How Prescribing Opioids to Student-Athletes May Increase Risk of Abuse
This article is featured in the magazine, A Public Health Perspective on the Opioid Crisis. Download it now.
By Leslie D. McManus, Faculty Member, Sports & Health Sciences, American Public University
Injuries in athletics are inevitable. Sprains, strains, ruptures, and fractures are a common part of competition. But how we treat these injuries, and even more importantly, the individual student-athletes who obtain them, may have a significant effect on the current opioid crisis in the United States.
There was a time when passive modalities were commonplace in the athletic training room. Athletic trainers often used hydrotherapy, electric simulation, ultrasound, iontophoresis, heat, and ice as often, if not more regularly, than active rehabilitation techniques like resistance training and active stretching.
Then, in 2014, the American Physical Therapy Association (APTA) joined the Choosing Wisely campaign. The goal of this campaign from the American Board of Internal Medicine Foundation is to encourage patients to keep communicating with medical professionals about their recovery and to help them make better choices in the rehabilitation setting. When APTA joined the campaign, they released a bold statement: “Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program.”
Pain Medication as a Passive Treatment
Although athletic trainers and physical therapists do not prescribe pain medications, the physicians whom they work with do. According to the Centers for Disease Control and Prevention (CDC), providers wrote nearly 250,000 opioid prescriptions in 2013. These prescriptions are written for injuries as minor as an ankle sprain and as severe as post-operative pain.
According to a study by Penn Medicine, where a person lives can have a large impact on the types of medications that are prescribed, how many are provided, and how long the prescription (how many refills) can be taken. In states considered to be “high prescribers” of opioids, a student-athlete with a sprained ankle is nearly three times as likely to receive a prescription for these medications as a student-athlete with the same injury in a “low-prescriber” state.
Non-Medical Use of Opioids by Student-Athletes
Nearly a third of student-athletes who become addicted to opioids obtained their pills through a legitimate previous prescription from their physician and 83 percent of student-athletes had access to their medication without parental consent or supervision. Student athletes who had prescriptions for a long course of treatment (generally 30 pills) were five times more likely to fill another prescription for opioids within the next six months than student-athletes who only received 10 pills, or enough for just a few days. Student-athletes who are considered at a higher risk for non-medical use of opioids are those who participate in collision sports (including football, rugby, and wrestling), as well as athletes with a history of mental illness.
Not only are we giving our student-athletes access to these controlled substances, we are opening them up for the possibility of addiction to opioids and possibly even heroin. According to data from the Substance Abuse and Mental Health Services Administration, the rate of heroin use is 19 times higher in people aged 12-49 who have a history of non-medical opioid use than in those who had not used opioids.
In the article Playing Through Pain, published in the American Journal of Public Health, Veliz et. al found that student-athletes competing in high-injury sports were 50 percent more likely than other adolescents to become addicted to opioids.
“Don’t Employ Passive Physical Agents Except When Necessary…”
Now that we know the risks for student-athletes who become injured, what can we do? As part of a sports medicine team, physicians, coaches, physical therapists, and athletic trainers should all work together to be sure their athletes are getting the best care, with minimum cost to the athlete. For physicians, this can mean taking a variety of steps. Careful diagnosis and minimum prescription strengths and lengths are two great starts. For those on the rehabilitation side of student-athlete injuries, like physical therapists and athletic trainers, this means keeping the student-athlete involved in their treatment.
It has been shown that passive treatments like medication and those mentioned earlier may lead student-athletes to feel a sense of powerlessness. The NCAA has identified student-athletes as a unique population who may present differently than non-athletes with anxiety. While rehabilitating an injury, we certainly don’t want to add to their negative emotional state. Alternative pain management techniques, such as meditation that actively involve the athlete, should be considered.
Educate, Educate, Educate
The sports medicine team must be sure they are up-to-date on current news about student-athletes and opioid use. If there is a need to prescribe pain medication, a pain plan should be in place so athletes, parents, coaches, and rehabilitation staff know what the effects of the medication may be, what the risks are, and what changes to look for in the athlete.
Potential signs or symptoms of opioid use include:
- increased sensitivity to pain
- nausea or vomiting
- dry mouth
- dizziness or sleepiness
- depression or low levels of energy and strength
When possible within health information policy guidelines, parents should be in control of dispensing pain medication. Proper disposal of medication that is left at the end of treatment (at pharmacies, police stations, etc.) should also be discussed.
As society becomes more aware of the dangers of over-prescribing opioids, we have the opportunity to take this time to carefully examine our rehabilitative techniques and our communication with athletes and parents. Perhaps most importantly, we can begin by making ourselves open and available for questions from our student-athletes. It’s time to start looking for pain-management alternatives to help keep our student-athletes in the competition without putting them at risk for addiction.
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About the Author: Leslie D. McManus, MS, LAT, ATC, is a faculty member at American Public University. She is a graduate of the Pennsylvania State University with a Bachelor of Science degree in Exercise and Sports Science with a concentration in Athletic Training (AT) and has remained a BOC-certified athletic trainer since her graduation. She also earned her Master’s degree in Kinesiology from the University of Texas-Pan American. McManus has worked in the field of sports medicine for more than 20 years and has extensive experience in athletic training. She has worked as an AT at all levels of athletics from middle school through the NBA, WNBA, and NHL. She has also worked as a hospital administrator as a Sports Medicine Manager. As a Sports Medicine Manager, she worked with a team of professionals including physicians at the Brain and Spine Institute at Sinai Hospital in Baltimore, Maryland. The team was developing a comprehensive care system for student athletes suffering from traumatic brain injuries. The study of TBI rehabilitation remains a strong interest for McManus. To reach the author, email IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.
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