Professional athletes’ physically demanding jobs put them at risk for injury almost on a daily basis.
When an injury does occur, these professionals might be prescribed opioids to keep them out of pain and in the game.
However, the number of safer pain management options is growing, due in large part to the devastation caused by the decades-long opioid epidemic.
These options not only honor the body’s healing process, and pain’s role in that process, but also help protect the mental health of athletes from the ravages of drug addiction.
Read on to learn more about opioid use in sports and how athletic teams can better support all aspects of athletes’ health.
Effects Of Opioid Misuse And Addiction Among Athletes
Although studies on professional athlete opioid addiction and other painkiller use have been limited, reports of painkiller use among athletes indicate that it is an issue.
When an injury occurs, athletes and their medical teams might turn to prescription pain management as a solution for various reasons.
Addressing these reasons can be a first step in making pain treatment alternatives and mental healthcare a priority for professional athletes as well as for tomorrow’s pros.
One study did show the following risk factors for opioid use among professional and college athletes:
- Caucasian race
- contact sports
- postretirement unemployment
- undiagnosed concussion
Professional Athlete Opioid Addiction In Contact Sports
Contact sports like football, soccer, and ice hockey can lead to serious injuries for athletes, including torn anterior cruciate ligaments, bone fractures, and dislocations.
However, even the most common injuries among athletes, such as joint injuries and muscle strains and sprains, can be painful, difficult to heal, and performance-limiting.
Professional athletes may be prescribed opioids following surgery or to numb the pain of injuries so that they can continue to play and maintain their earning potential.
For instance, English soccer players and their doctors report using injectable painkillers in order not to miss a game, which helps the athlete keep a spot on the roster and reach the minimum-games threshold for extra pay.
Athletes might also use pain medication if they can’t afford surgery or other high-cost medical care, as was the case for former pro footballer Ray Lucas, who went on to develop an opioid addiction.
Doctors prescribed Lucas opioids so that he could avoid a $400,000 surgery and continue playing. Lucas said his health insurance with the NFL only lasted five years and had run out.
Many retired pro athletes face similar financial obstacles to care. The average age of retirement in the NFL is 27; in the NHL, it’s 28.2; and for soccer players, it’s 35.
Professional Athlete Opioid Addiction In Non-Contact Sports
Although contact-sports athletes may seem to be injured more than athletes in non-contact sports, that might not be true.
According to the National Safety Council, the leading cause of sports injuries in 2021 was the use of exercise equipment and exercise in general.
The next leading cause was the use of bicycles, followed by playing basketball. Next was the use of skateboards, scooters, or hoverboards. Football was fifth on the list, and soccer was eighth.
Professional bicyclists and skateboarders experience high rates of injuries and also report using prescription pain management.
Banned for use in competitive cycling in 2019, the opioid tramadol will be on the World Anti-Doping Agency’s list of banned substances for all sports starting in 2024.
A study of ballet dancers and painkiller use revealed that more than half use painkillers, with more than 10% using them regularly.
Although there is very little data on college athletes’ prescription painkiller use, these athletes are also at risk for opioid misuse, dependence, and addiction.
One study by the National Collegiate Athletic Association (NCAA) showed that, of college athletes surveyed, 11% had used painkilling medication prescribed by a doctor in the past year.
A recent article in Psychology Today brought attention to suicide among college athletes — students who were performing well both in school and on the field.
This indicates a need to make mental health more of a priority among college athletes, such as by replacing a “win at all costs” culture with one that prioritizes health.
High School Athletes
Opioid misuse isn’t just a concern for college and professional athletes. Having access to highly addictive painkillers puts young athletes at risk of misuse and abuse.
Recent data from the National Council on Alcoholism and Drug Dependence shows that 12% of male and 8% of female high school student-athletes had been prescribed opioids in the past 12 months.
In another study, youths participating in high-injury sports like wrestling and football were 50% more likely to use opioids for nonmedical reasons than non-athletes of the same age.
In addition, male athletes had double the chance of being prescribed painkillers and were four times as likely to abuse them.
