A Clinical Approach: Integrative Care Overview for OUD Treatment

Find out how the clinical approach for integrative care for OUD can transform treatment and support recovery journeys effectively.

Educational Abstract: Integrative, Evidence-Based Opioid Use Disorder Care in a Multidisciplinary Clinic

As a clinician practicing at the intersection of chiropractic medicine, advanced practice nursing, and functional medicine, I present an educational overview on opioid use disorder (OUD) that reframes complex science into an accessible, evidence-based guide for patients, families, and healthcare professionals. I explain the history and pharmacology of opioids; the drivers of the three “waves” of the U.S. overdose epidemic; current legislation; stigma and language that shape care; and the latest research-supported treatments, including medications for opioid use disorder (MOUD), motivational interviewing, and harm-reduction strategies. I also detail how our multidisciplinary team at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas integrates chiropractic care, medical oversight, functional medicine, personal injury care, and rehabilitation with rigorous clinical pathways for OUD screening, treatment, and recovery. Our medical director and collaborative physician, Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933), works closely with me, Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, to provide comprehensive, person-first, physiology-informed care that follows modern, evidence-based research methods. Throughout, I address myths, clarify the neurobiology of addiction, and show precisely how integrative chiropractic approaches support musculoskeletal stability, autonomic regulation, and pain modulation alongside MOUD in a responsible, medically supervised framework.
What follows is a step-by-step, clinically grounded journey through OUD—what it is, how we treat it effectively, and why integrative, multidisciplinary care can improve outcomes, reduce harms, and restore function and dignity.

About Our Multidisciplinary Team and Clinical Framework

I am Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. My clinical focus bridges chiropractic medicine, advanced practice nursing, and functional medicine. I direct rehabilitative, biomechanical, neuromuscular, and lifestyle interventions within a comprehensive, safety-forward framework under medical oversight.
Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933) is our Medical Director and Collaborative Physician at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas. With over 40 years of experience in internal medicine, Dr. Cardenas provides medical supervision, diagnostic and pharmacologic guidance, and directs our OUD-related medical protocols, including MOUD, comorbidity management, and transitions of care.
Our clinic integrates:
Evidence-based chiropractic care to address pain, movement dysfunctions, and neuromuscular imbalances
Internal medicine diagnostics and medical management (Dr. Cardenas)
Functional medicine assessments (metabolic, inflammatory, endocrine, and gut-brain axis considerations)
Personal injury and trauma-informed rehabilitation
Behavioral health referrals (motivational interviewing, CBT/REBT-aligned group supports)
Harm reduction strategies (naloxone education, fentanyl test-strip guidance, infectious disease risk mitigation)
Coordinated care pathways with regional methadone programs and community services
This collaborative model—an MD providing medical direction alongside a chiropractor—is a common, effective approach in integrative or injury care clinics. It enables us to safely combine non-pharmacologic spine and pain care with MOUD, medical monitoring, and comprehensive recovery support.

Understanding Opioids: Origins, Types, and Pharmacology

When I discuss opioids with patients and colleagues, I begin with clarity about what opioids are and how they differ.
Natural opioids (opiates): Derived from the opium poppy. Examples: morphine, codeine.
Semi-synthetic opioids: Synthesized from natural opiates. Examples: heroin, oxycodone, hydrocodone.
Synthetic opioids: Fully lab-synthesized. Examples: methadone, fentanyl.
Key physiological concept
Opioids act primarily on the mu-opioid receptors (MOR) in the central and peripheral nervous system. MOR activation modulates nociception, produces analgesia, and at higher levels suppresses respiratory drive within the brainstem respiratory centers. This potency-respiratory relationship is central to overdose risk.
Why this matters clinically
Different opioids vary in potency, half-life, receptor affinity, and formulation. These factors determine their therapeutic window, misuse potential, and safety profile. In our clinic, understanding these properties guides every decision—from acute pain rescue to long-term, non-opioid pain strategies and OUD treatment.

Morphine Milligram Equivalents and Potency

To prevent unintentional dose escalation and to calibrate risk, we reference morphine milligram equivalents (MME), a comparative index of analgesic potency.
Tramadol: ~0.1 MME
Codeine: ~0.15 MME
Hydrocodone: ~1.0 MME
Oxycodone: ~1.5 MME
Hydromorphone: ~4.0 MME
Fentanyl transdermal: very potent; dose comparisons often expressed in micrograms/hour relative to MME.
Clinical rationale
MME helps assess overdose risk, polypharmacy hazards, and transitions between opioids. However, MME is not a perfect science; individual pharmacogenomics, tolerance, organ function, and drug interactions can shift risk. Our policy emphasizes the lowest effective dose, shortest duration, and rapid transition to non-opioid modalities with robust functional rehabilitation.

