For a study, it was determined that opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) were evidence-based plans for the treatment of chronic low back pain (cLBP). Still, the long-term safety of these therapies was uncertain. The researchers aimed to compare and contrast OAT versus SMT concerning the risk of adverse drug events (ADEs) among older adults with cLBP. All patients were given long-term management of LBP with SMT or OAT. Researchers collected cohorts of patients who received SMT or OAT only and cohorts of patients who crossed over from OAT to SMT or SMT to OAT. Poisson regression was used to calculate the adjusted incidence rate ratio for outpatient ADE among patients who initially chose OAT compared with SMT. With controlling for patient characteristics, health status, and propensity score, the adjusted rate of ADE came out to be more than 42 times higher for the initial choice of OAT versus an initial selection of SMT (rate ratio 42.85, 95% CI 34.16–53.76, P<0.0001). Among older Medicare beneficiaries receiving long-term care for cLBP, the adjusted rate of ADE for patients who initially chose OAT came to be substantially greater than those who initially chose SMT.