Types Of Painkillers Used In Sports
Opioids are powerful drugs that come with a high risk of abuse. This can lead to addiction and overdose, which can be fatal.
Although this guide focuses on opioid use among athletes, over-the-counter painkillers are also used in an effort to treat sports injuries.
The Use And Misuse Of Prescription Opioids
Athletes may be prescribed opioids such as Vicodin and OxyContin following major injuries and surgeries or to treat chronic pain conditions.
Codeine and tramadol are two other opioid medications used by athletes to treat pain and improve performance.
Although tramadol use is being banned by the World Anti-Doping Agency, codeine is not a banned substance in sports.
Anyone who takes opioids is at risk of developing an addiction.
The Use And Misuse Of Over-The-Counter (OTC) Painkillers
Although risks associated with prescription painkillers, such as addiction and overdose, aren’t associated with OTC painkillers, their use still has potentially serious ramifications for athletes.
Athletes aren’t always aware of the side effects of these drugs, including kidney injury and digestive system issues.
In a study on marathon runners, there was no difference in withdrawals from a particular race due to pain between those who took OTC painkillers and those who didn’t.
However, almost five times as many runners who took painkillers versus those who didn’t withdrew due to an adverse gastrointestinal event. Those who took higher doses experienced worse effects.
A recent study also showed that 400 milligrams (mg) of ibuprofen taken before an athletic event did not improve performance.
It would also be helpful for athletes to know that non-steroidal anti-inflammatory drugs (NSAIDs) have been shown in studies to reduce ligament, tendon, and cartilage healing and slow muscle regeneration.
Identifying Painkiller Addiction Symptoms In Athletes
Education about opioid addiction among athletes can help coaches, medical teams, loved ones, and athletes themselves identify warning signs of addiction.
If you notice any of these symptoms in yourself or in an athlete you care about, seeking medical attention can help them to avoid the dangers of addiction.
Signs and symptoms of addiction in athletes include:
- loss of interest in the game and other activities once enjoyed
- declining performance on the field
- prescriptions from multiple doctors
- changes in appetite, sleeping habits, or hygiene
- emotional volatility
- ignoring risks associated with drug use
- financial problems due to the cost of drugs
- possessing unmarked bags of pills or empty pill bottles
- experiencing drug cravings
What To Do If An Athlete Has An Injury
Drug addiction is a mental health disorder, but the pathway to opioid addiction for many comes through the treatment of a physical injury, especially for athletes.
With today’s increased awareness of the importance of mental health, leaders of athletic teams have an opportunity to make mental health more of a priority.
Having honest, open communication about injuries and performance expectations can help players protect their mental health as they heal physically.
This might include:
- providing information about injuries and the role that pain plays in the healing process
- making it clear that doctors and other healthcare providers will determine when returning to play is OK, not coaches, family members, or the athlete
- having regular check-ins with injured players on their mental health as well as their physical health
- encouraging positive attitudes and healthy behaviors among players
It’s also important for the coaching staff to be aware of the athlete’s treatment plan for returning to play and the progress that’s being made.
If an injury can be given adequate time to heal, pain management through the prescribing of opioids may never be required.
Taking access to opioids out of the picture is one of the best ways to prevent opioid addiction in athletes — or anyone, for that matter.
Steps To Help Ensure Safe Pain Management
When pain management is required, coaches, medical teams, and the athlete can work together to ensure that the medical plan is being followed closely.
Steps to take to ensure safe pain management for athletes involving opioids:
- Make healing the priority. One way you can do this is by checking in on the athlete regularly and not pressuring them to get back into play.
- Provide consequences for sharing or misusing prescriptions. This might include missing a number of games or an entire season.
- Have discussions about alternative treatments for pain. This may include yoga, massage, or therapy.
If athletes are aware that they have the support of their coach and team during the healing process, they will be more likely to stick to their return-to-play plan established by their doctors.
Pain Management Alternatives For Pro Athletes
Research into alternative methods of pain management has only just begun. The good news is that several alternatives show promising results.
