Among athletes, it usually starts pretty innocently.

He or she is injured, and the first line of treatment, the RICE method (rest, ice, compression, elevation) does not seem to be enough to curb the pain. Anti-inflammatory medication also does not appear to be providing enough help.

So a physician will prescribe a painkiller to offset some of the athlete’s severe discomfort. Nobody involved – not the athlete, not the parent, not the coach and not the doctor – believes that this player may now be at risk for misusing prescription opioids. But the statistics tell a different story.

Prescription opioids are narcotic pain medications, including Vicodin, OxyContin, Oxycodone and others, and should only be taken in the amounts and frequency prescribed. Like all medications, there are possible risks and side effects.

“Opiates are very effective painkillers, but at the same time, they produce a high level of euphoria,” said David A. Errickson, director of clinical operations at Corner House, a substance abuse treatment facility in Princeton, N.J.

So how does a high school or college athlete progress from taking a prescribed pain medication to moving into substance abuse. Isn’t substance abuse defined by the use of illicit or street drugs, as well as alcohol and tobacco? 

It’s necessary to understand that all abused substances, including the overuse of prescribed drugs, can form intoxication that alters judgment, perception, attention, or physical control. 

Continued and sustained use of many substances, such as alcohol, tranquilizers, opiates, and stimulants, can produce a phenomenon known as tolerance, where users require a larger amount of the drug to produce the same level of intoxication or comfort.  

“Tolerance can happen pretty quickly,” Errickson said.

While starting with dependence, over-the-counter and prescription drugs can also lead to addiction, in which a user becomes physically and mentally reliant on the effects of the substance.

“Addiction is different than dependence, and is marked by distinct behavior patterns,” Errickson said. “It gets to the point that the user is seeking more of the euphoria than the pain relief. Ultimately, addiction impairs their ability to function.”

For athletes, the slippery slope may begin with the desire to return to competition and to overcome the psychological distress inherent in being injured.
 
“This can go down the wrong path pretty quickly,” said Dr. Bruce Griffin, director of the Center for Sport Science at US Lacrosse. “Substance abuse can start with prescribed pain medicine and spiral from there. That’s the way it affects athletes.”

The phenomenon is widespread enough that Sports Illustrated published a special report in 2015 entitled, “How painkillers are turning young athletes into heroin addicts.”  The article cites a sobering statistic from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) that a full 80% of all users arrive at heroin after abusing opioid painkillers. 

“This is a national pandemic,” Errickson said. “There is a significant increase in younger athletes who become addicted. I have certainly seen it in clinical practice.”

According to the National Institute on Drug Abuse, the three classes of prescription drugs that are often abused are: 

• Opioids, used to treat pain
• Central nervous system depressants (ie-Xanax, Valium) used to treat anxiety and sleep disorders.
• Stimulants, such as amphetamines, used to treat attention deficit disorder and narcolepsy.

One of the first signs of potential substance abuse for these types of medications is taking increased doses, or more frequent dosages, without a doctor’s order. Using medicines prescribed for other people is also an indication of a problem.

“There has been a concerning trend in the use and misuse of prescription opiates in young athletes,” said Dr. Margot Putukian, chair of US Lacrosse’s Sports, Science and Safety Committee and director of athletic medicine for Princeton University.  

“High school students that are prescribed opiates for legitimate medical reasons are more likely to misuse opiates after high school and at the college level. According to a 2014 NCAA survey, about one in four college athletes use prescription opiates, with 25% of them using opiates without a prescription.”

The 2014 NCAA-administered survey of approximately 21,000 student-athletes also found that men’s lacrosse players reported the highest or near-highest use of many substances, including alcohol, cigarettes, spit tobacco, marijuana, synthetic marijuana and cocaine. Approximately 11% of men’s lacrosse players indicated that they had used cocaine in the last 12 months. 

Among women, lacrosse student-athletes reported high usage rates for alcohol, amphetamines, cigarettes, and marijuana. 

While marijuana use has been legalized in some states, it is still the most commonly used illegal drug in the United States. The NCAA survey of athletes found that 22% reported having used marijuana in the past year. 

Overall, alcohol was the most widely used substance among NCAA athletes, with 80% reporting alcohol use in the past year. That percentage is consistent with the usage rate found in studies of similarly aged non-athletes.

A copy of the NCAA’s final report from the substance use survey can be accessed online in PDF format

The good news is that assistance for addictions is widely available, and could involve either inpatient or outpatient treatment. The early recognition of symptoms related to substance abuse can increase the chances of successful recovery.  

While not a complete list, some of the signs that may indicate substance abuse among high school and college athletes include:

- Giving up participation in sports activities
- A decline in academic performance, declining grades and incomplete assignments
- Aggressiveness, irritability and forgetfulness
- Believing that in order to have fun or enjoy social settings, drugs and alcohol must be present

Errickson notes that early intervention is critically important.

“By the time they see me, many times the young person’s life has become pretty disastrous,” he said. “This is a very real thing.”

Unfortunately, studies indicate that it can be difficult for those suffering from substance addiction to stay sober without professional help. 

Depending on the addiction, the withdrawal process can also be dangerous. Many people need to be under a doctor’s supervision for the first several weeks of recovery so that they can detox safely. 

The Substance Abuse and Mental Health Services Administration offers an online listing of resources for those trying to find help and identify treatment options.

Some additional online resources are available at the sites listed below:

National Institute on Drug Abuse
Center for Disease Control
NCAA’s Sport Science Institute  
 

National Prevention Week

SAMHSA has designated May 14-20 as this year’s annual observance dedicated to increasing public awareness of substance use disorders.

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