A Brief History of Opioids and Key Milestones in Regulation and Treatment

Highlights in opioid development
Early cultivation: opium poppy in Mesopotamia (~3400 BCE).
Renaissance and Enlightenment era uses: analgesia and antidiarrheal applications.
19th–20th centuries: extraction and synthesis milestones—morphine (1803), codeine (1832), heroin (1874), methadone (1939), fentanyl (1959), buprenorphine (1966).
Regulatory milestones
Harrison Narcotics Tax Act (1914): Criminalized non-medical opiate use.
Controlled Substances Act (1970): Established a scheduling framework and DEA oversight.
Narcotic Addiction Treatment Act (1974): Federal regulation of methadone programs.
Drug Addiction Treatment Act (2000, DATA 2000): Buprenorphine in office-based settings (waiver era).
Comprehensive Addiction and Recovery Act (2016): Expanded prescribing to NPs/PAs for buprenorphine.
SUPPORT Act (2018): Expanded OUD care within Medicare/Medicaid.
Mainstreaming Addiction Treatment (MAT) Act (2023): Eliminated buprenorphine waiver; DEA-registered clinicians may prescribe Schedule III buprenorphine per state scope.
Why regulation matters
Regulation aims to balance access to life-saving treatment with control of diversion and misuse. The shift toward enabling more clinicians to prescribe buprenorphine reflects strong evidence that expanding MOUD access lowers mortality and improves retention in care.

The Three Waves of the U.S. Opioid Overdose Epidemic

Wave 1 (1999–2010): Prescription opioid sales quadrupled; overdose deaths doubled (from ~2.9 to ~6.8 per 100,000). Drivers included liberal pain prescribing, marketing pressures, and underestimation of misuse risks.
Wave 2 (2010–2013): Cheaper heroin fueled a surge; heroin-involved deaths rose from ~1.0 to ~4.9 per 100,000, surpassing prescription opioid deaths.
Wave 3 (2013–present): Synthetic opioids, especially illicitly manufactured fentanyl, drove an exponential increase; death rates climbed dramatically (>1000% increase in some analyses). Co-involvement of non-opioid sedatives like xylazine has been detected in up to ~10% of fentanyl-related overdoses regionally.
Clinical implications
Today, contamination of non-opioid drugs with fentanyl (e.g., cocaine) is common. Harm reduction, routine naloxone co-prescribing, fentanyl test-strips education, and universal overdose education are essential—even for patients who do not self-identify as opioid users.

Prevalence and Treatment Gap: Why We Must Treat OUD

Millions of Americans report opioid misuse each year, with pain reliever misuse comprising the larger share compared with heroin misuse. Yet only a fraction of individuals with OUD receive MOUD.
Demographics most likely to receive treatment historically skew toward white males ages 35–49, underscoring inequities in access.
The economic burden exceeds $193 billion annually, and tens of thousands of deaths occur each year.
Why we act
OUD is a chronic medical condition with well-validated treatments that reduce mortality and improve functioning. Our clinic is committed to closing the treatment gap with equitable, person-centered, medically supervised care integrated into our spine, injury, and rehabilitation services.

Reducing Stigma with Accurate Language and Science

I see daily how language shapes outcomes. Stigma undermines treatment adherence and access. We use person-first, nonjudgmental, precise language:
Preferred: “person with opioid use disorder,” “person in recovery,” “people who use drugs (PWUD),” “people who inject drugs (PWID).”
Avoid: “addict,” “abuser,” “dirty urine.” Instead, we state results objectively: “positive for X,” “negative for Y.”
Babies cannot be “addicted”; we use “neonatal opioid withdrawal syndrome” (NOWS).
We refer to “medications for opioid use disorder (MOUD),” not “medication-assisted treatment,” because medication is treatment.
Clinical rationale
Lowering stigma increases acceptance of MOUD, reduces dropouts, and enhances therapeutic alliances. Evidence shows that stigma from individuals, institutions, and public policy historically has curtailed treatment access and worsened outcomes. We train our team to practice noncoercive, patient-centered care anchored in compassion, autonomy, and science.

