immigrants, and LGBTQ+ individuals, historical and ongoing systemic inequities have created specific patterns of trauma, mistrust, and health disparity that directly influence OUD risk and treatment access. Clinicians who fail to account for these dimensions will inevitably miss critical elements of the clinical picture.
Pharmacotherapy alone is rarely sufficient for individuals with OUD and co-occurring mental health disorders. Psychotherapy is a cornerstone of comprehensive treatment, and the evidence base clearly supports specific therapeutic modalities for specific conditions.
Cognitive Behavioral Therapy is the most extensively studied and consistently supported psychotherapeutic approach for both major depressive disorder and generalized anxiety disorder (Hofmann et al., 2012). CBT operates on the principle that thoughts, emotions, and behaviors are interconnected, and that maladaptive thought patterns drive emotional distress and problematic behaviors.
In the context of OUD, CBT is particularly valuable because:
Patients should be encouraged to seek therapists specifically trained in evidence-based CBT for depression and anxiety, rather than accepting any generalist counseling that may not follow the structured CBT protocol.
PTSD requires specific therapeutic approaches that go beyond general supportive counseling. The evidence base for PTSD treatment supports three primary approaches:
Prolonged Exposure (PE): PE is a structured, exposure-based therapy developed by Dr. Edna Foa that involves systematic, repeated confrontation of trauma memories and trauma-related situations in a safe therapeutic context. The physiological rationale for PE is rooted in fear extinction learning. By repeatedly activating the traumatic fear network without the aversive consequence, the brain learns to associate trauma cues with safety rather than danger, gradually reducing the PTSD symptom profile. The amygdala, which drives the fight-or-flight response, becomes less hyperreactive, and the prefrontal cortex, which provides regulatory control, resumes its modulatory function (Foa et al., 2019).
Cognitive Processing Therapy (CPT): CPT focuses on identifying and modifying the stuck points: the specific maladaptive cognitions that maintain PTSD symptoms. Common stuck points in trauma survivors include beliefs like “I deserved what happened to me,” “The world is completely dangerous,” or “I am permanently damaged.” By systematically challenging and restructuring these beliefs, CPT reduces the cognitive and emotional burden of PTSD. This is particularly relevant for individuals with OUD who often carry enormous shame and self-blame about their substance use (Resick et al., 2017).
Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a structured therapy that uses bilateral stimulation (most commonly guided eye movements) while the patient briefly focuses on a traumatic memory. The precise neurobiological mechanism of EMDR is still under active research. Still, leading theories suggest that bilateral stimulation activates working memory processes that reduce the vividness and emotional charge of traumatic memories, facilitating adaptive information processing (Shapiro, 2018). EMDR has accumulated a robust evidence base and is recommended by the World Health Organization, the American Psychological Association, and the Department of Veterans Affairs.
In our integrative clinic, we maintain a network of referral relationships with mental health professionals trained in these specific evidence-based modalities, so that when we identify PTSD through PCL-5 screening, we can connect patients with therapists who will deliver the appropriate treatment rather than generic supportive counseling.
For major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD), selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the first-line pharmacological treatments supported by clinical guidelines and evidence (APA, 2022).
The physiological rationale for SSRIs and SNRIs in these conditions is deeply connected to the monoamine hypothesis of depression and anxiety, which proposes that deficient serotonergic and noradrenergic neurotransmission underlies these disorders. By blocking the reuptake of serotonin (SSRIs) or both serotonin and norepinephrine (SNRIs) into the presynaptic neuron, these medications increase the availability of these neurotransmitters at the synaptic cleft, gradually improving mood regulation, anxiety control, and emotional resilience over weeks of treatment.
Not all SSRIs and SNRIs have FDA approval for all three conditions, though clinical practice appropriately extends their use based on evidence. Understanding the approved indications, side effect profiles, and specific clinical considerations for each agent helps clinicians make individualized, well-reasoned prescribing decisions.
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluoxetine (Prozac)
Escitalopram (Lexapro)
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
This is an area of clinical complexity that demands careful attention, because the medications used to treat OUD and those used to treat co-occurring mental health conditions interact in ways that require active monitoring and patient education.
Buprenorphine itself possesses serotonergic properties due to its activity as a kappa-opioid receptor antagonist. The kappa-opioid receptor is involved in dysphoria, stress, and negative affect regulation, and its antagonism by buprenorphine contributes to the medication’s antidepressant and mood-stabilizing effects beyond its purely opioid receptor-mediated actions.
When buprenorphine is combined with SSRIs or SNRIs, there is a theoretically elevated risk of serotonin syndrome due to additive serotonergic activity. However, this risk is characterized in the literature as low rather than prohibitive, and the clinical evidence consistently demonstrates that the benefits of treating co-occurring depression or anxiety with SSRIs while maintaining buprenorphine outweigh the risks. Specifically, the literature has found that treating underlying depression and anxiety is important. At the same time, maintaining a patient on buprenorphine increases retention in OUD treatment, which is one of the most powerful predictors of sustained recovery (Manhapra et al., 2018).
