The Prescription Rights and
Expanded Practice Debate Page

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

Most Recent Additions

	Chiropractors as the Spinal Health Care Experts A Chiro.Org article collection Enjoy this series of articles that encourage us to re-define ourselves as spinal health care experts in the health care system or as primary care professionals in spinal health and well-being.
	The Great Faceoff: Chiropractic Goes Head-to-Head With NSAIDs and Acupuncture A Chiro.Org article collection The following commentary involves reviewing a brilliant series of 3 consecutive studies, comparing popular forms of treatment for chronic spinal pain, including NSAID use, acupuncture, and spinal adjusting for relief.   This author reports that this is the first study of long-term efficacy of 3 distinct and standardized treatment regimens for patients with chronic spinal pain syndromes.
	Chiropractic Identity: A Neurological, Professional, and Political Assessment J Chiropractic Humanities 2016 (Dec); 23 (1): 35–45 ~ FULL TEXT Over 120 years since its inception, chiropractic has struggled to achieve an identity for which its foundations could provide optimal health care. Despite recognition of the benefits of spinal manipulation in various government guidelines, advances in US military and Veterans Administration, and persistently high levels of patient satisfaction, the chiropractic profession remains underrepresented in most discussions of health care delivery. Distinguishing characteristics of doctors of chiropractic include the following:
	A Commentary on the Implications of Medication Prescription Rights for the Chiropractic Profession Chiropractic & Manual Therapies 2016 (Aug 24); 24 (1): 33 ~ FULL TEXT There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine/ musculoskeletal disorders.
	Deconstructing Chronic Low Back Pain in the Older Adult – Shifting the Paradigm from the Spine to the Person The Introduction to the Article Series Pain Medicine 2015 (May); 16 (5): 881–885 ~ FULL TEXT Over the past decade, the estimated prevalence of low back pain (LBP) among older adults (typically defined as those ≥age 65) has more than doubled [1], and the utilization of advanced spinal imaging (e.g., computerized tomography (CT), magnetic resonance imaging [MRI]) and procedures guided by this imaging (e.g., epidural corticosteroids, spinal surgery) have continued to skyrocket. [1–3]   Treatment outcomes, however, have not improved apace. Why? Part of the answer lies in the fact that treatment may in part be misdirected.   This issue of Pain Medicine contains the first in a series of articles on how to systematically and comprehensively rethink our approach to evaluating and designing management for older adults with chronic low back pain (CLBP). You may also enjoy they other 12 Deconstructing Chronic Low Back Pain Series
	Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students Chiropractic & Manual Therapies 2015 (Feb 2); 23 (1): 4 ~ FULL TEXT The last thirty years in health care have brought about many changes in thoughts and practice ideologies. One of these recent trends is an emphasis on cost-effective treatments and interprofessional collaboration. [1–3] Additional changes in health care over this time have included an increase in medical specialization and sub-specialization, the concept and implementation of evidence-based practice, and a greater acceptance of complementary and alternative medicine (CAM) therapies in mainstream medicine. Amid all of these transformations and shifts in the health care arena, a primary spine care specialist role has not been established. The current state of spinal care has been classified as a “supermarket approach” consisting of multiple practitioners including primary care providers, chiropractic physicians, acupuncturists, physical therapists, physiatrists, orthopedic surgeons, neurosurgeons, massage therapists, and naturopathic physicians with multiple treatment philosophies, high salesmanship and little interprofessional communication. [4] Chiropractic physicians possess many attributes that would be required of a primary spine care practitioner, and with specific modifications in education and practice, chiropractors may be in a position to make a relatively lateral transition to occupy this role. [4]
	Chiropractors as Primary Spine Care Providers: Precedents and Essential Measures J Can Chiropr Assoc. 2013 (Dec); 57 (4): 285–291 ~ FULL TEXT Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a ‘primary spine care provider’ may be a worthwhile niche position to create for society’s needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada.
	The Establishment of a Primary Spine Care Practitioner And Its Benefits To Health Care Reform in the United States Chiropractic & Manual Therapies 2011 (Jul 21); 19 (1):17 ~ FULL TEXT It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs). Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.
	How Can Chiropractic Become a Respected Mainstream Profession? The Example of Podiatry Chiropractic & Osteopathy 2008 (Aug 29); 16: 10 ~ FULL TEXT The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise. Several lessons can be learned from the podiatric medical profession in this effort.
	Chiropractic As Spine Care: A Model For The Profession Chiropractic & Osteopathy 2005 (Jul 6); 13: 9 ~ FULL TEXT This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