Defining Substance Use Disorders: DSM-5 Criteria and Clinical Meaning

Per DSM-5, substance use disorders are chronic, relapsing brain conditions defined by 11 criteria across control, social impairment, risky use, and pharmacologic dimensions (tolerance and withdrawal). A diagnosis requires at least two criteria within 12 months and is graded as mild, moderate, or severe.
What I emphasize to patients
The criteria capture behavioral patterns that reflect neuroadaptations in reward, salience, stress, and executive function circuits. We look at how the substance reshapes priorities and coping, not just how much is used. This framework legitimizes treatment as medical and behavioral—not moral.

Neurobiology of OUD: Why Medication Works

Reward and salience: Opioids drive dopamine release and reshape synaptic plasticity in the mesolimbic system (ventral tegmental area–nucleus accumbens). This heightens drug salience over natural rewards.
Stress and dysphoria: Chronic use recruits stress systems (CRF, dynorphin), amplifying negative affect and driving compulsive use to avoid withdrawal.
Executive function: Prefrontal cortical changes impair planning, impulse control, and decision-making, perpetuating cycles of use.
Tolerance and dependence: Receptor desensitization and downstream signaling adaptations require higher doses to achieve prior effects and produce withdrawal upon cessation.
Why MOUD is effective
Methadone (full agonist) and buprenorphine (partial agonist) stabilize the mu-opioid system, reduce cravings, blunt withdrawal, and allow cortical control and behavior change to re-emerge. Naltrexone (antagonist) blocks opioid effects and can support motivated individuals at specific stages. Meta-analyses show MOUD reduces all-cause and overdose mortality substantially—often cited near a 50–60% reduction—while improving retention and reducing illicit opioid use.

Motivational Interviewing: Partnering for Change

Our clinic operationalizes motivational interviewing (MI) to align care with patient goals.
Core MI spirit
Partnership: Collaborative over prescriptive.
Evocation: Elicit the patient’s own reasons and values.
Acceptance: Honor autonomy; affirm strengths; practice empathy.
Compassion: Nonjudgmental, nonblaming, nonshaming stance.
Process
Engage: Build rapport and trust.
Focus: Clarify a shared goal.
Evoke: Draw out motivation and confidence.
Plan: Co-create specific, supportive steps.
Practical tools
OARS: Open questions, Affirmations, Reflective listening, Summaries.
DARN-CATS: Desire, Ability, Reasons, Need → Commitment, Activation, Taking steps.
Stages of change: Precontemplation, Contemplation, Preparation, Action, Maintenance. We match interventions to stage (e.g., education and empathy early; planning and skills training later).
Why MI matters
MI reduces resistance, enhances engagement, and respects the person’s lived realities. In OUD, aligning MOUD, harm reduction, and functional goals with what matters most to the person drives persistence and outcomes.

Enhancing Health Together: Embracing Multidisciplinary Evaluation and Treatment- Video

Non-Pharmacologic Supports: Behavioral and Peer-Based Options

Individual therapy: Cognitive behavioral therapy (CBT), rational emotive behavioral therapy (REBT), trauma-informed modalities; recovery coaching; social work supports.
Groups: SMART Recovery (CBT/REBT-based), Narcotics Anonymous (12-step), secular sobriety organizations. Many groups allow provider observation to inform sensitive referrals.
Clinic approach: We never make group participation a precondition for MOUD. We present options, normalize preferences, and help patients select supportive resources congruent with their values.