This means that the combination should not be avoided; rather, it should be implemented thoughtfully with:
Methadone is a full mu-opioid receptor agonist with complex pharmacokinetics, including blockade of the hERG potassium channel in cardiac myocytes, which predisposes patients to QTc interval prolongation and, in severe cases, torsades de pointes, a potentially fatal cardiac arrhythmia. This cardiac risk is inherent to methadone itself, before any additional medications are considered.
Several antidepressants also prolong the QTc interval, and when combined with methadone, the cumulative effect can be clinically dangerous. The most notable example is citalopram, which has a dose-dependent QTc-prolonging effect that is particularly significant:
Clinical monitoring protocol for patients on methadone combined with QTc-prolonging antidepressants:
General QTc thresholds of clinical concern:
Naltrexone, as an opioid antagonist, blocks the mu-opioid receptor and thereby eliminates the reinforcing effects of opioid use. However, naltrexone carries a black box warning regarding depression and suicidality. The physiological basis for this warning is that endogenous opioid signaling through the mu-opioid receptor plays an important role in mood regulation, reward, and social bonding. When this system is completely blocked by naltrexone, some individuals experience a worsening of mood, anhedonia, or dysphoria, which may increase suicide risk.
When naltrexone is combined with SSRIs or SNRIs that also carry black box warnings about suicidality in young adults, this creates a layered clinical risk that must be explicitly discussed with the patient and their support network.
Critically, however, this is not a contraindication to either naltrexone or antidepressant use. The risk-benefit calculus here is clear: untreated OUD in the presence of untreated depression carries a far greater risk of death by suicide than the theoretical additive risk of these medications together. The combination must be approached with thorough informed consent, close monitoring, and a clear safety plan that includes the 988 Suicide and Crisis Lifeline and emergency department resources.
Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central and peripheral nervous system. It occurs on a spectrum from mild to life-threatening and can develop rapidly after the addition of any serotonergic medication to an existing regimen.
The SHIVERS mnemonic provides an efficient clinical recall tool:
All clinicians managing patients on any combination of serotonergic medications, including buprenorphine with SSRIs or SNRIs, should be familiar with these signs and symptoms and should educate patients to seek immediate evaluation if they experience any of them.
To make these clinical concepts tangible, consider the following case:
Patient profile:
Screening results:
Clinical reasoning and treatment planning:
The PHQ-9 score of 18 indicates moderately severe depression, which is significantly impacting her daily functioning. The GAD-7 score of 15 indicates severe anxiety. The PCL-5 score of 10 does not cross the diagnostic threshold for PTSD. Still, given her history of intimate partner violence, this should be repeated at future visits, particularly if her situation changes or her symptoms evolve.
Her urine drug screen is positive for buprenorphine and negative for other substances, confirming her self-report of abstinence from other opioids. This is an important clinical data point: she is adherent to her MOUD and engaged in her recovery. The psychological suffering she is experiencing represents an untreated co-occurring condition, not a sign of treatment failure.
Treatment plan:
This last element is where our clinical model adds distinctive value. By addressing her chronic musculoskeletal pain through non-opioid chiropractic care and functional medicine, we reduce the physiological motivation to return to opioid use for pain management, making her recovery more sustainable.
The intersection of opioid use disorder and pregnancy represents one of the most urgent public health challenges in contemporary maternal-fetal medicine. The epidemiological data paint a sobering picture:
These numbers are not abstract statistics. Each represents a mother navigating one of the most physically and emotionally demanding experiences of her life while simultaneously managing a complex neurobiological disorder, frequently in the presence of poverty, trauma, limited social support, and systemic stigma.
The profound stigma that surrounds pregnancy and OUD is a clinical concern in its own right, because it directly impairs access to care and is associated with worse maternal and neonatal outcomes. Pregnant women with OUD frequently face:
This stigma is not simply an interpersonal problem; it is a systemic clinical problem because it drives patients away from the prenatal care, addiction treatment, and harm reduction services they desperately need. When stigma deters a pregnant woman with OUD from seeking care, the consequences include increased risk of overdose, inadequate prenatal monitoring, and worse neonatal outcomes.
In our clinical setting, we address this by implementing trauma-informed, non-stigmatizing care at every level of the patient encounter, from the language used in clinical documentation to the tone of every provider-patient interaction.
Given the high prevalence of OUD in pregnancy and the serious associated risks, universal screening is essential. Universal screening means that all pregnant patients are screened, not just those whom clinicians suspect of substance use based on appearance, demographics, or behavior. Selective screening is known to reflect implicit bias and systematically misses patients, particularly those from higher socioeconomic backgrounds or those who do not fit the stereotyped profile of a person with OUD.