Drug Evidence Articles

A Unique Series of Medical Guidlines
All 6 of the following guideline-related articles reviewed the medical literature on low back pain and strongly advise medical doctors to first recommend non-pharmacologic therapies, including chiropractic, BEFORE resorting to offering NSAIDs, opiates or other more invasive treatments, for low back (spinal) pain patients. These recommendations will: save money, will increase patient satisfaction, will improve patient outcomes and will reduce chronicity and potential addiction.
	Guideline for Opioid Therapy and Chronic Noncancer Pain CMAJ. 2017 (May 8); 189 (18): E659–E666 ~ FULL TEXT This new Canadian guideline published today (May 8, 2017) in the Canadian Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.   The guideline is the product of an extensive review of evidence involving input from medical, non-medical, regulatory, and patient stakeholders.
	National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy European Spine Journal 2018 (Jan); 27 (1): 60–75 ~ ~ FULL TEXT In 2012, the Danish Finance Act appropriated a total of €10.8 mio for the preparation of clinical guidelines. The Danish Health Authority (DHA) was subsequently commissioned to formulate 47 national clinical guidelines to support evidence-based decision making within health areas with a high burden of disease, a perceived large variation in practice, or uncertainty about which care was appropriate. [1] Two of these areas were low back pain (LBP) and lumbar radiculopathy (LR). Consequently in 2014, two working groups were formed with the aim of developing national clinical guidelines for non-surgical interventions for recent onset (<12 weeks) LBP and for recent onset (<12 weeks) LR. The primary target groups for these guidelines were primary sector healthcare providers, i.e., general practitioners, chiropractors, and physiotherapists, but also medical specialists or others in the primary or secondary healthcare sector handling patients with LBP or LR.
	Association of Spinal Manipulative Therapy with Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis JAMA. 2017 (Apr 11); 317 (14): 1451–1460 ~ FULL TEXT For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. [1] On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials in order to evaluate the safety and effectiveness of spinal manipulation for low back pain.   The authors concluded:   “Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”
	Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline Annals of Internal Medicine 2017 (Apr 4); 166 (7): 480–492 The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.
	Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline Annals of Internal Medicine 2017 (Apr 4); 166 (7): 493–505 ~ FULL TEXT This report updates and expands on the earlier ACP/APS review [105] with additional interventions and newer evidence. We found evidence that mind–body interventions not previously addressed — tai chi (SOE, low) and mindfulness-based stress reduction (SOE, moderate) [45–47] — are effective for chronic low back pain; the new evidence also strengthens previous conclusions regarding yoga effectiveness (SOE, moderate). For interventions recommended as treatment options in the 2007 ACP/APS guideline [2], our findings were generally consistent with the prior review. Specifically, exercise therapy, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture are supported with some evidence of effectiveness for chronic low back pain (SOE, low to moderate). Unlike our previous report, which stated that higher-intensity multidisciplinary rehabilitation seemed to be more effective than lower-intensity programs, a stratified analysis based on currently available evidence [54] did not find a clear intensity effect. Our findings generally are consistent with recent systematic reviews not included in our evidence synthesis [106–117]. Although harms were not well-reported, serious adverse events were not described.
	Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians Annals of Internal Medicine 2017 (Apr 4); 166 (7): 514–530 ~ FULL TEXT Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). You will also enjoy the introductory Editorial, titled: Management of Low Back Pain: Getting From Evidence-Based Recommendations to High-Value Care Annals of Internal Medicine 2017 (Apr 4); 166 (7): 533-534

	Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline Annals of Internal Medicine 2017 (Apr 4); 166 (7): 480–492 The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.
	Regular Use of Medication for Musculoskeletal Pain and Risk of Long-term Sickness Absence: A Prospective Cohort Study Among the General Working Population European Journal of Pain 2017 (Feb); 21 (2): 366–373 ~ FULL TEXT Regular use of pain medication due to musculoskeletal pain is prospectively associated with long-term sickness absence (LTSA) even when adjusted for pain intensity. This study suggests that use of pain medication can be an important factor to be aware of in the prevention of sickness absence. Thus, regular use of pain medication - and not solely the intensity of pain – can be an early indicator that musculoskeletal pain can lead to serious consequences such as long-term sickness absence.
	Non-steroidal Anti-inflammatory Drugs for Spinal Pain: A Systematic Review and Meta-analysis Annals of the Rheumatic Diseases 2017 (Feb 2) [Epub ahead of print] ~ FULL TEXT While it is now clear that paracetamol is ineffective for spinal pain, there is not consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for this condition. We performed a systematic review with meta-analysis to determine the efficacy and safety of NSAIDs for spinal pain. We included 35 randomised placebo-controlled trials. NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo. Six participants (95% CI 4 to 10) needed to be treated with NSAIDs, rather than placebo, for one additional participant to achieve clinically important pain reduction. When looking at different types of spinal pain, outcomes or time points, in only 3 of the 14 analyses were the pooled treatment effects marginally above our threshold for clinical importance. NSAIDs increased the risk of gastrointestinal reactions by 2.5 times (95% CI 1.2 to 5.2), although the median duration of included trials was 7 days.
	Combining Pain Therapy with Lifestyle: The Role of Personalized Nutrition and Nutritional Supplements According to the SIMPAR Feed Your Destiny Approach J Pain Res. 2016 (Dec 8); 9: 1179–1189 ~ FULL TEXT Recently, attention to the lifestyle of patients has been rapidly increasing in the field of pain therapy, particularly with regard to the role of nutrition in pain development and its management. In this review, we summarize the latest findings on the role of nutrition and nutraceuticals, microbiome, obesity, soy, omega-3 fatty acids, and curcumin supplementation as key elements in modulating the efficacy of analgesic treatments, including opioids. These main topics were addressed during the first edition of the Study In Multidisciplinary Pain Research workshop: "FYD (Feed Your Destiny): Fighting Pain", held on April 7, 2016, in Rome, Italy, which was sponsored by a grant from the Italian Ministry of Instruction on "Nutraceuticals and Innovative Pharmacology".
	Treatment of Neck Pain: Noninvasive Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S141–S175 ~ FULL TEXT For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.
	Treatment of Neck Pain: Injections and Surgical Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S176–193 ~ FULL TEXT Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term outcomes are improved with the surgical treatment of cervical radiculopathy compared to nonoperative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%-20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients.
	Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/ American College of Physicians Clinical Practice Guideline Annals of Internal Medicine 2007 (Oct 2); 147 (7): 492–504 ~ FULL TEXT Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation.
	Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/ American College of Physicians Clinical Practice Guideline Annals of Internal Medicine 2007 (Oct 2); 147 (7): 505–514 ~ FULL TEXT Medications with good evidence of short-term effectiveness for low back pain are NSAIDs, acetaminophen, skeletal muscle relaxants (for acute low back pain), and tricyclic antidepressants (for chronic low back pain). Evidence is insufficient to identify one medication as offering a clear overall net advantage because of complex tradeoffs between benefits and harms. Individual patients are likely to differ in how they weigh potential benefits, harms, and costs of various medications.

