People who first visit a physical therapist or chiropractor for lower back pain, rather than a primary care physician, are much less likely to be prescribed opioids.

That’s the takeaway from a new study that looked at commercial insurance and Medicare Advantage claims data from more than 200,000 U.S. adults. The study subjects had new-onset low back pain and none had been prescribed opioids before.

The researchers found that people who first saw a primary care physician were 79% more likely to use prescription opioids than patients who first went to a chiropractor. And they were 71% more likely than those who first went to a physical therapist to use these drugs. The results held after controlling for socio-demographic, geographical, and medical history factors.

In light of the findings, “insurers should incentivize patients to see physical therapists or chiropractors first or early on following a bout of low back pain,” said the study’s lead author, Lewis Kazis, Sc.D., Boston University.

The findings also illustrated the impact of state-level regulations on opioid prescribing, the researchers wrote. Study subjects who lived in states with provisional or unrestricted access to physical therapy were much more likely to see a physical therapist first than patients in states with limited physical therapy access.