The 4Ps is a brief, validated screening tool specifically designed for use in prenatal settings. The four domains assessed are:
Any positive response to any of the four questions triggers further assessment. The tool is brief and non-threatening, making it suitable for integration into routine prenatal intake processes.
The inclusion of questions about family and partner history is clinically significant, as it reflects the evidence that familial and environmental factors are major predictors of substance use disorder risk. A patient whose parent has an alcohol use disorder and whose partner currently uses substances is at substantially elevated risk, regardless of their own current use patterns.
The NIDA Quick Screen is a validated brief screener developed by the National Institute on Drug Abuse for use in primary care and prenatal settings. It asks about substance use within the past year, covering alcohol, tobacco, and other drugs.
For women, a positive screen is triggered by:
A positive screen triggers structured follow-up assessment using validated substance-specific tools to determine the nature and severity of the substance use.
The CRAFFT is a validated screening tool primarily designed for individuals under age 27, making it particularly applicable for adolescent and young adult pregnant women, a population with unique risk profiles. The CRAFFT acronym represents a series of behavioral questions:
Two or more positive responses indicate a need for further assessment. The CRAFFT captures the behavioral and functional consequences of substance use that are most relevant to identifying a disorder, going beyond simple use frequency to assess impact and loss of control.
Understanding the physiological mechanisms by which OUD affects pregnancy outcomes is essential for motivating both patients and clinicians to pursue aggressive treatment. Many of the complications associated with OUD in pregnancy result from the cyclical pattern of opioid intoxication and withdrawal that characterizes untreated OUD.
During opioid intoxication, the fetus is exposed to the sedating, vasodilatory, and respiratory-depressant effects of opioids. During opioid withdrawal, the mother and fetus both experience a hyperadrenergic state, characterized by surges in norepinephrine, cortisol, and other stress hormones, which produces vasoconstriction, tachycardia, uterine irritability, and fetal distress.
This oscillating physiological state is far more damaging to maternal and fetal health than a stable state of opioid maintenance at a consistent dose, which is a fundamental argument for medications for opioid use disorder (MOUD) over untreated OUD or medically supervised withdrawal.
Specific complications associated with OUD in pregnancy include:
Neonatal Opioid Withdrawal Syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), refers to the constellation of symptoms experienced by neonates who were exposed to opioids in utero and are experiencing withdrawal from those opioids after birth.
A critical clinical and ethical point that must be clearly understood and communicated to both patients and healthcare teams is that babies cannot be diagnosed with opioid use disorder. Opioid use disorder, per the DSM-5, requires a pattern of maladaptive behaviors related to substance use, which a neonate is developmentally incapable of exhibiting. NOWS is a physiological withdrawal state, not evidence of addiction. This distinction is not merely semantic; it is foundational to providing ethical, non-stigmatizing care to these infants and their mothers.
Clinical signs of NOWS typically emerge within 24 to 72 hours after birth for short-acting opioids, and 36 to 48 hours for buprenorphine or methadone, reflecting the longer half-lives of these medications. Symptoms include:
NOWS symptoms can last days to weeks, depending on the type of opioid the baby was exposed to, the dose, the duration of exposure, and individual genetic and physiological variability.
The Eat Sleep Console (ESC) Method
The Eat Sleep Console approach has been increasingly adopted as a simplified, functional, family-centered assessment of NOWS severity. Rather than complex physiological scoring, ESC asks three straightforward questions:
If a baby consistently meets these three criteria, pharmacological treatment may be deferred or avoided, and non-pharmacological supportive care can be prioritized. This approach has been associated with reduced pharmacological treatment rates, shorter hospital stays, and higher breastfeeding rates than traditional Finnegan-based scoring (Grossman et al., 2017).
The Finnegan Neonatal Abstinence Scoring System (FNASS)
The Finnegan Neonatal Abstinence Scoring System is the historically dominant NOWS assessment tool. It is a comprehensive 21-item scoring system that rates the severity of specific withdrawal symptoms, including:
Each item is scored based on severity, and a total score above 8 on two consecutive assessments, or above 12 on a single assessment, typically triggers pharmacological intervention in traditional Finnegan-based protocols. The complexity of this system is one of the primary reasons that many institutions are transitioning to the simpler, more functional ESC model.
Non-pharmacological care is the first-line approach for NOWS management and is effective in mild to moderate cases:
Critically, rooming-in with the mother is recommended for all NOWS babies, consistent with standard newborn care protocols. Separating mother and infant is associated with worse outcomes, increased pharmacological treatment needs, and impaired maternal bonding, which is particularly harmful given the already elevated risk of maternal depression and anxiety in this population.
