Sports Medicine’s Role in the Opioid Epidemic

According to the Centers for Disease Control and Prevention, 91 Americans die every day from an opioid overdose. While needle parks, drug dens and overdose victims seem far away from the world of sports medicine, James C. Puffer, M.D., president and CEO of the American Board of Family Medicine in Lexington, Kentucky, and professor of family and community medicine at the University of Kentucky told an audience at the recent American College of Sports Medicine annual meeting in Denver, Colorado, that we all are culpable in the opioid epidemic.

At a session on how the sports medicine community should respond to this crisis, Puffer said that the opioid epidemic has no geographic or sociodemographic boundaries and that inappropriate pain management and the ready availability of prescription drugs is at the root of many people’s addiction.

He said more than 20 million U.S. residents have a substance use disorder and that in 2015, 48 million Americans used an illicit drug or misused a prescription in 2015.

“And as we have become more aware of opioid epidemic, the street value of prescription opioids has skyrocketed and we have seen a rise in heroin deaths,” he added.

Because of needle sharing, HIV and hepatitis C are also on the rise. According to Puffer, in 2015, there were 33,900 new hepatitis C infections, which was a 294% increase in incidence from 2010.

Puffer stressed that our athletes are not untouched by this epidemic, referring to a June 22, 2015 special report in Sports Illustrated on how painkillers are turning young athletes into heroin addicts. One of the athletes in the story, Michael Duran, was a promising high school baseball player who became addicted to OxyContin after straining his knee playing soccer and who then became hooked on heroin and died of an overdose in 2011.

According to the Secondary Student Life Survey, male athletes had an 86% greater likelihood of being prescribed an opiate than their non-athlete male counterparts.

Being prescribed painkillers for acute or chronic pain has been the rabbit hole into addiction for many people, Puffer said. He pointed to the Veterans Health Administration’s Pain as a Fifth Vital Sign Initiative in 1999 and the mandate by the Joint Commission on Accreditation of Healthcare Organizations that accredited health care settings need to assess patient’s pain in order to receive federal health care funding as contributing factors to the epidemic.

Guidelines are starting to change, however. Puffer said that the Centers for Medicare and Medicaid announced starting this year they will no longer include questions assessing pain management in the Hospital Consumer Assessment of Healthcare Providers and Systems Survey.

What else can be done? Puffer said that while the medical community has been doing a good job with pre-counseling patients about the addictive qualities of painkillers, more focus on alternative pain management strategies is needed.

He said, “Opioids should only be used for moderate to severe pain and doctors should prescribe the lowest dose indicated by patient-specific risks. Too often patients are sent home with more pills than they really need.”

Another big issue, according to Puffer, is that chronic pain is often not fully understood leading some doctors to treat it like acute pain with opioids. Puffer referred to a Journal of the American Medical Association article which commented on the management of pain in the primary care setting.

“The primary goal of caring for the patient with chronic pain is not the elimination of pain, but the improvement of function,” the authors wrote.

They suggested more of an emphasis on nonpharmacological therapies including cognitive behavioral therapy, mindfulness meditation and exercise.