It’s time to recognize high school sports as the high-risk activities they are — for concussions, broken bones, repetitive injuries, and drug addiction.
Sports have long been pitched as a great way to keep kids off the streets and engaged in healthy activities and, for most teenagers, they are. For some young men, the combination of performance pressure, injury, and treatment with opioid painkillers creates a toxic mix that leads to drug abuse and sometimes death.
Recent research from the University of Michigan found that 11% of high school athletes have used a narcotic pain reliever or an opioid such as OxyContin or Vicodin for “nonmedical purposes.” That means one in nine have abused a prescription drug to get high.
Generally, athletes get opioids from their doctors, who prescribe them to athletes at twice the rate of other adolescents. The stakes associated with high school sports — college scholarships, professional careers, as well as issues of community pride and team expectations — many athletes request pain relievers so they can continue to play with an injury and many physicians provide prescriptions that enable them to do that.
The risk of 30-day prescriptions
Two things can happen that pose a risk for kids. First, they have extra pills. Guidelines increasingly recommend treating acute pain with narcotics for just two or three days, but most prescriptions are written for 30 days. Second, once the pain from the injury improves they like the feeling they get from opioids. While narcotics make many people nauseated, some find them very energizing, almost like a stimulant. Instead of being knocked out by the pills, they are eager to wash the car, party with friends. Even when the pain remits, they keep taking the pills.
Narcotic addictions don’t take long to develop. With daily use, dependence and tolerance requiring ever higher doses to produce the same pain relief or high can happen in a few days or weeks.
Young athletes who have taken all their prescribed OxyContin may approach friends looking extra pills they may have. On the street, prescription opioids go for 50 cents to $1 per milligram. Because they build tolerance for the drug, addicts often take 300-400 mg a day, which makes supporting their habit very expensive.
The cheaper alternative
A cheaper alternative to prescriptions opioids that produces the same or better high and is easy to obtain on campuses nationwide exists — heroin. To many people, it seems like a reach that a clean-cut high school athlete would start taking hard core drugs. The fact is that more than 80% of new heroin addicts now in treatment started with prescription opioids. If a kid complains that his opioid addiction costs too much, a dealer can set them up with heroin, explaining that they can get the five to seven times as many highs for the same price.
Heroin purity and potency are greater now than in past decades, so new users can get high effectively by snorting it or putting it on foil and inhaling as they burn it. As tolerance increases, they switch to the most efficient delivery system: injection.
As physicians, coaches and others involved with young people, what can we do to stop this epidemic? The NCAA recommends these steps:
1. Reconsider the use of opioids. Non-steroidal anti-inflammatories such as acetaminophen or ibuprofen effectively control moderate pain and can significantly reduce even severe pain.
2. Prescribe opioids for a very limited time and write prescriptions for just the amount of time needed, usually just two or three days.
3. When prescribing these drugs, explain to the athlete and parent their potential, specifically the risks of addiction and overdose.
4. Avoid prescribing long-acting or extended release narcotics, which have greater potential for overdoses, particularly in opioid-naïve patients.
5. Monitor athletes on opioids.
In addition, new guidelines expected shortly from the Centers for Disease Control and Prevention may also cause physicians to reconsider prescribing opioids for chronic pain. The CDC draft document states that, aside from cancer pain, there is little evidence to support the ongoing use of opioids.
Coaches, parents and athletes may also want to reconsider encouraging athletes to “play through the pain.” Pain is the body’s cry for time to heal, so it’s important to teach young people to listen to their bodies.
Because of the potential risk for addiction use of prescriptions opiates should be used sparingly and prescribed only for the duration needed. First consideration should be given to non-steroidal anti-inflammatory drugs and urging young people to understand that pain is their body’s way of telling them it is healing.