When non-pharmacological care is insufficient:
One of the most important and frequently misunderstood clinical issues in OUD and pregnancy is breastfeeding. Cultural stigma and clinical misconceptions have led to inappropriate restriction of breastfeeding for mothers on MOUD, depriving both mothers and infants of significant benefits.
The evidence is clear: breastfeeding benefits are present for mothers with OUD on MOUD and are comparable to those observed in the general population.
In the specific context of NOWS, breastfeeding has been shown to reduce the severity of withdrawal symptoms, reduce the need for pharmacological treatment, and shorten the duration of hospitalization.
Breastfeeding is not universally contraindicated in women on MOUD. In fact, buprenorphine and methadone are explicitly safe for breastfeeding. The levels of these medications that transfer into breast milk are pharmacologically insignificant and are actually associated with reduced NOWS severity in nursing infants.
Contraindications to breastfeeding in this population include:
Buprenorphine and methadone are the established, first-line treatments for OUD in pregnancy, supported by universal recommendations from:
Both medications are FDA-approved for OUD treatment during pregnancy and have decades of evidence supporting their safety and efficacy in this population.
Medically supervised withdrawal (detoxification) is not recommended for pregnant women with OUD, despite the intuitive appeal of eliminating opioid exposure. The evidence clearly demonstrates that:
The goal of treatment in pregnancy is not to eliminate all opioid exposure; it is to stabilize the mother’s physiology, eliminate the harm of the use-withdrawal cycle, and support consistent engagement in prenatal care and behavioral health treatment.
Buprenorphine is a partial mu-opioid receptor agonist and kappa-opioid receptor antagonist that provides stable, sustained opioid receptor occupancy without the peaks and troughs associated with illicit opioid use. Its ceiling effect on respiratory depression makes it significantly safer than full agonists like methadone in terms of overdose risk.
Buprenorphine-naloxone (Suboxone) is the most commonly prescribed formulation for OUD treatment, combining buprenorphine with naloxone (an opioid antagonist) to deter intravenous misuse. The naloxone component has negligible systemic bioavailability when taken sublingually or buccally, so it does not pose a significant risk to the fetus.
Clinical evidence supports buprenorphine in pregnancy for:
Methadone is a full mu-opioid receptor agonist with complex pharmacokinetics, including its long half-life (24 to 36 hours) and the need for daily dispensing through specialized opioid treatment programs (OTPs). Despite greater access challenges, methadone remains a critically important option for women who:
Methadone in pregnancy is associated with more severe NOWS compared to buprenorphine, due to its full agonist properties and longer half-life. However, it is still associated with far better outcomes than untreated OUD.
Naltrexone is not contraindicated in pregnancy, but it is not the first-line treatment for OUD in pregnant women. The primary reasons for this are:
If a patient is strongly motivated for naltrexone and has been fully informed of the risks and limitations, it may be considered on a case-by-case basis with careful shared decision-making.
The evidence on the impact of MOUD on neonatal outcomes is reassuring:
Patient profile:
Clinical workup:
Treatment plan:
The opioid crisis has reached deeply and devastatingly into the adolescent population, with mortality data that should alarm every clinician who works with young people:
That final statistic is perhaps the most damning: the vast majority of adolescents who died from opioid overdose had never received treatment for their opioid use disorder. This represents a catastrophic failure of identification, engagement, and access to care that the clinical community has a moral obligation to address.
The emergence of illicitly manufactured fentanyl as the dominant driver of adolescent overdose deaths reflects a fundamental change in the risk landscape. Adolescents who might previously have experimented with prescription opioids or heroin and survived due to dose familiarity are now encountering substances of unpredictable, lethal potency. A single counterfeit pill containing fentanyl can deliver a fatal dose to an opioid-naive adolescent. This reality makes harm reduction education and naloxone access more urgent than ever.
Understanding the risk and protective factor landscape in adolescent substance use disorder allows clinicians to tailor prevention and early intervention strategies effectively.
Effective adolescent substance use screening requires attention to both the clinical content and the relational context in which it occurs. Adolescents are less likely than adults to disclose substance use if they fear judgment, punishment, or breach of confidentiality.
Before initiating any substance use screening with an adolescent patient, clinicians should:
The S2BI (Screening to Brief Intervention) is a validated adolescent substance use screening tool that assesses frequency of use for specific substance categories within the past year. For each substance (tobacco, alcohol, marijuana, other drugs), the adolescent is asked how many times they used it in the past year:
The S2BI’s frequency-based approach reflects the evidence that frequency of use is the strongest behavioral predictor of substance use disorder development, making it a clinically efficient stratification tool.
The BSTAD takes a more quantitative approach, asking how many days in the past year each substance was used. This level of specificity provides more granular clinical information and allows for more precise risk stratification.
