Sports Medicine Research: In the Lab & In the Field: How Much is Too Much? Defining Nonprescription Pain Medication Misuse (Sports Med Res)
Monday, June 23, 2014

How Much is Too Much? Defining Nonprescription Pain Medication Misuse

Nonprescription pain medication use in collegiate athletes: A comparison of samples

Stache S., Close J.D., Mehallo C., Fayock K. Clinical Focus: Pain Management, Orthopedics, and Sports Injuries. 2014;42(2):19-26.

Take Home Message: Division II and III athletes use and misuse nonprescription pain medication for sports-related pain less often compared with Division 1-A football athletes.

Athletes tend to consume more nonsteroidal anti-inflammatory drugs (NSAIDs) than the general public; however, much of the research has been performed among high level American football athletes (NCAA Division 1-A teams). This is concerning because the risk of adverse effects from using NSAIDs is highly related to dose and duration of use. There is sparse research examining if nonprescription pain medication is being abused among collegiate athletes in other sports as well as other college divisions. Therefore, the purpose of this research was to survey athletes from non-Division 1-A sports about their nonprescription pain medication use. One hundred and ninety eight athletes (141 men; 57 women) who competed in a NCAA-sanctioned sport during the 2011-2012 academic year at 1 Division II and 1 Division III school anonymously completed a modified Over-the-Counter Drug Screen for Athletes questionnaire (38% response rate).
62% reported using nonprescription medication for sports-related pain,
12% reported taking more than the recommended dose,
1.5% reported taking pain medication for more than 10 consecutive days,
47% reported that they purchased their own nonprescription pain medication,
59% reported directing their own use, and
38% reported that they read the label when they took a new nonprescription pain medication.
The authors compared this study’s data with a study by Wolf et al. (144 NCAA Division 1-A football athlete’s survey responses). Results revealed that Division 1-A football athletes were more likely to take nonprescription pain medication for sports-related pain (73% vs. 62%), take more than the recommended dose (37% vs. 12%), take nonprescription pain medication for more than 10 consecutive days  (7% vs. 1.5%) compared to Division II and III athletes, respectively. Division II and III (38%) were more likely to read the label prior to first use of new nonprescription pain medication compared to Division 1-A football athletes (25%). Similar results were found when the authors compared Division 1-A and non-Division 1-A American football athletes.

This study is important because it is the first to explore nonprescription pain medication habits among Division II and III athletes. The authors found that NCAA Division 1-A football athletes’ are more likely to use and misuse nonprescription pain medication compared with Division II and III athletes, even when focusing just on football athletes. This contradicts the conclusions by Wolf et al that Division 1-A football athletes do not misuse nonprescription pain medication. There may be an increase in NSAID use due to the physical nature of Division 1-A football. Overall, athletes may self-treat with nonprescription pain medication so that they do not have to miss a practice or a contest in fear of loosing their position or scholarship. However, we need to keep in mind that this study focused on one Division II and III school while Wolf and colleagues assessed 8 randomly selected schools. It will be interesting to see if these findings hold up when more schools are included. None-the-less, we need to be proactive about reducing the risk of adverse events related to the misuse of NSAIDs, particularly among athletes in Division 1-A football. Medical professionals need to educate athletes about the risks and long-term effects due to the misuse of nonprescription pain medication as well as introduce what are the safe practices for handling their nonprescription pain medication usage.

Questions for Discussion: How do you control nonprescription pain medication at your facility? Do you educate athletes on their nonprescription pain medication use?

Written by: Jane McDevitt, PhD
Reviewed by: Jeffrey Driban

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Stache, S., Close, J., Mehallo, C., & Fayock, K. (2014). Nonprescription Pain Medication Use in Collegiate Athletes: A Comparison of Samples The Physician and Sportsmedicine, 42 (2), 19-26 DOI: 10.3810/psm.2014.05.2054

4 comments:

Stacy Schurr said...

This is a very interesting topic, and you made a lot of good points. Non-prescription medication use is certainly something that needs to be studied. My undergraduate university was Division II, and our head athletic trainer always did an excellent job explaining medications to our athletes. She kept up with how much they were taking and for how long, and that definitely taught me a lot about the importance of educating athletes about misusing medications. It definitely makes sense that Division I-A football athletes are more at risk of misuse because there is that fear of missing a practice or game, or losing their spot on the team. I could see that at the Division II level as well. It will certainly be interesting to see results as more Division II and III schools are surveyed. Non-prescription medication use is overlooked sometimes in our practice, and it's important to be aware of the long-term effects it can have on athletes.

Jane McDevitt said...

I agree, I would like to see more Division II and Division III school surveyed. I would also to see club sports surveyed because they do not always have an athletic trainer to report to. It seems like your athletic trainer did everything possible to make sure her athletes were practicing safe medication practices. I feel like it is important to take those extra steps to educate as well as really look at the medication log sheets to see how much and for how long the athletes are on these non-prescription pain medications.

Chelsea Williamson said...

Having worked clinical rotations with football at both the Division I and junior college level, I think a large part of nonprescription pain medication use involves the athletes themselves buying a bottle. We did track their usage from our supplies with logging, but often times with asking have you taken anything today, the answer was always yes. We then explain why we can't give it to them and the purpose of dosing correctly. While education is incredibly important, I think it's difficult to track exactly how much they are taking that we don't know about. The same people would come in and ask and repeatedly we would have to explain that more is not always better for you and there can be side-effects.

Jane McDevitt said...

Chelsea,
You are pointing out the biggest problem. Almost half of the athletes buy their own medication and self medicate. I think that it is great that you double check to make sure they didn't already take medication prior to them seeking additional meds. I am also glad to hear that they are truthful, which tells me that in addition to education you need gain the athlete's trust so they will be honest with what is going on with them. It is very hard to track over the counter medication, and I cant think of any good ways of controlling it other than education; however, I think you are right on point with developing a professional relationship with the athletes so they will listen and be honest about their injuries/pain and how they are dealing with these issues.

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