Background Materials

	Organized Medicine Attempts To Deny Chiropractors Right To Diagnose in Texas A Chiro.Org Editorial ~ 2–04–2010 The AMA has joined the TMA (Texas Medical Association) in trying to challenge Texas chiropractor's "right" to diagnose. They are doing this under the guise of trying to halt expansions of the scope of practice of various alternative pratitioners. The AMA News web site currently brags that they are involved in fighting more than 300 scope-increasing bills around the country.
	Live and Let Live? A Chiro.Org Editorial ~ 3–24–2010 Here's a question I don't have an answer for:   Do chiropractors need to adjust people while the patient is under anesthesia (a.k.a MUA)?   I have no experience to guide me. I have never met a patient whose muscle spasm (or spinal "fixation") was so great that I was not able to adjust them. Of course, that doesn't mean that they might not be out there somewhere. I can only assume that's why someone came up with the idea of MUA in the first place. Until now this never seemed relevant to me, and I didn't pay attention to the evolution of this practice.   What I do know is that organized medicine is in a huge uproar about MUA.
	A Constitutional Challenge to DCs Diagnosing – What This Means for Health Care ProviderLaw.Com ~ 4–27–2010 In January, 2006, the American Medical Association (AMA) announced an industry consortium known as the “Scope of Practice Partnership” (SOPP).   The consortium was originally formed by the AMA, along with 6 national medical specialty societies and 6 state medical associations, including the Texas Medical Association (TMA).   As part of its formation, the original members of SOPP agreed that they needed to begin reigning in the scope of practices of various professions, the chiropractic profession included.
	AMA’s “Contain and Eliminate” Tactics Are Alive and Well Dynamic Chiropractic ~ 7–15–2010 As a modern-day doctor of chiropractic, you may think this article is born of ancient paranoia. Perhaps you're convinced this is about AMA bashing and yesterday's news. But just look around and you will see clear and compelling evidence that the long-standing war between the AMA and everyone else who does not come under the AMA umbrella is far from over.
	Medical Pushback on Provider Nondiscrimination Law Health Insights Today ~ 7–18–2010 Among the important changes in the recently passed health reform law is Section 2706, which makes it illegal for insurance companies to discriminate against providers acting within the scope of their state licenses. Predictably, medical physicians who have benefited from many decades of discrimination now seek to turn back the clock and reinstate the pro-discrimination policies that have served them so well for so long.
	UPDATE: Texas Judge Finally Rules on Diagnosis Issue Dynamic Chiropractic ~ 9–17–2010 Put yourself in the position of a practicing doctor of chiropractic in Texas right about now (if you are one, this is easy). With the Texas Medical Board and Texas Medical Association breathing down your neck, threatening to take away your right to diagnose (or even use the word diagnosis in your scope-of-practice act, claiming that by medical definition, the word is reserved for medical doctors and doctors of osteopathy), a Texas judge has ruled in your favor - depending on your perspective.
	If Not Chiropractic Care, Then What’s Your Alternative? A Chiro.Org Editorial ~ 9–25–2010 Informed Consent involves discussing the risks and benefits of the treatment you propose (in my case, chiropractic) AND reviewing the risks and benefits of the alternatives, which are "conservative" medical care, which typically involves prescribing muscle relaxers, NSAIDs (nonsteroidal anti-inflammatory drugs), and less frequently, prescribing physical therapy. Many patients who present to a chiropractor for the first time have already gone the medical route, with minimal or negative results. Today I would like to review the risks associated with the most commonly recommended pain relieving analgesics (NASIDs).
	Just In Case You Don't Believe Me Texas Medicine Journal 2011 (Apr 1);   107 (4):   20–26 Medicine Under Attack:   The Texas Medical Association is fending off attacks on the practice of medicine by nonphysician practitioners who want to expand their scope of practice and diagnose and treat patients without going to medical school. Most recently, TMA went to court to protect patients, filing another lawsuit against the Texas Board of Chiropractic Examiners.