Pharmacologic Treatments: Mechanisms, Safety, and Rationale

Medications for opioid use disorder (MOUD) include methadone, buprenorphine (with or without naloxone), and naltrexone; naloxone is used for overdose reversal.
Methadone
Mechanism: Full mu-opioid agonist; long-acting stabilization; reduces cravings and withdrawal.
Clinical use: Dispensed through certified opioid treatment programs; daily observed dosing initially improves safety and adherence.
Side effects: Constipation, sedation, nausea, sweating; serious risks include respiratory depression and QTc prolongation (notably with higher doses).
Contraindications: Methadone allergy; caution with severe respiratory disease and GI obstruction.
Why we refer: For patients needing tighter agonist coverage, high opioid tolerance, repeated buprenorphine induction failures, or those who benefit from structured daily support, we coordinate with methadone programs, ensuring continuity with our rehab and functional care.
Buprenorphine (with or without naloxone)
Mechanism: Partial mu agonist, kappa antagonist; high receptor affinity and slow dissociation; ceiling effect on respiratory depression.
Clinical pearls:
Strong affinity means it can displace full agonists, potentially precipitating withdrawal if started too soon; conversely, when initiated during moderate withdrawal, it relieves symptoms and cravings.
Ceiling effect confers a safety advantage versus full agonists, particularly regarding respiratory depression.
Side effects: Headache, constipation, nausea, orthostatic hypotension, oral hypoesthesia (with sublingual/buccal forms); rare respiratory depression primarily with sedative co-use; hepatotoxicity risk warrants monitoring in liver disease.
Interactions: Caution with benzodiazepines (FDA advises benefits often outweigh risks), CYP3A4 inhibitors (erythromycin, grapefruit) and inducers (rifampin, St. John’s wort), certain antiretrovirals, and serotonergic agents.
Naloxone in combination products: Added to deter injection misuse; minimal effect when taken as directed sublingually/buccally.
Why we integrate: In office-based care, buprenorphine allows timely stabilization, reduces illicit use, and pairs well with our rehabilitation and non-opioid pain strategies under medical supervision.
Naloxone
Mechanism: Competitive opioid antagonist; rapidly displaces opioids from MOR, reversing respiratory depression.
Clinical use: Intranasal and intramuscular formulations; short half-life mandates calling emergency services due to re-narcotization risk.
Side effects: Precipitated withdrawal symptoms in opioid-exposed individuals; rare hypertension or allergic reactions.
Our policy: Universal overdose education; co-prescribe naloxone with any current or prior opioid use; educate families; teach two-dose protocol.
Naltrexone
Mechanism: Mu and kappa receptor antagonist; blocks opioid effects and reduces alcohol-induced dopamine release.
Clinical use: Oral daily dosing or monthly extended-release IM; requires opioid-free interval (typically ≥7–10 days) before initiation.
Side effects: Headache, GI upset, injection-site reactions; serious hepatotoxicity risk; avoid in acute hepatitis or liver failure.
Practical considerations: Appropriate for motivated individuals who are opioid-free, for co-occurring alcohol use disorder, or post-MOUD in specific recovery trajectories.
Why MOUD saves lives
By stabilizing the opioid system, MOUD reduces volatile cycles of intoxication and withdrawal, normalizes stress-response systems, and enables re-engagement with rehabilitation, work, family, and health. Rigorous research consistently demonstrates improved survival and functioning with MOUD (see references).

Harm Reduction: Keeping People Safe While We Treat

We operationalize harm reduction alongside MOUD and rehabilitation:
Naloxone education and distribution: Teach families; co-prescribe routinely; emphasize calling EMS after administration.
Fentanyl test strips: Encourage testing of all substances; reduce unintentional fentanyl exposure; empower informed decisions.
Never Use Alone hotline: Facilitate supervised-use calls that can trigger EMS if the caller becomes unresponsive.
Syringe services: Promote sterile injection supplies to reduce HIV/HCV transmission; educate on wound care and abscess prevention.
Urine drug testing: Use nonjudgmental discussions to reveal contamination and align treatment; avoid punitive framing.
Prescription Drug Monitoring Programs (PDMP): Coordinate with prescribers to avoid dangerous overlaps and improve transparency.
Motivational interviewing: Aligns harm reduction with the person’s goals; builds trust and consistent engagement.