BSTAD is also notable for its comprehensive substance list, which includes:
This comprehensive approach is important in the contemporary drug environment, where polysubstance use is increasingly common and where the interaction between substances (particularly opioids and benzodiazepines or alcohol) dramatically amplifies overdose risk.
As previously described in the pregnancy section, the CRAFFT assesses the behavioral consequences of substance use rather than simply frequency, making it particularly sensitive for identifying disordered use patterns even at lower frequency levels. Two or more positive responses indicate a need for full clinical assessment.
Naloxone distribution and education is the most immediately impactful harm reduction intervention for adolescents with OUD and those in their social networks. The reality of the current fentanyl-dominated drug supply makes naloxone not merely a treatment adjunct but a life-saving emergency intervention that must be universally accessible.
Clinical action steps include:
Adolescents with OUD require developmentally appropriate behavioral health services that differ meaningfully from adult addiction treatment. Considerations include:
Buprenorphine is FDA-approved for adolescents aged 16 and older with moderate to severe opioid use disorder. This approval reflects the accumulated evidence that the benefits of buprenorphine in reducing opioid use, overdose risk, and treatment dropout significantly outweigh the theoretical concerns about providing an opioid-based medication to a developing adolescent brain.
Naltrexone and methadone are not FDA-approved for adolescents under 18 for OUD treatment. The age thresholds reflect both the regulatory framework and practical considerations about the developmental appropriateness of each medication’s requirements and side effect profile.
Importantly, ASAM (American Society of Addiction Medicine) adolescent treatment guidelines are currently being updated, with new guidance anticipated in 2026. Clinicians working with adolescents should monitor for these updated guidelines, which will reflect the most current evidence on developmentally appropriate OUD treatment.
Patient profile:
Clinical workup:
Treatment plan:
Integrative care note: Her history includes an ankle injury requiring surgery, the original event that triggered opioid exposure. This is precisely the type of clinical scenario that our integrative model is designed to address. Had she had access to comprehensive chiropractic rehabilitation and functional medicine support after her ankle surgery, the trajectory of opioid prescribing and subsequent misuse might have been very different. This case is a powerful argument for integrating non-opioid pain management into all post-surgical recovery protocols, particularly for adolescents with identified vulnerability factors.
Opioid use disorder in older adults is a growing clinical concern that has historically received far less attention than OUD in younger populations. The data, however, are clear:
Several factors contribute to the elevated and growing OUD burden in older adults:
Treatment of OUD in older adults requires thoughtful, individualized pharmacological decision-making that accounts for the physiological changes of aging. The fundamental principle remains the same: the benefits of MOUD almost universally outweigh the risks, particularly given that the alternative, untreated OUD in the context of a fentanyl-contaminated drug supply, carries an extremely high mortality risk.
However, the absence of sufficient clinical trial data in participants over age 65 means that evidence-based dosing guidance is more limited in this population, requiring greater reliance on clinical judgment, pharmacological principles, and close monitoring.
Age-related decline in hepatic and renal function is a universal physiological phenomenon that directly affects the metabolism and clearance of MOUD medications:
Renal considerations with methadone:
Hepatic considerations with methadone:
Renal considerations with buprenorphine:
Hepatic considerations with buprenorphine:
Older adults face an inherently elevated cardiac risk profile due to:
In this context, QTc monitoring in older adults on methadone is particularly critical:
Methadone carries a heightened risk of respiratory depression in older adults compared to buprenorphine, due to several age-related factors:
These factors collectively argue for more conservative methadone dosing in older adults, more frequent monitoring, and a lower threshold for considering buprenorphine as a potentially safer alternative in patients where QTc and respiratory concerns are significant.
Given the heightened pharmacological risks and the limited evidence base in this population, older adults on MOUD benefit from:
Among the most clinically challenging scenarios in OUD management is the care of patients who are concurrently using or prescribed benzodiazepines or other CNS depressant medications. This situation is extremely common, given the high prevalence of anxiety disorders, sleep disorders, chronic pain, and psychiatric conditions in the OUD population, all of which are frequently managed with CNS depressant medications.
The clinical tension is clear: benzodiazepines and other CNS depressants, when combined with opioids (including MOUD medications), increase the risk of respiratory depression, which is the primary mechanism of opioid overdose death. At the same time, withholding MOUD from a patient with OUD who is also taking benzodiazepines exposes that patient to the far greater respiratory depression risk of illicit opioid use, particularly in the current fentanyl-dominated drug supply.
The U.S. Food and Drug Administration (FDA) addressed this tension definitively in a landmark statement, urging healthcare providers not to withhold MOUD from patients with OUD solely because they are also prescribed benzodiazepines or other CNS depressant medications (FDA, 2017). This guidance was issued precisely because clinicians were making a dangerous error of clinical reasoning: withholding the safer medication (MOUD) out of concern about drug interactions, while leaving patients exposed to the far more dangerous alternative (illicit opioid use).
