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