Massachusetts Law Better Positions Chiropractic to Address Opioid Crisis April 29, 2025

The Massachusetts Legislature passed into law last December a sweeping bill (H. 5143) covering topics related to substance use disorder and ushering in new strategies to address opioid use disorder (OUD) that are inclusive of a broad range of stakeholders, including doctors of chiropractic. Howard Ewert, DC, a member of the Massachusetts Chiropractic Society (MSC) and the ACA Opioid Advisory Board, who has been involved in the effort to pass the bill, says the changes bring the chiropractic profession “to the table” in a meaningful way to tackle OUD.

The legislation (H. 5143) addresses the opioid crisis by, among other things, creating a new profession of “peer recovery coaches” who have themselves recovered from OUD and are trained to help others in recovery, and by ensuring that insurance companies provide adequate coverage and access to a broad spectrum of pain management services that include integrative therapies such as chiropractic. The new law further instructs insurers to provide access to non-drug therapies for pain management with no prior authorization. In addition to chiropractic, the bill mentions options such as acupuncture, massage and movement therapies.

Another significant addition is the inclusion of “relevant stakeholders” in the development of new training for prescribers, to ensure they are educated about effective pain management options – including non-drug pain approaches – available to their patients, if appropriate.

“The Massachusetts Chiropractic Society has been introducing legislative bills for many years seeking to require this type of inclusion of relevant stakeholders (such as MCS) in the preparation of such training programs, and implementation of other governmental policies,” explained Dr. Ewert. “Based on this new law, we will now finally have a seat at the table, to be able to discuss how to use safer alternatives to opioid prescribing [when clinically appropriate], specifically including chiropractic.”

The ACA Blog caught with Dr. Ewert recently to learn more:

What is the situation today regarding opioids in Massachusetts? Has some progress been made in reducing prescriptions?

Massachussetts has a prescription monitoring program (PMP) since 2015, which monitors every schedule II opioid prescription. There has been a decrease in opioid prescriptions by approximately 50% since the peak in 2015, with currently about 200,000 individuals receiving an opioid prescription each quarter. Opioid overdose deaths have also dropped by approximately 10% between 2022 and 2023, but the current number is still about the same as the previous high of 2,111 individuals in 2016. There is clearly room for further improvement.

You mentioned that MCS has been introducing this type of legislation for years. What finally got you past the finish line?

Team effort. MCS has made this a priority for years now, and focused lots of energy and effort on this. The MCS legislative team has been vigilant and hard-working, and had many discussions with the chairs of the Joint Committee on Mental Health, Substance Use and Recovery as well as Rep. Adrian Madaro (D), House Speaker Ronald Mariano (D), Senate President Karen Spilka (D) and Sen. John Velis (D), where they appreciated the role that chiropractic could play in this effort. Legislators have seen the need for primary prevention of opioid initiation, which can be provided by utilizing chiropractic care more broadly, at the onset of a patient’s care for pain management. The House of Representatives and the Senate voted unanimously for the precurser bills that led to the H. 5143 bill that eventually got through both houses and signed into law. It took the whole village cooperating.

What was most challenging about getting this bill passed?

Waiting for the stars to finally align, for everything to be in place.

Was there any pushback regarding the stipulation that there would be no prior authorization required for non-drug treatments? If so, how did you address that?

Actually, that language was written into the bill by the legislators who wrote the compromise bill between the house and senate version, which became the final bill, H. 5143. They introduced different levels of “incentivizing” use of various parts of the new bill. So, for example, if a patient uses naloxone for reversal of an overdose, that will not require prior authorization, nor a prescription, nor will that be subject to any deductible, coinsurance, copayments or out-of pocket limits.

Have other states reached out to Massachusetts, asking how you got this done?

MCS is hoping that disseminating this information through the ACA blog will help inform and encourage other states to pursue this avenue. Any requests for information should be directed to Tracey Lane, MCS executive director, at www.masschiro.org.

Do you know if your Massachusetts bill is novel in comparison to opioid legislation in other states?

