Background-Athletes with injury-related pain, especially National Football League (NFL) players, are at increased risk for opioid use and misuse which may result in medical, psychiatric and social problems. This is the first study to evaluate the intersection of sports pain and opioid use and misuse among former NFL players.Methods-A telephone survey of 644 retired NFL players from the 2009 Retired Players Association Directory was conducted (53.4% completion rate) from March to August 2010.Results-Over half (52%) used opioids during their NFL career with 71% reporting misuse. Additionally, 15% of NFL misusers currently misused vs. 5% among players who used just as prescribed during their NFL career. Prevalence of current opioid use was 7%--3 times the rate of the general population. Multivariate analyses indicated that significant NFL pain increased the adjusted odds (AOR) of any current opioid use vs. non-use (AOR 6.76, 95%CI 2.88-15.87), as did moderate to severe mental impairment (AOR 1.88, 95%CI 1.19-2.98) and heavy drinking in the past week (AOR 2.15, 95% CI 1.17-3.98). Undiagnosed concussions singly predicted current misuse vs. use just as prescribed (AOR 4.25,. Three variables predicted current misuse vs. non-use: significant pain (AOR 8.33, 95%CI 1.98-35.04), undiagnosed concussions (AOR 3.51, 95%CI 1.98-35.04) and heavy drinking (AOR 3.48,).* A copy of the survey instrument used in this study can be found as supplementary materials by accessing the online version of this paper at http://dx.doi.org and by entering doi:... Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of Interest:Authors Cottler and Ben Abdallah currently receive funding from Pinney Associates to conduct a national epidemiological study of stimulant use among teenagers. Pinney Associates is funded from Shire Pharmaceuticals for that study. Neither Cottler nor Ben Abdallah is a clinician. All other authors declare that they have no conflicts of interest. Conclusions-Players who misused during their NFL career were most likely to misuse currently compared to others. Current misuse was associated with more NFL pain, undiagnosed concussions and heavy drinking. Longitudinal studies are needed to determine the long term effects of opioid misuse among athletes. NIH Public Access

Objectives Substance related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of the present study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring due to substance-related impairment, in order to develop better mechanisms of prevention and intervention. Methods A total of 55 physicians (94.5% male) who were being monitored by their State professional health program due to substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from nine separate focus groups, lasting 60–90 minutes each. Qualitative analyses were conducted to examine themes. Results All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented five primary reasons for prescription drug misuse: 1) to manage physical pain, 2) to manage emotional/psychiatric distress, 3) to manage stressful situations, 4) for recreational purposes, and 5) to avoid withdrawal symptoms. Conclusions Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, though recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education occurring throughout the physicians’ careers.

Substance misuse, abuse, and dependence are serious problems among a minority of pharmacists. Though various environmental risk factors have been implicated, few data are available describing the underlying mechanisms or the extent to which the environmental risk factors actually contribute to the problem. In the present study, 32 pharmacists (72.7% male), under contract with a State impaired healthcare provider monitoring program, were recruited to participate in one of 6 guided group discussions regarding substance use among healthcare providers. These groups included 4-6 pharmacists, on average, and lasted approximately 60-90 minutes each. Participants anonymously contributed to the group discussions, providing in-depth commentary and describing their substance-related experiences. The discussions were digitally audio-recorded and transcribed for analysis using the Grounded Theory method. Results indicated that several occupational hazards unique to the pharmacy profession might contribute to the problem of substance use disorders among some members of this population, including: increased access to potent drugs of abuse, a stressful/unpleasant working environment, a culture that unofficially condones medication diversion, lack of education related to addiction, and lack of support for individuals seeking treatment. These results have important implications for the education of pharmacy students, the continuing education of licensed pharmacists, and the management of pharmacies in which these individuals work.

Efforts to address the problem of prescription drug abuse and diversion by pharmacists should be expanded in order to safeguard pharmacies and the patients they serve. Future research should extend this study to larger samples and assess best practices for decreasing prescription drug diversion by pharmacists with addiction.