In 2018, the National Institutes of Health (NIH) launched the Helping to End Addiction Long-term (HEAL) Initiative in direct response to the opioid epidemic.
In addition to finding the best treatments for opioid misuse and addiction, HEAL has accelerated research into alternative, non-pharmacological treatments for pain.
Professional athletic teams can show a dedication to their athletes’ physical and mental health by being open to and looking into these evidence-backed options.
Acupuncture For Pain Management
Acupuncture stems from traditional Chinese medicine and involves placing small, thin needles at strategic energy points in the body.
Acupuncture has been shown to lower the number of opioid doses required following surgery.
Additionally, in a study of 300 emergency room patients with pain, 92% who received acupuncture treatments reported successful pain reduction, while just 78% of those who received morphine said the same.
Acupuncture also shows “strong positive evidence” for treating chronic pain, a 2017 review of scientific literature reported.
Behavioral Interventions For Pain Management
Behavioral interventions can help people change their behavior in order to address the symptoms they are experiencing.
In the case of pain management, treatments such as cognitive behavioral therapy (CBT) and mindfulness meditation have a twofold benefit.
They can help people adhere to pain treatment plans, thereby avoiding the misuse and abuse of medication, for example, as well as avoiding needing them in the first place.
CBT and meditation are two research-backed methods for reducing stress and anxiety and improving mental health on a variety of levels.
Mind-Body Therapies For Pain Management
Mind-body therapies are those that grow a person’s awareness of their mind’s influence on their body’s functions and vice versa. They can aid in developing healthy coping mechanisms.
Yoga, tai chi, and guided imagery are examples of mind-body therapies, and meditation can be placed in this category as well.
Research into these treatments is limited but promising. For example, yoga is as effective as physical therapy in treating low-back pain, a recent research review shows.
It can also help with pain associated with headaches and fibromyalgia.
Cryotherapy For Pain Management
The image of a football player soaking in a tub filled with ice water after the game is one that many people are familiar with. Others might have heard of Wim Hof, or “The Iceman,” a Dutch athlete who touts cold therapy.
Cryotherapy is a relatively new treatment for pain, but studies show that it can help reduce inflammation and speed healing.
Additionally, people who use cryotherapy report experiencing less pain, and even less depression and anxiety, studies show.
Supplements For Pain Management
There are many natural substances that have been shown to help reduce inflammation and decrease pain.
Fish oil, and in particular the omega-3 polyunsaturated fatty acids found in it, has been especially effective in fighting inflammation.
Studies have shown white willow bark to be as effective for inflammation and pain relief as aspirin and other NSAIDs.
Other evidence-based supplemental treatments for pain and inflammation include curcumin, green tea, pycnogenol, and capsaicin.
Supporting Athletes And Preventing Opioid Misuse And Abuse
There are many things that athletic teams can do to help prevent opioid addiction in athletes.
These efforts can focus on showing support through open communication around all aspects of mental health and providing relevant education materials.
Education About Opioid Addiction
Drug addiction is a mental health disorder that is treatable but not curable. The majority of people who experience opioid use disorders, including heroin abuse, report first misusing a prescription opioid.
Opioids affect the reward centers of the brain, releasing endorphins, the brain’s “feel good” neurotransmitters.
Endorphins have the ability to mask pain and cause feelings of euphoria. Once these effects wear off, cravings for the drug can occur and addiction can result.
Anyone who takes opioids is at risk of developing an addiction. In 2020, nearly 75% of all drug overdose deaths involved opioids, according to the Centers for Disease Control and Prevention (CDC).
Bolstering Mental Health
Athletes’ perceptions of sports medicine professionals (SMPs) indicate that there is an opportunity for SMPs to begin addressing the mental, emotional, and other psychosocial needs that accompany the physical healing process.
If it isn’t feasible for SMPs to become trained in this area, sports teams might consider hiring additional medical professionals who can address athletes’ mental health needs.
Conducting random or regular drug screenings helps sports teams determine if drug use is an issue.