The core principles of this guidance are:
Benzodiazepines are not first-line treatment for generalized anxiety disorder in any population, but they are prescribed frequently for anxiety and sleep disorders, and many patients with OUD are already established on benzodiazepines when they present for addiction treatment. This creates a clinical situation that requires careful management.
Benzodiazepines work by potentiating the effect of GABA (gamma-aminobutyric acid) at the GABA-A receptor, producing rapid anxiolytic, sedative, and muscle-relaxing effects. While this mechanism is effective in the short term, it creates several problems with long-term use:
For patients with anxiety disorders and OUD, SSRIs and SNRIs are the appropriate first-line pharmacological treatment, supplemented by evidence-based psychotherapy such as CBT, as discussed in Section One.
When a patient with OUD presents already established on benzodiazepine therapy:
The FDA guidance specifically identifies several other classes of CNS depressant medications that require similar clinical attention:
Non-benzodiazepine sleep medications (the “Z-drugs”), including zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), work through similar GABA-A mechanisms as benzodiazepines and carry similar risks in combination with MOUD. Sleep disturbance is extremely common in OUD and recovery, often persisting for months to years after opioid cessation due to opioid-induced disruption of sleep architecture.
Management strategies:
Baclofen and other muscle relaxants have significant CNS depressant effects and are commonly prescribed for chronic musculoskeletal pain conditions, which are highly prevalent in the OUD population. The combination of baclofen with opioids has been associated with increased overdose risk, including through a synergistic effect on GABA-B receptors and brainstem respiratory centers.
In our integrative clinical model, chiropractic care and rehabilitation provide effective, evidence-based alternatives to chronic muscle relaxant use for musculoskeletal pain. By addressing the underlying biomechanical dysfunction, myofascial trigger points, and movement impairments that drive pain and muscle spasm, we reduce the clinical need for muscle relaxant medications, decreasing the CNS depressant burden in patients on MOUD.
Antipsychotic medications, including aripiprazole, paliperidone, quetiapine, and others, are frequently prescribed for patients with co-occurring psychotic disorders, bipolar disorder, and treatment-resistant depression. Many of these medications carry CNS depressant effects and QTc prolongation risk that interact clinically with MOUD.
Quetiapine, in particular, is frequently prescribed off-label for insomnia and anxiety in patients with substance use disorders, sometimes at doses that produce meaningful sedation. When combined with MOUD, this increases respiratory depression risk and warrants careful clinical monitoring.
The management approach for antipsychotics differs from benzodiazepines: because antipsychotics are often prescribed for conditions (psychosis, bipolar disorder) that cannot be safely managed without medication, the goal is not necessarily to taper or discontinue them, but to:
The overarching principle that should guide all clinical decision-making in the complex polypharmacy scenarios described above is the explicit, systematic risk-benefit analysis applied to each patient.
This means:
As I regularly discuss in my clinical observations at ChiropracticScientist.com, the integration of functional medicine and chiropractic perspectives into these complex clinical decisions often reveals additional dimensions of care that purely pharmacological approaches miss, including the role of nutrition, gut-brain axis function, inflammatory burden, and neuroendocrine dysregulation in both addiction biology and co-occurring mental health conditions.
Functional medicine is an approach to healthcare that seeks to identify and address the root biological, environmental, and lifestyle causes of disease, rather than simply managing symptoms. In the context of OUD, functional medicine offers a powerful complementary lens to the standard addiction medicine framework.
Several functional medicine domains are particularly relevant to OUD prevention, treatment, and recovery support:
Emerging research demonstrates that neuroinflammation plays a significant role in both the development and perpetuation of opioid addiction and in the genesis of the chronic pain conditions that frequently precede opioid misuse. Chronic opioid use activates microglia (the brain’s resident immune cells). It promotes the release of pro-inflammatory cytokines, including TNF-alpha, IL-1beta, and IL-6, in brain regions critical to reward, motivation, and pain processing.
This neuroinflammatory state contributes to:
Functional medicine approaches to reducing neuroinflammation in the OUD population include:
The hypothalamic-pituitary-adrenal (HPA) axis is the body’s primary stress response system, coordinating the release of cortisol and CRF (corticotropin-releasing factor) in response to perceived threats. Chronic opioid use profoundly dysregulates the HPA axis, producing a state of chronic hypercortisolemia during use and HPA axis hyperreactivity during withdrawal and early recovery.
This HPA dysregulation manifests clinically as:
Functional medicine strategies to support HPA axis normalization in OUD recovery include:
Opioid use disorder is associated with significant nutritional deficiencies through multiple mechanisms, including poor dietary habits, gastrointestinal effects of opioids on nutrient absorption, and the metabolic demands of the recovery process. Common deficiencies include:
Comprehensive nutritional assessment and targeted supplementation, integrated into the overall OUD treatment plan, supports neurological recovery, mood stabilization, immune function, and the restoration of physical wellbeing that is central to sustainable recovery.