Integrating Chiropractic Care Safely Within OUD Treatment

As a chiropractor and family nurse practitioner, I design spine and musculoskeletal care plans that complement MOUD and medical management under Dr. Cardenas’s oversight.
Why chiropractic in integrative OUD care
Pain is both a driver and consequence of opioid use. Biomechanical dysfunction, myofascial trigger points, joint restriction, and deconditioning amplify pain signals via peripheral and central mechanisms. Evidence-based chiropractic techniques can:
Improve segmental joint motion and reduce nociceptive input
Normalize proprioceptive signaling to the spinal cord and sensorimotor cortex
Downregulate sympathetic overactivity and facilitate parasympathetic tone
Reduce myofascial hypertonicity and improve functional movement patterns
Enhance endogenous pain inhibition (descending modulatory pathways)
Core strategies we use
High-velocity, low-amplitude (HVLA) spinal manipulation: When appropriate, this can reduce pain, improve mobility, and modulate spinal reflexes. We screen for contraindications rigorously (osteoporosis, coagulopathy, acute fractures, infection, malignancy).
Low-force mobilization and instrument-assisted approaches: For hyperalgesic or deconditioned patients, we start with gentle mobilizations to gradually restore range of motion and reduce fear-avoidance behaviors.
Myofascial therapies: Trigger point therapy, active release, instrument-assisted soft tissue mobilization to reduce taut bands, improve perfusion, and downregulate nociceptive input.
Stabilization and motor control exercises: Target deep spinal stabilizers (multifidus, transversus abdominis), hips, and thoracic mobility; build load tolerance with graded exposure.
Posture and ergonomic coaching: Reduce biomechanical stressors in daily routines and work tasks.
Neuromuscular re-education: Improve sensory integration and movement efficiency; address gait and balance where relevant.
Non-opioid analgesic adjuncts: Heat/cold therapy, TENS, topical analgesics, NSAIDs/acetaminophen when medically appropriate, and nutraceuticals with evidence for pain modulation under physician guidance.
Safety and coordination
Dr. Cardenas reviews comorbidities, medication interactions (e.g., anticoagulants, severe osteoporosis risk), and monitors hemodynamics and labs as needed.
We avoid overreliance on passive care; we prioritize active rehabilitation to prevent dependency and empower self-efficacy.
For patients on MOUD, we adjust manual therapy intensity to respect altered pain thresholds and autonomic responses.
Why this works
Pain is multidimensional—biomechanical, inflammatory, neurocognitive, and psychosocial. By reducing nociceptive burden and improving function, chiropractic care diminishes relapse drivers and supports sustainable recovery.

Functional Medicine Lens: Metabolic, Inflammatory, and Neuroendocrine Considerations

As a functional medicine practitioner, I evaluate physiologic systems that can worsen pain sensitivity and recovery challenges:
Inflammation and immune tone: Chronic low-grade inflammation (elevated CRP, altered cytokines) sensitizes nociceptive pathways. Dietary interventions emphasizing whole foods, omega-3 fatty acids, polyphenols, and reduced ultra-processed intake can modulate inflammatory mediators.
Gut-brain axis: Dysbiosis and increased intestinal permeability may influence systemic inflammation and neuroimmune signaling, affecting mood, pain sensitivity, and cravings. We consider fiber-rich diets, targeted probiotics, and elimination of individual trigger foods where relevant.
Sleep architecture: Sleep deprivation increases pain sensitivity and cravings; we deploy sleep hygiene protocols, circadian strategies, and CBT-I referrals.
Stress physiology: HPA-axis dysregulation amplifies pain and relapse risk. Breathing retraining, biofeedback, mindfulness-based stress reduction, and graded exercise restore autonomic balance.
Micronutrients: Deficiencies (e.g., vitamin D, magnesium, B vitamins) can affect neuromuscular function and mood; we correct deficiencies based on lab guidance from Dr. Cardenas.
Movement prescriptions: Aerobic and resistance exercise enhance endogenous opioid and endocannabinoid signaling, improve mood, and normalize insulin sensitivity and inflammatory tone.
Clinical rationale
Addressing physiologic load lowers symptom burden and can reduce reliance on pharmacologic rescue. This integrated strategy aligns with current research linking lifestyle, systemic inflammation, and pain chronification.

Personal Injury, Trauma-Informed Rehabilitation, and OUD

Injury can precipitate opioid exposure and escalate risk for misuse. Our trauma-informed rehabilitation:
Screens for OUD risk factors when opioids are considered for acute pain
Emphasizes non-opioid analgesia and early mobilization
Coordinates with Dr. Cardenas for limited, tightly monitored opioid trials if necessary, with clear taper plans
Integrates chiropractic, physical therapy principles, and graded activity to restore function
Embeds psychological safety: we avoid retraumatization, respect autonomy, and foster control and informed consent
Goal
Restore function quickly and safely, minimize opioid exposure, and, if OUD is present, link immediately to MOUD and comprehensive support.

