I Posted One Line About Opioids and Chiropractors. Here's What Happened.
- Dr. Lucas Marchand
- 3 days ago
- 6 min read
A social media thread, 500,000 deaths, and a credibility contest nobody should be winning.
By Dr. Lucas Marchand, DC · MyChiro · Sioux Falls, SD
It started with a simple observation.
I posted this to my social media feed on a Tuesday evening, the kind of post you write in three minutes and expect maybe twelve people to read:
"Allopathic doctors love dunking on chiropractors for lacking 'real science.' These are the same people who prescribed OxyContin because Purdue Pharma funded a study that said it was fine. 500,000 overdose deaths later, maybe sit this credibility contest out."
What followed was two hours of replies, counter-arguments, citations, personal attacks, and at least one stranger who showed up exclusively to tell me my opinion doesn't count. It was, in the parlance of our times, a whole thing.
But buried inside the noise was something worth examining. Because the arguments people made — and the ones they couldn't make — reveal something true about how medicine decides what counts as legitimate, who gets to hold the credential, and why a chiropractor citing population studies makes a certain kind of person extremely angry.
The credibility hierarchy and who built it
Let's start with the most common objection I received, which went something like this: real medicine has problems, sure, but it also saves lives and advances human health in ways that are genuinely hard to comprehend. Chiropractic doesn't operate at that scale. Therefore, the comparison is unfair.
This is a reasonable point, and I said so. Medicine's achievements are real. Vaccines, surgical interventions, antibiotics — the list is long and the accomplishments are genuine.
But notice what the argument does: it moves the goalposts from "what went wrong" to "what went right." And it does so selectively. When the question is chiropractic's legitimacy, the standard is rigorous evidence. When the question is medicine's culpability in the opioid epidemic, the standard becomes "but think of everything else we've done."
That's not a scientific argument. That's a PR strategy.
"The system that gets to define legitimate medicine is the same system that profits from the definition."
500,000 deaths and the self-correcting system
One respondent made what they clearly believed was the sophisticated version of the OxyContin defense: yes, Purdue marketed it irresponsibly for long-term pain management. But the system learned. Prescription limits changed. FDA approval processes were revised. Science adapts to new information. Chiropractic cannot.
I want to sit with that framing for a moment.
The opioid crisis killed an estimated 500,000 Americans over roughly two decades. It destroyed communities, overwhelmed emergency rooms, and created a generation of patients who were told by credentialed physicians, backed by industry-funded research, that a highly addictive opioid was safe for chronic pain management. The FDA approved it. Journals published the studies. The system worked exactly as designed.
And the defense is: we fixed the paperwork afterward.
I don't raise this to suggest medicine is uniquely corrupt. I raise it because the same people who cite this as evidence of science's self-correcting nature are the ones who dismiss chiropractic as fundamentally illegitimate. The standard, again, is applied in only one direction.
Actual reply from the thread
"OxyContin IS fine, if used as a short term pain reliever. Purdue marketing it as a long term pain management drug is very different... Science learns and adapts to new information. Chiropractic medicine cannot change."
The stroke argument
Two studies were cited in the thread as evidence that chiropractic causes strokes, specifically through vertebral artery dissection following cervical manipulation. One was a German case series that identified 36 cases across the entire country over three years.
Thirty-six. All of Germany. Three years.
The more substantive counterpoint is this: the largest population-based studies on the subject have found no excess risk of vertebrobasilar stroke associated with chiropractic care compared to primary care visits. The leading hypothesis is that patients who are already experiencing a dissection — which often presents as neck pain — seek care from whoever is available, including chiropractors. The association is real. The causation is not established.
This is not me dismissing the concern. Vertebral artery dissection is serious, and any practitioner working in the cervical spine should take it seriously. But presenting a case series with no control group as a settled indictment of an entire profession is not how you're supposed to evaluate evidence. Which is ironic, given the topic of conversation.
Your PCP has 10-15 minutes
Here is a fact that did not come up in the thread but probably should have: the average primary care appointment in the United States runs approximately 9 minutes. That is the gold standard. That is the evidence-based gatekeeper patients are told to see instead of a chiropractor.
Meanwhile, physical therapists now routinely perform spinal manipulation — the same technique, delivered by different hands, with a different diploma on the wall. Nobody calls it pseudoscience. Nobody shows up in their mentions with case series. The hands are identical. The cultural reception is not.