One of the most exciting developments in contemporary chiropractic science is the growing understanding of how spinal manipulative therapy (SMT) affects not only local musculoskeletal function but also central nervous system physiology in ways relevant to pain processing, stress response, and neurological health.
My clinical observations, which I share regularly at ChiropracticScientist.com and on my LinkedIn profile, have consistently reflected the profound neurological dimension of chiropractic care in patients recovering from opioid use disorder. The following mechanisms are supported by current research:
Research has demonstrated that SMT is associated with increased plasma concentrations of beta-endorphins, the body’s endogenous opioid peptides (Haavik-Taylor & Murphy, 2007). In a patient in OUD recovery, this mechanism is particularly compelling. By activating endogenous opioid signaling through a non-opioid, non-pharmacological intervention, chiropractic care can help restore the normal tone of the endogenous opioid system that has been disrupted by years of exogenous opioid exposure.
The endogenous opioid system comprises beta-endorphins, enkephalins, dynorphins, and their respective receptors (mu, delta, and kappa opioid receptors). This system is critically important for:
Chronic opioid use downregulates endogenous opioid receptor expression and depletes endogenous opioid peptide production, contributing to the anhedonia, emotional blunting, and pain hypersensitivity that characterize protracted opioid withdrawal. Chiropractic care, by stimulating endogenous opioid release through non-pharmacological mechanisms, may help accelerate the normalization of this dysregulated system during recovery.
The autonomic nervous system (ANS), encompassing the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) branches, is profoundly dysregulated in OUD and withdrawal states. The hyperadrenergic state of opioid withdrawal, characterized by tachycardia, hypertension, diaphoresis, anxiety, and gastrointestinal distress, is essentially a state of sympathetic overdrive.
Research demonstrates that cervical and thoracic spinal manipulation has measurable effects on autonomic nervous system balance, including:
By promoting parasympathetic tone and reducing sympathetic hyperactivity, chiropractic care supports the physiological transition from the hyperarousal state of withdrawal to the calmer, more regulated state conducive to recovery.
Physical exercise and movement are among the most powerful non-pharmacological modulators of the brain’s reward and motivation systems. Exercise activates the mesolimbic dopamine system (the same system dysregulated by opioid use), promotes BDNF (brain-derived neurotrophic factor) expression (which supports neuroplasticity and cognitive function), and reduces anxiety, depression, and craving through multiple neurobiological mechanisms (Leuenberger et al., 2022).
In many individuals with OUD, the ability to engage in regular exercise has been severely impaired by:
Comprehensive chiropractic rehabilitation addresses these barriers, restoring the physical capacity to engage in the exercise and movement foundational to neurological recovery. This is why physical rehabilitation is not a peripheral concern in OUD treatment but a central component of comprehensive integrative care.
At Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, the clinical philosophy that guides our approach to complex conditions like OUD reflects everything described in this educational post.
Dr. Maria Guadalupe Cardenas, MD, and I, Dr. Alexander Jimenez, DC, APRN, FNP-BC, operate within a truly integrated clinical model where the boundaries between disciplines are intentionally permeable. A patient presenting with chronic low back pain following a motor vehicle accident, for example, does not see a chiropractor for their spine and a physician for their mental health as two separate, disconnected encounters. They receive care within a coordinated framework where:
This model is particularly powerful for patients whose pain management journey has led them into the territory of opioid misuse or dependence, a story that, as the research in this post clearly demonstrates, is far more common than most people appreciate. Whether the patient is a 32-year-old mother with degenerative disc disease and co-occurring depression, a 16-year-old soccer player whose post-surgical oxycodone prescription opened the door to heroin, or a 65-year-old veteran managing chronic spinal pain and opioid dependence, our integrative model provides a clinical home where all dimensions of their complexity can be addressed.
As I have discussed in my clinical observations and educational content at ChiropracticScientist.com and LinkedIn, the future of pain management and addiction medicine lies in integration: the thoughtful, evidence-based combination of biomedical, behavioral, nutritional, and mechanical interventions that address the whole person rather than isolated organ systems or diagnostic categories.
The landscape of opioid use disorder is complex, evolving, and deeply human. As I reflect on the evidence presented throughout this educational post, several overarching themes emerge:
At Injury Medical Clinic PA, we are committed to this comprehensive vision of care. We invite patients, families, clinicians, and community members to engage with the evidence presented here and to reach out to our team to explore how integrative care can support recovery, health, and human flourishing.