Clinic Pathways: Screening, Diagnosis, and Care Coordination

Our standardized workflow ensures timely, safe, and person-centered care.
Intake and screening
Validated tools: Opioid Risk Tool, DSM-5 checklist, pain interference and function scales
Medical evaluation (Dr. Cardenas): Comorbidities, medications, EKG when indicated (methadone), liver function tests (naltrexone/buprenorphine), infectious disease screening where relevant
Functional assessment: Movement, posture, joint mechanics, myofascial findings, balance/gait
Shared decision-making
Present MOUD options (methadone referral vs buprenorphine in-clinic; naltrexone when appropriate), risks/benefits, and patient goals
Arrange naloxone co-prescription and training
Buprenorphine inductions
Conventional induction: Begin during moderate withdrawal to avoid precipitated withdrawal; titrate to symptom control
Low-dose/micro-induction options: For patients on full agonists who cannot tolerate withdrawal; carefully staged with medical oversight
Follow-up: Early and frequent check-ins to stabilize dosing, manage side effects, and coordinate rehabilitation
Methadone coordination
Referral and communication with OTPs; continuity of chiropractic and functional care; monitor QTc and drug interactions via medical team liaison
Naltrexone initiation
Ensure opioid-free period; assess liver function; consider for alcohol co-use disorder or tailored recovery plans.
Harm-reduction and MI integration
Provide fentanyl test strips, education, and community resources; use MI at each visit to reinforce goals and adapt plans.
Rehabilitation timeline
Early phase: Pain control without overreliance on passive care; gentle mobilization; sleep and stress strategies
Middle phase: Progressive strengthening, motor control, ergonomic changes
Late phase: Return-to-activity milestones, relapse prevention strategies, independent self-management
Quality metrics
Retention in MOUD, functional gains, pain interference scores, overdose education uptake, PDMP consistency, patient satisfaction, and safety events

Addressing Co-Occurring Conditions

Common comorbidities in OUD require coordinated care:
Psychiatric: Depression, anxiety, PTSD—refer for psychotherapy; consider pharmacotherapy under Dr. Cardenas; recognize how mood disorders interact with pain and cravings.
Infectious disease: HIV/HCV screening and linkage to care; vaccination updates (HBV, HAV).
Endocrine/metabolic: Diabetes, thyroid disorders; optimize for wound healing, energy, and mood stability.
Respiratory and cardiac: Evaluate for COPD and sleep apnea (especially with sedatives); monitor cardiac rhythm when indicated (methadone).
Pain syndromes: Fibromyalgia, neuropathic pain—non-opioid pharmacologic options, graded exercise, cognitive pain reframing, and integrative care strategies.

My Clinical Observations: Chiropractic and Functional Medicine in OUD Recovery

Drawing from my clinical work and observations shared across my professional platforms, I consistently see the following patterns:
When integrative musculoskeletal care reduces nociceptive input and improves function, patients report fewer cravings tied to pain spikes.
Autonomic balancing through breathwork, gentle manipulation, and progressive exercise improves sleep and mood—key pillars for sustained recovery.
A structured, empathetic team culture fosters trust; patients are more willing to disclose lapses and seek help early, allowing us to course-correct without shame.
Functional nutrition and anti-inflammatory strategies reduce baseline pain and fatigue, increasing adherence to exercise and therapy plans.
References to my professional perspectives and practice insights are available through my clinic and professional profiles:
chiromed.com
linkedin.com/in/dralexjimenez/

Case Practice: Language and Bias Reframing

Original biased phrasing (example themes we see in reports)
“Patient abused heroin IV … after seven years clean … involved with addict community … baby born addicted.”
Reframed with person-first, accurate language
“Patient reports intravenous heroin misuse from age 20 to 30, with daily use emerging soon after initiation. Last heroin use occurred 1 month ago following 7 years of no use. The patient entered recovery after a non-fatal overdose and began medications for opioid use disorder. Strengths and protective factors include a supportive family and regular participation in a recovery community. The patient’s child was born with neonatal opioid withdrawal and is currently healthy.”
Why this matters
Words influence policy, clinician attitudes, and patient self-concept. Reframing improves engagement, reduces shame, and is aligned with the scientific understanding of OUD.

Practical Safety Points for Patients and Families

Always carry naloxone; teach family and friends how to use it. Use one intranasal device per dose; if no response in 2 minutes, use the second device in the other nostril and call EMS immediately.
Test substances with fentanyl strips when possible; assume contamination risk.
Avoid using alone; consider the Never Use Alone hotline as a safety net.
For those on naltrexone, inform all providers (including surgeons) since opioid analgesics will not be effective.
For those on buprenorphine, communicate with medical and dental teams; many procedures can be managed with non-opioid strategies or carefully coordinated peri-procedural plans.
Maintain follow-up appointments; early communication about side effects prevents setbacks.