Following Tyler Skaggs’ death in 2019 from a toxic mix of opioids and alcohol, Major League Baseball began testing players for opioid use.
Only the non-prescribed use of opioids counts as a violation. Teams must still address the misuse of painkillers when prescribed to an athlete.
However, screenings such as these can help prevent the sharing of prescription opioids and using opioids when they aren’t prescribed.
Substance Abuse Assessments
When it is determined that athletes are misusing opioids or other drugs, a substance abuse assessment can help provide the best path forward for their healing.
Typically provided by addiction treatment centers, drug assessments help determine:
- whether the person has an addiction
- the severity of the addiction
- if any co-occurring mental health disorders exist
- how the addiction is affecting the person’s life
- the best course of treatment
Assessments help athletes with a substance use disorder feel supported and cared about as they take steps to improve their mental health and overcome addiction.
Opioid Addiction Treatment For Athletes
An ounce of prevention is worth a pound of cure, the saying goes. However, if an athlete you know is living with opioid addiction, professional care is necessary.
Treatment for opioid use disorders might include:
- medically supervised detox
- medication-assisted treatment (MAT)
- cognitive behavioral therapy (CBT)
- motivational interviewing (MI)
- group or family therapy
- holistic approaches, such as music therapy and yoga
- aftercare support
Resources To Reduce Opioid Use In Sports
Leaders of athletic teams and others involved with pro athletes’ health and well-being are often in need of resources to help ensure their teams’ physical and mental health.
In addition to this guide, the following resources provide a good place to start:
- Centers for Disease Control and Prevention’s Real Stories: YouTube video stories from people, including athletes, who have lived with opioid addiction or seen a loved one struggle with it
- Indiana Department of Health, Traumatic Brain Injury and Opioid Use Toolkit: resources for athletes with traumatic brain injuries and their families and healthcare providers to prevent opioid misuse
- Massachusetts Department of Public Health, Opioid Misuse Prevention: Student Athletes Fact Sheet Packet: free printable resources for educating student-athletes on opioid misuse and injury management
- National Athletic Trainers Association, Opioids Fact Sheet: information on and tips for preventing opioid abuse among athletes
- National Institutes of Health, Helping to End Addiction Long-term Initiative: resources and strategies from the government’s program to prevent and treat opioid addiction through science
- Public Health Management Corporation, Student-Athlete Injury Toolkit: resources for athletes, coaches, and parents to help prevent opioid misuse
- The Sports Medicine Broadcast Podcast, “Opioid Abuse in Athletics”: an interview with a friend of an athlete who died from opioid abuse
- Substance Abuse and Mental Health Services Administration, Treatment Resources for Opioid Use Disorder: resources that sports team healthcare providers can use to prevent and treat opioid abuse
- U.S. Department of Health and Human Services, President’s Council on Sports, Fitness & Nutrition: details about President Biden’s current focus on increasing awareness about mental health as it pertains to sports and physical activity, plus other recent related initiatives
- U.S. Department of Health and Human Services, National Opioid Crisis: Help and Resources: grant opportunities, a treatment locator, pain management, and other resources related to preventing opioid addiction
- American Journal of Managed Care — 5 Things About Opioid Abuse Among Athletes
- Anesthesia & Analgesia — Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence
- Centers for Disease Control and Prevention — Opioids: Data Overview
- Clinical Journal of Sport Medicine — Analgesic Management of Pain in Elite Athletes: A Systematic Review
- Journal of Athletic Training — Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: professional athletes' views
- National Federation of State High School Associations — NJSIAA Issues Recommendations to Combat Opioid Use Among Athletes
- National Library of Medicine — Natural anti-inflammatory agents for pain relief
- National Safety Council — Sports and Recreational Injuries
- Psychology Today — College Student-Athletes Are Dying in Mental Health Crisis
- Sports Injury Bulletin — Medication in Sport: Is your client a painkiller junkie?
- World Anti-Doping Agency — WADA publishes 2023 Prohibited List