Initial Treatment for Acute Low Back Pain and Risk of Opioid Use Disorder and Overdose

Source:

Doan LV, Hung AM, Olfson M, Williams NT, Rudolph KE. Initial Treatment for Acute Low Back Pain and Risk of Opioid Use Disorder and Overdose. JAMA Netw Open. 2026;9(10):e2639420. doi:10.1001/jamanetworkopen.2026.39420

Key Points

Question  What is the incidence of opioid use disorder (OUD) or overdose diagnoses after initiating treatment for acute low-back pain (aLBP), and what is the comparative risk for different treatment options?

Findings  In this cohort study of 399 500 opioid-naive adults with Medicaid insurance, the cumulative incidence of OUD or overdose diagnosis was 2% at 13 months after initiating treatment for aLBP. Initiating higher-dose opioids (>50 mg of morphine equivalent) was associated with the highest risk, whereas chiropractic work was associated with the greatest risk reduction.

Meaning  These findings support guideline recommendations favoring nonpharmacologic treatment for aLBP.