SEO Tags: opioid use disorder treatment, OUD co-occurring mental health, buprenorphine pregnancy, neonatal opioid withdrawal syndrome, MOUD medications, chiropractic and opioid use disorder, integrative addiction treatment, adolescent opioid use disorder, OUD older adults, benzodiazepines and MOUD, trauma-informed care addiction, functional medicine opioid recovery, Dr. Alex Jimenez El Paso, Injury Medical Clinic PA, Dr. Maria Cardenas MD, PHQ-9 GAD-7 PCL-5 screening, SSRI SNRI opioid use disorder, methadone QTc prolongation, buprenorphine naloxone, naltrexone OUD, neonatal abstinence syndrome treatment, eat sleep console NOWS, CRAFFT adolescent screening, opioid overdose prevention, harm reduction fentanyl, serotonin syndrome SHIVERS, cognitive behavioral therapy addiction, EMDR PTSD opioid, prolonged exposure therapy, OUD pregnancy complications, breastfeeding buprenorphine methadone, functional medicine neuroinflammation, HPA axis addiction, spinal manipulation endorphins, chiropractic autonomic nervous system, integrative chiropractic care El Paso, multidisciplinary addiction clinic, personal injury opioid misuse, degenerative disc disease opioids, post-surgical opioid dependence, 988 crisis lifeline, naloxone prescription, NIDA quick screen pregnancy, 4Ps pregnancy screening, S2BI adolescent screening, BSTAD substance use, OUD Medicare Medicaid older adults, Black Americans opioid disparity, Native American opioid use, OUD socioeconomic factors, chiropractic scientist, evidence-based addiction medicine 2026
Professional Scope of Practice *
The information herein on "Integrative OUD Care Approaches With Chiropractic Rehabilitation" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
Blog Information & Scope Discussions
Welcome to El Paso's Premier Wellness, Personal Injury Care Clinic & Wellness Blog, where Dr. Alex Jimenez, DC, FNP-C, a Multi-State board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our multidisciplinary team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those on this site and our family practice-based chiromed.com site, and focuses on restoring health naturally for patients of all ages.
Our areas of multidisciplinary practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.
Our information scope is multidisciplinary, focusing on musculoskeletal and physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somato-visceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and functional medicine articles, topics, and discussions.
We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for musculoskeletal injuries or disorders.
Our videos, posts, topics, and insights address clinical matters and issues that are directly or indirectly related to our clinical scope of practice.
Our office has made a reasonable effort to provide supportive citations and has identified relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900.
We are here to help you and your family.
Blessings
Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-state Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
Colorado License #: C-APN.0105610-C-NP, Verified: C-APN.0105610-C-NP
New York License #: N25929, Verified N25929
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)
(Licensed Medical Doctor)
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
Licenses and Board Certifications:
MD: Medical Doctor
DC: Doctor of Chiropractic
APRNP: Advanced Practice Registered Nurse
FNP-BC: Family Practice Specialization (Multi-State Board Certified)
RN: Registered Nurse (Multi-State Compact License)
CFMP: Certified Functional Medicine Provider
MSN-FNP: Master of Science in Family Practice Medicine
MSACP: Master of Science in Advanced Clinical Practice
IFMCP: Institute of Functional Medicine
CCST: Certified Chiropractic Spinal Trauma
ATN: Advanced Translational Neutrogenomics
Memberships & Associations:
TCA: Texas Chiropractic Association: Member ID: 104311
AANP: American Association of Nurse Practitioners: Member ID: 2198960
ANA: American Nurse Association: Member ID: 06458222 (District TX01)
TNA: Texas Nurse Association: Member ID: 06458222
NPI: 1205907805
| Primary Taxonomy | Selected Taxonomy | State | License Number |
|---|---|---|---|
| No | 111N00000X - Chiropractor | NM | DC2182 |
| Yes | 111N00000X - Chiropractor | TX | DC5807 |
| Yes | 363LF0000X - Nurse Practitioner - Family | TX | 1191402 |
| Yes | 363LF0000X - Nurse Practitioner - Family | FL | 11043890 |
| Yes | 363LF0000X - Nurse Practitioner - Family | CO | C-APN.0105610-C-NP |
| Yes | 363LF0000X - Nurse Practitioner - Family | NY | N25929 |
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
MFAT for Auto Injury Recovery: How Regenerative Medicine and Chiropractic Rehabilitation Work Together Abstract Car… Read More
IV Therapy and Chiropractic Care for Injury Recovery Abstract Musculoskeletal injuries can affect joints, muscles,… Read More
By Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST Read More
Can Bioidentical Hormone Therapy Help With Mobility and Flexibility? Abstract: Bioidentical hormone replacement therapy (BHRT)… Read More
BHRT Diet Plan for Hormone Health and Inflammation Bioidentical hormone replacement therapy, or BHRT, uses… Read More
By Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST Read More
Personal Injury, Trauma & Spine Rehab Specialists