Several novel components. An important part of our MCS goal was to increase communication between our chiropractic society and our state governmental health agencies. We think that is a novel approach for tackling the opioid epidemic, because it is not merely about opioids, it’s about communication and creating opportunities for collaboration, about noticing that many different groups within the healthcare system can and should work together for the public good. Also novel in that although the Commonwealth of Massachusetts was a pioneer in terms of making legislative changes around 2015 to try to reduce the opioid epidemic, it took another 10 years until the legislature included specific novel wording [in H. 5143] about ensuring that patients have access and coverage for “treatment options that serve as alternatives to opioid prescribing,“ recognizing that the chiropractic profession (and other nonpharmacologic professions) can be a partner, a collaborator with them, in the effort to reduce the opioid epidemic and protect citizens.

MCS has been pushing the concept of including relevant stakeholders and experts in pain management through nonopioid care (such as chiropractic) in the effort to reduce the opioid epidemic. This concept was expressed well by the 2023 document from RAND by Drs. Ryan Burdick and Michele Miers et al, “Alternatives to Opioids – A missing piece of the strategy.” We were very glad to see that concept (relevant stakeholders and experts in treatment options that serve as alternatives to opioid prescribing) included in the new opioid law.

Also novel: subsequent to the new law going into effect, MCS has had the opportunity to have several meetings with relevant departments of the Massachusetts government, which simply have not happened before. When we introduce the simple concept that, of course, patients deserve access to prescription medications when necessary, but patients also deserve the option of using OTHER forms of care that are safe and effective and serve as alternatives to opioid prescribing, along with financial access and coverage on par with access to opioids, government policy makers seem quick to agree. What is there for them to disagree with?

Are prescribers supportive of the inclusion of chiropractic and other relevant stakeholders? Do they see the value of bringing different approaches together to develop training?

MCS has not yet had the opportunity to address prescribers directly on this. But as directed by the new law, we are now working with the Massachusetts Department of Public Health to “develop standards” for appropriate prescriber relicensure training programs, teaching prescribers about treatment alternatives, such as chiropractic, that prescribers can refer their patients to instead of initiating use of prescription opioids. (Section 3 of the new law specifies some of the topics that will now be included in prescriber relicensure trainings, including specific risks of opioids, effectiveness of nonopioid alternatives such as chiropractic, options of referring patients to nonopioid treatment alternatives, following clinical guidelines, considering patient preference, etc.).

This is truly an exciting new opportunity for interprofessional cooperation, for the benefit of public safety. These training programs will have a different focus than the current programs that focus on what they call “safe opioid prescribing.” Patients deserve interprofessional cooperation, including chiropractic, for their safety.

One of the other hats I wear is as a volunteer at a local Opioid Task Force (OTF), where the OTF is an umbrella organization that coordinates more than 300 local groups that each serve the opioid community in their own individual way (Narcan dispensing, housing, drug testing, counseling, etc.). Within that OTF group, we have established a Complimentary and Alternative Medicine working group, where we have a multidisciplinary group looking at novel ways, complementary ways, to reduce the opioid epidemic. We commonly focus on primary prevention approaches, more than tertiary programs such as Narcan. Within the OTF group are many different types of providers, and I find that some prescribers are totally on board with utilizing chiropractic and other CAM approaches as part of the solution, while other prescribers seem definitely opposed. Change is not easy; opinions are not uniform.

What did you/MCS learn that you could share with other states that might be trying to get similar legislation passed?

Perseverance. Patient access to chiropractic is a simple and obvious benefit that patients clearly deserve, but it doesn’t seem to happen easily. If there is something good to come out of the opioid epidemic, one thing could be that this epidemic is so glaringly awful for patients — the side effects are so damaging — that the value to patients of safe and effective chiropractic should be obvious by comparison.

Is there something else you would like to add about the bill or the effort to get it passed?

I would just add that getting the bill passed felt for a moment like an exhilarating success. Now we realize that it also means that the work is just beginning. The meetings the MCS always wanted with the DPH and other state agencies are now starting to take place, as required by the new law. These encounters are not easy, but they feel productive. We have many new opportunities for collaboration before us that will benefit patients.

MCS is eager to hear feedback from other states. (Reach out to Tracey Lane, MCS, at www.masschiro.org.) We will keep you posted on progress.