Why Our Multidisciplinary Model Improves Outcomes

Medical oversight (Dr. Cardenas): Ensures safe MOUD prescribing, lab and ECG monitoring, infection screening, and coordinated comorbidity care.
Chiropractic and rehabilitation: Reduce mechanical pain drivers, improve function, and normalize movement patterns, lowering reliance on pharmacologic solutions.
Functional medicine insights: Address systemic inflammation, sleep, stress physiology, and nutrition—critical for resilient recovery.
Behavioral collaboration: MI, group referrals, and trauma-informed care support motivation and coping.
Harm reduction: Makes care safer regardless of stage of change, decreases fatality risks, and keeps the therapeutic alliance intact.
Together, this integrated approach is modern, evidence-informed, and deeply humane. It respects the biology of OUD, the realities of pain, and the person’s goals for a meaningful life.

Evidence Highlights and Rationale

MOUD effectiveness: Strong evidence demonstrates reductions in all-cause and overdose mortality with methadone and buprenorphine, improved treatment retention, and decreased illicit opioid use.
Buprenorphine safety: Partial agonism with a ceiling effect reduces respiratory depression risk compared to full agonists; appropriate even when patients use benzodiazepines when benefits outweigh risks, per FDA guidance.
Harm reduction: Naloxone distribution and education prevent death; syringe services reduce HIV/HCV; fentanyl test strips inform safer choices.
Integrative pain care: Non-opioid multimodal strategies with manual therapy, exercise, and behavioral approaches are supported by clinical guidelines for back and neck pain and can be embedded within OUD care.
(See reference list for supporting sources.)

How to Begin Care with Us

Contact Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas.
Initial visit: Comprehensive intake, medical and functional assessments, and safety planning.
If OUD is identified or suspected: Same-day or rapid MOUD initiation pathways; naloxone provided; harm-reduction education; chiropractic and rehab plan tailored to your functional goals; functional medicine strategies to support recovery.
Ongoing care: Regular follow-ups with both medical and musculoskeletal teams; coordinated communications; outcome tracking focused on your goals and safety.
You are not alone. With the right team, tools, and plan, recovery is not only possible—it is probable.

References

• Centers for Disease Control and Prevention. (n.d.). Opioid overdose data. CDC. https://www.cdc.gov/drugoverdose/data
• Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. SAMHSA. https://www.samhsa.gov/data
• National Academies of Sciences, Engineering, and Medicine. (2019). Medications for opioid use disorder save lives. The National Academies Press. https://doi.org/10.17226/25310
• U.S. Food and Drug Administration. (2017). FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants. FDA. https://www.fda.gov/drugs/drug-safety-and-availability
• Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) National Practice Guideline for the use of medications in the treatment of addiction involving opioid use. Journal of Addiction Medicine, 9(5), 358–367. https://doi.org/10.1097/ADM.0000000000000166
• Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480
• Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, (2), CD002207. https://doi.org/10.1002/14651858.CD002207.pub4
• Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment. BMJ, 357, j1550. https://doi.org/10.1136/bmj.j1550
• Busse, J. W., et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ, 189(18), E659–E666. https://doi.org/10.1503/cmaj.170363
• Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the ACP. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367
• Bohnert, A. S. B., et al. (2018). Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA, 320(2), 185–186. https://doi.org/10.1001/jama.2018.7364
• Larochelle, M. R., et al. (2018). Medication for opioid use disorder after nonfatal opioid overdose and association with mortality. Annals of Internal Medicine, 169(3), 137–145. https://doi.org/10.7326/M17-3107
• Jones, C. M., Campopiano, M., Baldwin, G., & McCance-Katz, E. (2015). National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105(8), e55–e63. https://doi.org/10.2105/AJPH.2015.302664
• Katz, J., et al. (2018). The fourth wave: Co-use of opioids and stimulants. International Journal of Drug Policy, 55, 118–125. https://doi.org/10.1016/j.drugpo.2018.02.014
• Note: Additional guideline updates and local program information are incorporated from CDC, SAMHSA, FDA safety communications, and professional society recommendations current to the creation date.

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