In nearly every U.S. state, chiropractors cannot prescribe medication. The vast majority of state licensing laws explicitly prohibit chiropractors from prescribing, dispensing, or administering prescription drugs. New Mexico is the only state that grants chiropractors a meaningful prescriptive authority for common medications like muscle relaxers, anti-inflammatory drugs, and certain hormones. Idaho allows a narrow exception for injectable vitamins and minerals under a special certification. Beyond those two, the chiropractic profession in the United States is defined by its drug-free approach to care.
New Mexico: The One True Exception
New Mexico is the only state where chiropractors can prescribe a defined list of medications that most people would recognize as “real” prescriptions. To do so, a chiropractor must hold an Advanced Practice Chiropractic (APC) certification, which requires additional training beyond a standard chiropractic license. Once certified, they can prescribe from a state-approved formulary that includes several categories of drugs.
The formulary covers prescription-strength anti-inflammatory drugs like ibuprofen, naproxen, diclofenac, ketoprofen, and piroxicam, available in both oral and topical forms. It also includes the muscle relaxer cyclobenzaprine (the generic form of Flexeril), which is one of the most commonly prescribed medications for back and neck pain. Hormones are on the list too: estradiol, progesterone, testosterone, and desiccated thyroid, all for topical, oral, or sublingual use.
New Mexico’s formulary also permits certain injectable substances, though these are more specialized. Advanced practice chiropractors can inject sterile saline, procaine (a local anesthetic), epinephrine, caffeine, sarapin (a pain-relief extract), and homeopathic preparations. They can also use lidocaine topically and prescribe glutathione for inhalation. What they cannot prescribe are opioids, benzodiazepines, or any controlled substances. The formulary is deliberately limited to medications that support musculoskeletal care without venturing into the territory of addictive or high-risk drugs.
Idaho: A Narrow Nutritional Formulary
Idaho takes a different approach. Chiropractors there are called “chiropractic physicians” under state law, and those who earn a clinical nutrition certification from the state board can obtain and administer a small list of prescription-grade nutritional products. This is not prescribing in the way most people think of it.
The Idaho formulary is limited to prescription-strength vitamins (A, all B vitamins, and C), minerals (including calcium, magnesium, zinc, selenium, chromium, and several others), and IV fluids like saline, dextrose, and lactated Ringer’s solution. Epinephrine and oxygen are also on the list, but only for use during emergencies or allergic reactions. Idaho-certified chiropractors can administer these products during office visits, but they cannot write prescriptions for patients to fill at a pharmacy, and they cannot prescribe any conventional medications like pain relievers or muscle relaxers.
States That Explicitly Prohibit Prescribing
Most states draw a hard line. Oregon’s chiropractic statute is a clear example: “No person practicing under this chapter shall administer or write prescriptions for, or dispense drugs.” Oregon further specifies that chiropractors cannot administer any substance through the skin for a therapeutic purpose, which rules out injections as well. They can use over-the-counter supplements, food, water, and nutritional products taken orally, but nothing that qualifies as a prescription drug.
Texas is equally direct. Its administrative code states that a licensed chiropractor “may not prescribe controlled substances, dangerous drugs, or any other drug that requires a prescription.” Similar language exists in the licensing statutes of the vast majority of states. While the exact wording varies, the effect is the same: chiropractors are licensed to perform spinal adjustments, physical therapy modalities, and related manual therapies, not to prescribe medication.
Why the Profession Generally Avoids Prescribing
The restriction is not just legal. It reflects the chiropractic profession’s core identity. The American Chiropractic Association actively promotes chiropractic care as a “non-drug approach to pain management” and frames it as an alternative to prescription medications, particularly opioids. In its federal advocacy, the ACA highlights that chiropractic “helps patients avoid surgery and prescriptions” and positions this as a cost-saving benefit for the healthcare system.
This philosophy is baked into how chiropractors are trained. Chiropractic doctoral programs do not include the pharmacology coursework required of medical doctors, nurse practitioners, or physician assistants. Even in New Mexico, the Advanced Practice certification requires additional pharmacology education on top of the standard chiropractic degree. Expanding prescriptive authority to other states would require changes to both legislation and educational standards, and there is limited organized effort within the profession to push for it.
What Chiropractors Can Recommend Without a Prescription
In all 50 states, chiropractors can recommend over-the-counter medications like ibuprofen or acetaminophen, just as any person can. Many also recommend and sell nutritional supplements, vitamins, herbal products, and homeopathic remedies, since these do not require a prescription. Some states allow chiropractors to use topical analgesics, certain antiseptics, and radiopaque substances needed for diagnostic imaging.
If you’re seeing a chiropractor for pain and need prescription medication, such as a stronger anti-inflammatory, a muscle relaxer, or something for nerve pain, you will need to get that prescription from a medical doctor, nurse practitioner, or physician assistant in every state except New Mexico. Many chiropractors work alongside or refer to these providers, so getting a prescription is usually a matter of a phone call or a separate appointment rather than a barrier to care.