Injury, pain, and prescription opioid use among former National Football Leauge (NFL) Players
Cottler LB, Abdallah AB, Cummings SM, Barr J. Drug Alcohol Depend. 2011 doi:10.1016/j.drugalcdep.2010.12.003
Click Here to See Article in Press (the article is not indexed in PubMed yet)
The authors report the results of a telephone survey of 644 retired NFL players. The purpose was to determine how common it is for this population to misuse prescription opioids (pain relievers; during their career and the previous 30 days before the survey) and what the risk factors may be. The study included 54.4% of the athletes they contacted (7% refused to participate, 38.6% were unreachable). Here’s some quick numbers (the article has a fantastic flow diagram of this):
29.4% thought their teammates misused prescription opioids
52% reported using opioids during their career
37% of these athletes received their meds from a physician
12% of these athletes received their meds from a non-medical source*
51% of these athletes received their meds from medical and non-medical sources
*nonmedical source was defined as teammates, coaches, athletic trainers, or family members.
71% of these athletes misused opioids in their career
17% of those misusing in their career now use them as prescribed
68% of those misusing in their career now don’t use prescription opioids
15% still misuse opioids
29% of these athletes used opioids as prescribed in their career
8% of these athletes now use them as prescribed
87% of these athletes now don’t use prescription opioids
5% of these athletes now misuse opioids
2% of athletes who never took opioids in their career currently misuse them.
This means that players who misused during their career were close to 3 times more likely to still be misusing compared those who took opioids as prescribed and over 7 times more likely than those who never took opioids. The current misusers were also more likely to report 3 or more NFL injuries, undiagnosed concussions, self-perceived mental and physical impairments, drinking more alcohol, as well as the need for a walking assistive device.
Research on retired NFL players has been getting a lot of attention lately and this study will likely garner even more media attention. Can we know for sure that this data applies to other sports or other levels of sports (e.g., high school or college)? No, these findings may be unique to this group of retired athletes but regardless it can’t hurt us to become more aware of the long-term health of our patients. It can’t hurt to spend a little more time educating our athletes about safely using medications, about reporting concerns about medication misuse, and the potential long-term implications of decisions made during their athletic career. We also need to be aware that some patients maybe misusing their medication and decide how to intervene. Especially for the athletic trainers in our audience this needs to ring true. Athletic trainers are a unique healthcare worker with direct and regular (often daily) contact with the patients. Furthermore, athletic training education has a strong emphasis on prevention. Prevention must include reducing the risk of long-term negative health outcomes of our patients and not just preventing acute injuries. For a more detailed discussion about the role of athletic trainers in preventing long-term negative health outcomes see the November 2010 issue of the NATA News. Please leave comments on this post. What are your thoughts and experiences?
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas
I just wanted to note one statistic that was beyond the scope of my commentary that I thought was important: 81% of the retired players reported having undiagnosed concussions. It's hard to rely on someone's memory of whether they ever had an undiagnosed concussion but the high number of athletes thinking they have is interesting.
This is very interesting because I think this is bigger then the past steroid issue in baseball but commonly gets brushed under the rug. Dr. Joesph Torg at Temple University actually did a talk on the over prescription of narcotic pain medications by physicians. He suggested this level of medication gets prescribed for extended periods of time and for injuries that does not require that type of strength. This places the athlete at risk for addiction and dependence on the medication. Obviously there is a time and a place for narcotic medication however, and based on this article, this is commonly abused. Just something to think about.
This reminds me of an article I read in Time magazine about Rx pain reliever abuse (https://www.time.com/time/magazine/article/0,9171,2015763-1,00.html).
Thanks Christian for the link! It's a very interesting article. Some of the stats they cite from the CDC are amazing. The article you recommended reminded me that a few years ago a group of pain management specialists had a session at the NATA Annual Meeting (in Baltimore I think) to discuss management of chronic pain. They suggested that patient prescribed opioids should be advised to undergo counseling while they are taking the medications to help them deal with the chronic pain (as well as associated psychological concerns like depression) and to recognize that the medication is just a temporary solution. They also recommended that the patient should be told up front how long they will be prescribed the medication so that they can prepare to stop taking the medication. I am not sure how often these practices are often employed but they seem to be good recommendations.