Since the implementation of health insurance provider policies that mandate opioid painkillers as the first line treatment for chronic back pain in the 1990s, opioid prescriptions and subsequent opioid poisoning related deaths have quadrupled. In the U.S., the second leading cause of physician visits and disability is back pain symptoms. The decision to assign opioid painkillers as the first line treatment is due to current cost containment efforts of health insurance providers. The method of research used is a literature review of available clinical studies, research reports, news archives, and legislative policy examining the origin these first line treatment policies and the impact they have on communities in the United States, as well as, the ethical implications of this method of treatment. Further, I explored the safety and utilization of chiropractic spinal manipulation, a non-pharmaceutical treatment for back pain. To assess the influence of non-pharmaceutical treatment on the occurrence of opioid overdose, my research analysis compares public accessibility and utilization of chiropractic treatment in each of the 50 states. While painkillers are the current first treatment for chronic pain, chiropractic treatments are a form of preventative care that specifically focuses on spinal conditions and hold significantly less risk for the patient. My research indicates that communities which have increased accessibility to chiropractic care also have lower instances opioid overdose. My analysis concludes that as the number of opioid prescriptions rises, there is also an increased probability of patients with painkiller prescriptions developing a drug dependency. This correlation calls into question the ethics and morality of the decision to designate opioids as the first line treatment for chronic back pain, as patient suffering is highly influenced by designated treatment options, and that a non-pharmaceutical treatment should be considered as a replacement for the currently mandated first line treatment.