Opioid Abuse Series Part 2: Opioid Abuse Risks After Surgical Intervention
Posted March 12, 2018
By Desi Rotenberg, MS, LAT, ATC
Opioid addiction is earning the attention of healthcare professionals and lawmakers across the United States. It is estimated that each day, 90 people in the United States die due to an opioid overdose. While this number may be difficult to put into context, the number is a product of the 2 million people across the United States who are currently suffering from a substance abuse disorder related to prescription painkillers.1
Since surgical intervention is sometimes necessary in the athletic population following an injury, the subsequent potential risk for opioid addiction becomes a concern to Athletic Trainers (ATs). As ATs, we have a responsibility to educate our athletes on the risks of prescription pain killers. Athletes and parents trust us to deliver the highest standard of care, and in this case, help in identifying abuse of prescription medication following surgical intervention and recovery from an injury.
There is a growing concern regarding high school athletes who undergo surgical intervention and the prescription pain medications they are given following an injury. The concern stems from the notion that a legal prescription of opioids may progress into an opioid or illegal drug dependence later in life. According to a 2015 study published in the Journal of Pediatrics, adolescent athletes who are prescribed pain killers following surgery and have no prior history with pain killer usage, should be educated and monitored throughout the recovery course to prevent future drug misuse.2 Additionally, there is concern that participation in high school and collegiate athletics may increase the probability that an individual misuses prescription pain medication later in life.3 This concern is propagated on the fact that high school students who participate in athletics have increased access to controlled substances following an athletic injury.
In a 2014 study, Veliz et al. found that “adolescent, male athletes may have greater access to controlled substances, which puts them at greater risk for drug misuse.”4 The overall consensus among medical practitioners is the need to prioritize awareness through education on the potential harms of prescription pain medications.
ATs can play an important role in emphasizing the importance of using prescription pain medications responsibly. Athletic injuries can be accompanied by a period of emotional adjustment (impairment of athletic abilities, decreased value among the team, long-term rehabilitation, etc.). It is paramount for ATs to educate and monitor all stakeholders during pain management. If an athlete presents depressive symptoms and is exposed to prescription opioids, it could open the door for a misuse of the medication.5
Following an injury requiring surgical intervention, ATs should initiate a dialogue with the athlete (and parents if needed). It is a good idea to make the athlete aware of the purpose of an opioid and how it is used to treat pain. The conversation can include alternatives to pain management that consist of over-the-counter medications, meditation and other non-prescription medication interventions. There have been several studies identifying Tylenol or Ibuprofen as alternatives, as they may be just as effective as an opioid to manage pain.6 Also encourage patients to consult with their doctor for further information on proper pain medication and dosing. The following guidelines are posted on the FDA website:
USE OPIOIDS SAFELY: 3 KEY STEPS
1. Keep your doctor informed. Inform your health care professional about any past history of substance abuse. All patients treated with opioids for pain require careful monitoring by their health care professional for signs of abuse and addiction, and to determine when these analgesics are no longer needed.
2. Follow directions carefully. Opioids are associated with significant side effects, including drowsiness, constipation, and depressed breathing depending on the amount taken. Taking too much could cause severe respiratory depression or death. Do not crush or break pills. This can alter the rate at which the medication is absorbed and lead to overdose and death.
3. Reduce the risk of drug interactions. Don't mix opioids with alcohol, antihistamines, barbiturates, or benzodiazepines. All of these substances slow breathing and their combined effects could lead to life-threatening respiratory depression. Do not drive or use any machinery that may injure you, especially when you first start the medication. The dose of an opioid pain medication that is safe for you could be high enough to cause an overdose and death in someone else, especially children.
Source: US Food and Drug Administration
Through education and greater awareness, ATs can help prevent athletes from going down the dangerous path of prescription drug abuse. There is an abundance of resources that exist online and on various platforms within the medical field and we should all do our best to point all stakeholders in the correct direction.
1. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65. doi:10.15585/mmwr.mm655051e1.
2. Miech, R., Johnston, L., O’Malley, P. M., Keyes, K. M., & Heard, K. (2015). Prescription opioids in adolescence and future opioid misuse. Pediatrics, peds-2015.
3. Veliz, P., Epstein-Ngo, Q., Austic, E., Boyd, C., & McCabe, S. E. (2015). Opioid use among interscholastic sports participants: an exploratory study from a sample of college students. Research quarterly for exercise and sport, 86(2), 205-211.
4. Veliz, P., Epstein-Ngo, Q. M., Meier, E., Ross-Durow, P. L., McCabe, S. E., & Boyd, C. J. (2014). Painfully obvious: a longitudinal examination of medical use and misuse of opioid medication among adolescent sports participants. Journal of Adolescent Health, 54(3), 333-340.
5. Brewer, B. W., Linder, D. E., & Phelps, C. M. (1995). Situational correlates of emotional adjustment to athletic injury.
6. Chang, A. K., Bijur, P. E., Esses, D., Barnaby, D. P., & Baer, J. (2017). Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. Jama, 318(17), 1661-1667.
7. US Food and Drug Administration, (2009). A guide to the sage use of pain medication. US Department of Health and Human Services.
About the Author
Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015.