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Abuse of Painkillers on the Rise: A Call for Action

Abuse of Painkillers on the Rise: A Call for Action

Lara Ulfers, MS, RD, CSSD

Non-steroidal anti-inflammatory drugs (NSAIDs) and prescription opiates are some of the most common classes of medications used to treat pain and injury (1,2). The misuse and abuse of painkillers are reason for concern and policy reform within athletic programs as these drugs deliver not only short-term, but also long-term health consequences for the athlete.

The provision and abuse of pain pills spans all levels of play, from high school adolescents to collegiate and professional athletes. Adolescent athletes do not identify the use of these drugs as a potential health risk and are known to self-medicate without any form of medical consultation (1,3). About a third of NCAA athletes acknowledge there is nothing wrong with using painkillers to cope with pain associated with competition (4). In addition, the 2013 NCAA Substance Abuse Survey shows a five percent increase in total prescription pain medication use since 2009 (5). Over half of retired professional football players surveyed for drug use during active play reported using opioids during their careers. Seventy-one percent of those athletes affirmed their misuse of prescription painkillers (2).

NCAA Chief Medical Officer, Dr. Brian Hainline, asserts, “The chronic use and misuse of both NSAIDs and prescription opiates for athletic competition can mask symptoms essential to diagnosing and preventing overuse injuries that require enhanced rest and rehabilitation.”

Athletes rely on painkillers in anticipation of pain, and also to avoid missing practices or games (4,6). Self-medication with non-prescription analgesics
correlates with an athlete’s lack of knowledge or concern for label recommendations. Research shows these athletes consume higher than the recommended dose, and for more consecutive days than recommended (2,6). The use of prescription painkillers is prevalent and on the rise in
athletic participation as well (2,5).

Dr. Hainline makes the point that “there is no substantiated evidence for the long-term efficacy of NSAIDs or
prescription opiates in the treatment of overuse and other sports injuries. Rather, long-term use of NSAIDs can lead to kidney damage, high blood pressure, and gastric ulcers— not to mention dependency and addiction with opiate use.” Other considerations for athletic programs should be the
confounding variable of an athlete’s social and recreational behavior. This includes the potential of consuming alcohol while self-medicating with excessive or long-term doses of pain pills (7).

Based on the current landscape of prescription opiate medication use in sport, including the knowledge and attitudes of athletes, there is a distinct need for education and policy reform. According to Dr. Hainline, “student-athletes must be made aware that 1) these drugs are not an effective treatment for sports injuries related to overtraining; 2) they carry a risk for dependency and addiction; and 3) certain painkillers sourced without a valid or documented prescription can result in criminal prosecution.”

Athletic department staff is encouraged to stress the importance of full disclosure when athletes report all prescription medications and dietary supplements. This dialogue and accompanying documentation should specifically include questions related to pain management techniques employed by the athlete. Education and intervention initiatives may then begin to shift athlete perceptions and help regulate the administration and control of pain per established sports medicine policies. To address this need in the collegiate athlete population, the NCAA hopes to partner with institutions in the roll out
of a universal education standard for the proper treatment of sports injuries. This comprehensive programming will also be targeted at alcohol, street and prescription drug use deterrence.

1. Ciocca M1, Stafford H, Laney R. The athlete’s pharmacy. Clin Sports Med. 2011 Jul;30(3):629-39.
2. Cottler, L. B., Ben Abdallah, A., Cummings, S. M., Barr, J., Banks, R., & Forchheimer, R. (2011). Injury, pain, and prescription opioid use among former National Football League (NFL) players. Drug & Alcohol Dependence, 116(1-3), 188-194.
3. Veliz, P. T., Boyd, C., & McCabe, S. E. (2013). Playing through pain: sports participation and nonmedical use of opioid medications among adolescents. American journal of public health, 103(5), e28-e30.
4. Tricker R: Painkilling drugs in collegiate athletics: knowledge, attitudes, and use of student athletes. Journal Drug Education, 2000, 30:313-324.
5. National Collegiate Athletic Association. “2013 NCAA National Study of Substance Use Habits of College Student-Athletes.” 2014 NCAA Convention. PowerPoint. 2014. 16-18 Jan 2014. < http://www.ncaa.org/sites/default/files/convention2014_drug-usepreliminary. pdf >.
6. Wolf DA, Miller TW, Pescatello LS, Barnes C: National Collegiate Athletic Association Division I Athletes Use of Non-prescription medication. Sports Health: A Multidisc Approach. 2011;3:25-28.
7. Smith BJ, Collina SJ: Pain medications in the locker room: to dispense or not. Curr Sports Med Reports, 2007;6:367-370.


Second Quarter, 2014

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