Injury, pain, and prescription opioid use among former National Football League (NFL) players

Abstract

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

A critical review of chronic traumatic encephalopathy

“…Interestingly, in a post-mortem study of 34 opiate abusers under the age of 40, multifocal NFTs were common, and 19% of the control subjects had NFTs in the entorhinal cortex (Ramage et al, 2005). Some retired professional athletes have a problem with opiate abuse (Cottler et al, 2011). In a second study, this research group also reported elevated levels of hyperphosphorylated tau in drug users, similar to that of elderly control subjects, but far less than is seen in AD (Anthony et al, 2010).…”

“…In two recent reviews of the literature, it was concluded that there is insufficient scientific evidence to conclude that CTE is a risk factor for suicide (Iverson, 2014;Wortzel et al, 2013). That said, former NFL players might be at increased risk for depression (Gonzalez et al, 2010;Schwenk et al, 2007), and their rate of chronic pain and opioid use is high (Cottler et al, 2011).…”

Prediction of Injury by Limited and Asymmetrical Fundamental Movement Patterns in American Football Players

“…1,2 In a review of over 2500 retired players, 74% reported suffering a muscle or tendon injury in their career and approximately half reported at least 1 knee injury. 3 Long-term consequences of injury include general musculoskeletal disability, increased risk for opioid misuse, 4 and a threefold risk for knee arthritis. 3 Researchers have prospectively identified risk factors for injury in high school and college levels of competition in football.…”

When is a Drug Not a Drug? Troubling Silences and Unsettling Painkillers in the National Football League

“…Since 2009, center Randy Grimes, tight end Dan Johnson, guard Bob Newton, and offensive tackle Kyle Turley have all come forward to discuss their dependence on opioids in an attempt to lobby the league for better prevention, protection, and treatment for players with painkiller dependencies. Most notably, these lesser-known players all appeared as interviewees in ESPN's Outside the Lines program (Cottler et al, 2011), describing how pills are and were readily dispensed by team doctors "no questions asked." Moreover, a Drug Enforcement Agency spokesperson featured in the episode claimed that it is common for NFL team doctors to acquire and store large quantities of painkillers with no patient in mind.…”

“…1 Although the doped up athlete (usually a football player) returning heroically to the field of play is something of a cliché in sports films and in the mythology of legendary former players such as Walter Payton, such images have served to naturalize painkiller use at the same time that they have failed to penetrate everyday mass media discourse about sport-at least until recently. One catalyst for current interest in painkiller use in sport was a 2011 episode of ESPN's "Outside the Lines," highlighting the results from a Washington University survey of 644 former National Football League (NFL) players, 52% of whom acknowledged using these drugs during their careers (Cottler et al, 2011). Of those players, 71% claimed to have misused such substances (by, for example, taking more pills than prescribed) and 63% said they obtained them from illegal sources such as teammates, coaches, trainers, and drug dealers.…”