Prevalence and Risk Factors of Opioid Addiction in Athletes

RESEARCH ANALYSIS

Prevalence and Risk Factors of Opioid Addiction in Athletes

ROMEO MAYS, MS

Philadelphia College of Osteopathic Medicine

SUMMARY POINTS

-       Due to chronic pain, athletes are misusing and becoming addicted to opioids following injuries.

-       Athletes in contact sports are at higher risk of obtaining injuries and experiencing chronic pain, which is usually treated in part by opioids.

-       Greater awareness and understanding of opioid usage amongst athletic populations is imperative.

-       To address the growing opioid crisis among athletes, continued research, increased drug testing, and more education on the topic are required.

ANALYSIS

Background

Athletes are generally perceived to be a less susceptible group to drug abuse and addiction. This generalization may be true in certain contexts. For example, research by Baron and Dougherty found that adolescent males who played sports were found to be at lower risk of heroin use (1). Pertaining to opioids, however, athletes were found to use opioids at lower rates only if they were not retired and did not suffer an injury. Following injuries or surgery, athletes were found to use opioids at higher rates than the general public (1). Since most athletes will sustain an injury at some point in their careers, and all athletes eventually retire, it is more accurate to characterize the athletic population as particularly vulnerable to opioid misuse. The same study also found that collegiate athletes use opioids at higher rates than their non-athlete classmates (1). The reason athletes are at a higher risk of opioid abuse is due to the analgesic effect of opioid medications. Athletes involved in contact sports such as football and wrestling face a higher risk of injury, which often leads to surgeries or the use of medications to manage pain. Consequently, participation in contact sports significantly increases the risk of non-medical use of prescription opioids (2).

Findings

Many athletes are not adequately educated on the dangers of opioid addiction and misuse. Some may use old prescriptions to manage new injuries, while others distribute leftover medications to teammates or peers also dealing with pain (3). Without proper medical education regarding the risks and appropriate dosing of opioids, these practices pose a serious health risk to athletes and their communities. To properly address the opioid epidemic amongst athletes, it must be better understood. The number of high-level athletes at the adolescent and high school level is increasing. This is partially due to the increasing pressures to obtain scholarships or endorsements, which in turn encourage young athletes to play for longer periods of time. To remain competitive, young athletes often participate in year-round leagues and undergo intensive training, which increases their exposure to overuse and traumatic injuries. The chronic pain from these injuries can lead to the use of opioids for pain management. Collegiate and professional athletes also experience significant pressure to perform at a competitive level, regardless of their physical health. Their coaches are also under significant stress to have their players win. With this level of pressure to succeed, abusing opioids to manage pain and remain competitive can segue into addiction at an early age.

Participation in high school athletics continues to grow and is expected to expand further. Between the years of 1994 and 2007, the number of adolescents prescribed controlled medications at ambulatory medical centers increased from 6.4% to 11.2% (4). Research has found that increased sports participation is the main reason for this drastic increase in medication prescriptions (4). Despite common belief, sports participation alone is a major risk factor in opioid use (5). High school athletes who participate in at least one sport are at a 30% greater risk of future opioid use compared to their non-athlete peers (5).

While precise tracking of opioid use is difficult, as it relies mostly on self-reporting, research provides insight into prevalence. Opioid use amongst high school athletes is reported to be similar to usage amongst professional athletes (2). It is estimated that 28-46% of high school athletes will use opioids during their lifetime (2). Additionally, opioid use during an athlete’s active career is a strong predictor of continued use post-retirement. This suggests that early prevention and intervention at the high school level could mitigate long-term opioid dependence in professional athletes. In professional sports, especially the NFL, opioid use is monitored, yet still highly prevalent. An estimated 52% of all NFL players will use opioids during their careers, with 4% actively using at any given time (1). While research in this area is limited, the current evidence strongly suggests that there is an opioid epidemic within the athletic community.

Discussion

A better understanding of the opioid epidemic, increased awareness of the dangers of misuse, expanded research, and implementation of educational initiatives in high schools and colleges are essential to reducing opioid abuse and related deaths. One possible study could involve quarterly drug testing for all student-athletes across several colleges to assess the current prevalence of opioid and other substance use. To ensure full participation and accuracy, results would be anonymized—reporting only the number of positive cases per team without disclosing identities to team personnel. This approach could provide more reliable data than existing testing protocols, which often include only a few athletes per season and are preceded by warnings that allow time for detoxification.

To combat the opioid epidemic amongst athletes, affected individuals and their support systems must be educated on the dangers and prevalence of opioid usage. The opioid epidemic is increasingly prevalent, especially among young athletes. Though the research for the athletic population is limited, future research will likely expand our understanding in the coming years. Until then, increased awareness, expanded drug testing, and comprehensive educational programs at the high school, collegiate, and professional levels will be essential in reducing the incidence of opioid misuse.

REFERENCES

1.     Dougherty, J. W., & Baron, D. (2022). Substance use and addiction in athletes: The case for neuromodulation and beyond. International Journal of Environmental Research and Public Health, 19(23), 16082. https://doi.org/10.3390/ijerph192316082

2.     Ekhtiari, S., Yusuf, I., AlMakadma, Y., MacDonald, A., Leroux, T., & Khan, M. (2020). Opioid use in athletes: A systematic review. Sports Health: A Multidisciplinary Approach, 12(6), 534–539. https://doi.org/10.1177/1941738120933542

3.     Vandertuin, J., Abdulla, D., & Lowther, S. (2021). Student athletic therapists’ knowledge of opioids and other pain-relieving medications. Athletic Training Education Journal, 16(2), 112–119. https://doi.org/10.4085/1947-380x-20-088

4.     Veliz, P. T., Boyd, C., & McCabe, S. E. (2013). Playing through pain: Sports participation and nonmedical use of opioid medications among adolescents. American Journal of Public Health, 103(5). https://doi.org/10.2105/ajph.2013.301242

5.     Benjamin, H. J., Perri, M. M., Leemputte, J., Lewallen, L., & DeVries, C. (2024). Opioids and youth athletes. Sports Health: A Multidisciplinary Approach, 16(2), 269–278. https://doi.org/10.1177/19417381241228629