Football medicine: What comes after opioids?

The problems with overmedication and athletes has been well-known for over half a century. The iconic book - and later movie - North Dallas Forty brought the issue to the public’s eye. Pills and numbing injections were and are used to keep the player from knowing how much damage he was inflicting upon his body.

That’s what pain is - it’s a way of your body telling you that something’s wrong. Block it and you may injure yourself permanently. Oral painkillers were a daily part of life for many, perhaps most of the football players back then. For many players and ex-players of today, they still are.

At that time, in the 1960s, the use of amphetamines was a huge problem. In the 1970s, it was cocaine, which was in locker rooms everywhere. Drug testing has greatly reduced that concern. But as is inevitable, other options have risen to fill the gap amphetamines left behind. Designer steroids, difficult to detect, are popular in many sports. Anything that gets a player moving faster, reacting less to pain, and performing on the field gets tried by someone.

I’d like to take a moment to shine a light on a growing problem in sports. It’s related to the use of both prescribed and hard street drugs. There has been a substantial move to the use of heroin by high school and college athletes. It’s an equal problem among retired athletes. The reason is simple.

Injured athletes sometimes need to take medications that are, by their nature, potentially dangerous. Usually in the opioid class (drugs made from opium, or synthetic versions of them), they can be addictive. Much depends on the patient, but there’s a common scenario. The player gets injured. They go through treatment - perhaps surgery, then rehab. They use pain meds during the process, which is normal.

But often they’re told that they’re well and released. It’s not uncommon for their insurance coverage to run out. Most of the athletes are well by then. But the reality is that some are still in a lot of pain and aren’t asked about it. Others have become addicted to opioids during the injury rehab and are hiding that fact. At this point, ‘alternative options’ for pain management are often tried by the patient. Self medication is often the only kind they can afford.

Most of them involve some form of illegal medication. Prescription painkillers are incredibly expensive on the street. Older people on Social Security frequently have to sell some of their own medication to buy food. There’s a lot of money in it, but that makes it harder on the injured athlete. It’s unconscionable that many senior citizens have to make a choice between food and medicine.

Sometime around that point, an acquaintance might suggest a different alternative. At this point in time, heroin is cheaper than prescription painkillers. Athletes often start using it as they did the opioids - to control pain. They snort a little to get through practice or a game. Then there’s the movement to ‘skin popping’. That’s just injecting the medication right under the skin to get a stronger effect, as they develop a tolerance for it. Eventually, many move to injecting the heroin into a vein. We all know how this story usually ends. Rehab in general has an unpleasantly low success rate. It’s best to stop the problem before it gets entrenched.

If you’re a parent or family member of someone who goes through injury rehab, stay involved. Pay attention. Is the athlete walking normally? Has there been any change in their emotional state? I would grant that this might be a hormonally challenged teenager. When you ask about the injury, how does the athlete react? Are they comfortable talking about it? Are they evasive? If you have any question on any of these issues, get the player to a doctor, and don’t leave until you have a good explanation. They might just be acting out like many teenagers do. Or, they might be abusing medications.

Although it’s necessary at times, I believe that urine testing has become an outright scam. The companies that perform such tests need to create a demand for their product. One such situation has resulted in the requirement for students in some schools to take drug tests to be in chess or debate clubs. Yeah, those crazy, wild chess players....gotta keep them in line. It’s an overused approach that has shown little benefit in many of the situations in which it is employed.

When looking at some forms of drug abuse, urine testing is counteractive. Cannabis, for example, can stay in the body for up to a month. Ecstasy clears the body in four days. We’re seeing middle and high school youths using harder drugs in order to get a ‘clean’ urinalysis. They clear the body in a matter of a few days.

One frightening trend to prevent cannabis showing in the urine is that of ‘pill parties’. The youngsters each take a handful of meds from their parents’ cabinets or bedside and they put them in a bowl. Throughout the night, kids take a few of whatever to see what happens. Too often, what happens is an ambulance ride and a heck of a scare. Many fatalities have been recorded. It’s happening with heroin, too. Meth is also on the rise. Its side effects are hideously destructive. But your urine sample will come back clean after just a few days. That is, if you’re still alive to give it.

If your child, mate, or close friend’s behavior is changing following an injury, get involved right away. You may think their injury is resolved, but have you asked? Can they show you that they can move through the former injury’s range of motion without discomfort? Are their eyes clear or bloodshot? If you’ve asked about their situation - do you believe them? It’s hard to be clear on the problem, but ignoring it can be fatal.

They could be acting oddly due to hormones, emotions, pain, or medication. These are often youths who are prone to acting out for other reasons. That’s why this is one time that getting the patient an exam and urinalysis is simply common sense.

We’re discovering that this problem is more widespread than was previously thought. Friend and reader Doc Ponderosa tells me that he’s only seen this in the ER over the last two or three years. If someone close to you experiences a severe injury, become an advocate for them. With their agreement, make sure that they’re totally healthy and pain free before they consider returning to sports.

Sports are wonderful. I believe that they can help build character and provide a relatively safe (depending on the sport) outlet for youthful energy. You have to be alive to enjoy them, though, so make sure any post-injury problems are dealt with immediately. Be involved, if you’re close enough to the athlete. The most heartbreaking thing you can hear from a parent is, “We just didn’t know.”

Make sure that you do.

Learn to laugh at yourself. You will be ceaselessly amused. - Sri Gary Olsen

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