And then there is insurance, which functions in this debate as a proxy for legitimacy. What insurance covers shapes what gets studied. What gets studied shapes what gets called evidence-based. Insurance companies are not dispassionate followers of the science. They are financial entities making coverage decisions based on cost, liability, and negotiated contracts. Chiropractic's position outside the insurance system is frequently cited as evidence that it isn't real medicine. It is, more accurately, evidence that it developed outside the financial architecture that determines what gets called real medicine.
That's not a coincidence. That's how systems protect themselves.
Why does this make people so angry
The most revealing moment in the thread came near the end, when a person who had not been part of the previous two hours of discussion appeared to inform me that, as a chiropractor, my opinion doesn't count when actual medical issues are being discussed.
Not my argument. Not my citations. My opinion, categorically, as a function of my credential.
This is the tell. Irrelevant things don't generate two hours of engagement. Illegitimate fields don't require strangers to show up and announce their illegitimacy. If chiropractic were truly inconsequential, the correct response would be indifference.
The anger is not scientific. It is territorial. Chiropractic exists in the same patient pool. Someone who comes to a mobile chiropractor for back pain didn't go to a PT, didn't go to a PCP, didn't start a referral chain. That's a patient, a relationship, and a revenue stream that went somewhere outside the hierarchy. And the hierarchy, which spent decades and enormous resources constructing itself, does not enjoy that.
"We're not irrelevant. We're inconvenient. The unhinged reaction is the tell."
Where I actually agree with my critics
In the interest of intellectual honesty: the critics are not entirely wrong.
Chiropractors who diagnose autoimmune conditions through applied kinesiology, who promise to cure pediatric ear infections through spinal adjustment, who sell supplement protocols for diseases outside their scope — these practitioners exist, they cause harm, and they deserve every ounce of criticism directed at them.
Scope creep is a real problem in chiropractic. The profession has practitioners who have wandered so far outside their lane that they have become a genuine public health concern. I don't defend them. I don't need to. They are not me, and they are not the majority of the profession.
The argument I am making is not that chiropractic is above criticism. It is that the standard being applied is not actually about evidence. If it were, it would be applied consistently. It is about belonging — about who is inside the credentialed hierarchy and who is not.
And a profession that presided over the worst drug crisis in American history, then described the cleanup as evidence of its self-correcting nature, might want to think carefully before making belonging the primary criterion for legitimacy.
The credibility contest, as I said at the start, is one nobody should be winning.
But some of us are at least willing to say so out loud.
Works Cited
Opioid Deaths — 500,000 figure Wikipedia, "Opioid epidemic in the United States" — citing CDC data: from 1999 to 2020, prescription and illicit opioids were responsible for 500,000 of the approximately 841,000 total drug overdose deaths. https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_States
OxyContin FDA approval & Purdue history Kolodny et al., "How FDA Failures Contributed to the Opioid Crisis." Journal of Ethics, American Medical Association, August 2020. https://journalofethics.ama-assn.org/article/how-fda-failures-contributed-opioid-crisis/2020-08
Wikipedia, "Purdue Pharma" — FDA approval 1995, Dr. Curtis Wright revolving door, sales rep training to cite addiction risk of "less than one percent." https://en.wikipedia.org/wiki/Purdue_Pharma
Chiropractic & stroke — primary population study Cassidy JD, Boyle E, Côté P, et al. "Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study." Journal of Manipulative and Physiological Therapeutics, February 2009. PMID: 19251066. https://pmc.ncbi.nlm.nih.gov/articles/PMC2271108/
Chiropractic & stroke — systematic review Enrico Cassidy et al., "Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation." PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4794386/
Reuter 2006 — the German study cited in the thread Reuter U, Hämling M, Kavuk I, Einhäupl KM, Schielke E. "Vertebral artery dissections after chiropractic neck manipulation in Germany over three years." Journal of Neurology, June 2006. PMID: 16511634.
Primary care appointment length First Stop Health: "1 in 4 doctors spend just 9–12 minutes with a patient." https://blog.firststophealth.com/business-blog/how-much-time-does-doctor-visit-really-take
AJMC: "The Duration of Office Visits in the United States, 1993 to 2010" — average visit 20.3 minutes by 2010. https://www.ajmc.com/view/the-duration-of-office-visits-in-the-united-states-1993-to-2010
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