	The Evidence-based Rap, or What's Wrong With My Pain Meds? A Chiro.Org Editorial ~ 4–23–2011 This review, by scientists at the Dutch Institute for Health Care Improvement debunks the myth of the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP). Read on!
	Point/Counterpoint: Part I Seeking A Second Opinion on Expanded Chiropractic A Prescription for Professional Disaster Dynamic Chiropractic ~ 6–05–2011 The expansion of the scope of practice of chiropractors to prescribe drugs is an absolute non-starter for me. In recent weeks, this conversation has moved to center stage, as evidenced by activities in the states of New Mexico, South Carolina and Alabama, as well as at the biennial gathering of the World Federation of Chiropractic (WFC).
	Point/Counterpoint: Part II Seeking A Second Opinion on Expanded Chiropractic Best for the Profession or Best for the Public? Dynamic Chiropractic ~ 6–05–2011 Recently, I had the privilege of testifying for the chiropractic physicians in New Mexico who currently have some prescriptive rights and wished to expand that scope to improve their ability to provide stronger, more complete primary care.   It should be clear that I was asked to appear in behalf of the chiropractic physicians there or I would not have been there. It is not my purpose, as president of National University of Health Sciences, to dictate the direction of the chiropractic profession, but to provide the education that is required by the profession.
	Is “Expanded Practice” Our Pandora's Box? A Chiro.Org Editorial ~ 9–13–2011 I just read a Press Release from the Foundation for Vertebral Subluxation (FVS) this morning, titled Chiropractors Lash Out in Massive Campaign Against Accrediting Agency.   Previous press releases from this group have denounced (perhaps rightly) any movement to include prescribing rights for DCs, and our Blog has published extensively about both sides of that debate in the past. [1–15]
	The Subluxation Complex Saves Diagnosis for Texas Chiropractors Dynamic Chiropractic ~ 6–14–2012 On April 5, 2012, the Third Court of Appeals of Texas issued a 58-page opinion in Cause No. 03-10-673-CV – the Texas Board of Chiropractic Examiners (TBCE) and the Texas Chiropractic Association (TCA) vs. the Texas Medical Association (TMA), the Texas Medical Board (TMB) and the State of Texas.     According to an April 6, 2012 communication by the Texas Chiropractic Association [1], the case presented three questions for the court: 1)   Are the two TBCE rules that allow chiropractors to make certain "diagnoses" valid? 2)   Can chiropractors perform MUA? 3)   Can chiropractors perform needle EMG?
	AMA on Warpath to Overturn Provider Non-discrimination Provision of the Affordable Care Act ACA Press Release ~ 7–05–2012 The American Chiropractic Association (ACA) today reaffirmed its commitment to fighting provider discrimination, responding to a recent decision by the American Medical Association’s (AMA) House of Delegates to initiate a lobbying effort against Section 2706, the provider non-discrimination provision in the Patient Protection and Affordable Care Act (PPACA).
	Chiropractic Summit Promotes Drug-Free Approach to Health Care The Chiropractic Summit ~ 11–18–2013 The Chiropractic Summit, an umbrella leadership group of prominent chiropractic organizations, met on Nov. 7 in Seattle, Wash. and approved, by unanimous motion, the following historic statements of agreement: Summit Promotes Drug-Free Approach:   The drug issue is a non-issue because no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care.
	PRESCRIPTION RIGHTS: The Timex Topic: It Took A Licking But Kept On Ticking A Chiro.Org Editorial ~ 8–29–2016 The last I heard, all the significant National and International Associations, who comprise the Chiropractic Summit had all agreed (back in 2013) that chiropractic should maintain Drug-Free. However, I am also a member of a FaceBook group (Evidence-Informed Chiropractic Medicine) and the topic keeps popping up.
	The Death Knell for the Prescription Rights Movement? A Chiro.Org Editorial ~ 2–16–2017 The recent release (2-14-17) of American College of Physician’s new study ”Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” appears to raise an evidence-based obstacle in the path to adding Rx rights to our profession.   In essence it recommends AGAINST recommending drugs.

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