Opioid Use in Athletes: A Systematic Review

Abstract

Context: The opioid epidemic has been well-documented in the general population, but the literature pertaining to opioid use and misuse in the athletic population remains limited. Objectives: The objectives of this study were to seek answers to the following questions: (1) what are the rates of opioid use and misuse among athletes, (2) do these rates differ compared with the nonathletic population, and (3) are there specific subgroups of the athletic population (eg, based on sport, level of play) who may be at higher risk? Data Sources: The Embase, MEDLINE, and PubMed were used for the literature search. Study Selection: Records were screened in duplicate for studies reporting rates of opioid use among athletes. All study designs were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data regarding rates of opioid use, medication types, prescription patterns, and predictors of future opioid use were collected. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria for clinical studies and 5 key domains previously identified for survey studies. Results: A total of 11 studies were eligible for inclusion (N = 226,256 athletes). Studies included survey studies and retrospective observational designs. Opioid use among professional athletes at any given time, as reported in 2 different studies, ranged from 4.4% to 4.7%, while opioid use over a National Football League career was 52%. High school athletes had lifetime opioid use rates of 28% to 46%. Risk factors associated with opioid use included Caucasian race, contact sports (hockey, football, wrestling), postretirement unemployment, and undiagnosed concussion. Use of opioids while playing predicted use of opioids in retirement. Conclusion: Overall, opioid use is prevalent among athletes, and use during a playing career predicts postretirement use. This issue exists even at the high school level, with similar rates to professional athletes. Further higher quality observational studies are needed to better define patterns of opioid use in athletes.

Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes

“…In contrast, the most used analgesics, including non-steroidal anti-inflammatory drugs, acetaminophen, local anesthetics, and tramadol are not forbidden according to the WADA list of prohibited substances [84,186]. However, potential ergogenic effects of NSAIDs in sports performance have been recently reported, and, unfortunately, a significant difference between the use of NSAIDs in-competition vs. out-of-competition has been demonstrated, probably related to the postulated effects in improving physical performance [186][187][188][189][190][191]. Interestingly, performance enhancement seems to be related to the widely noted antalgic effect, which might improve exercise-induced pain level tolerance with consequent positive effects in sports performance [190].…”

Drugs in Sports

“…Several articles in this issue of Sports Health can help physicians develop and implement safe pain treatment parameters. 3,5,7,8…”

“…11 They are responsible for approximately 140 deaths a day in the United States and Canada. 2,4 An excellent systematic review by Ekhtiari et al 3 in this issue covers 11 reports of opioid use in sports. Of considerable concern is the realization that high school athletes had a lifetime use risk of 28% to 46%, with risk factors for opioid use including Caucasian race, contact sports, postretirement unemployment, and undiagnosed concussion.…”

“…Of considerable concern is the realization that high school athletes had a lifetime use risk of 28% to 46%, with risk factors for opioid use including Caucasian race, contact sports, postretirement unemployment, and undiagnosed concussion. 3 Opioid use at each sequential level of competition may increase the risk of opioid abuse. 3 As the level of competition rises, so does the risk of significant injury and subsequent surgery.…”

“…3 Opioid use at each sequential level of competition may increase the risk of opioid abuse. 3 As the level of competition rises, so does the risk of significant injury and subsequent surgery. A clinical review by Marrache et al 7 in this issue demonstrates how a common surgical procedure, such as anterior cruciate ligament (ACL) reconstruction, can be the pathway to opioid abuse.…”