Submitted to South University FNP-S, NSG 69999
Introduction
The consumption of alcohol, tobacco, and other drugs has become a concern in high-
performance athletes. Professional athletes are more exposed to drugs than the general
population, they have an active social life and encounter various pressures, which may lead to
greater risk of alcohol, marijuana, and cocaine misuse (Millman & Ross, 2003). Although some
drugs are unquestionably detrimental to performance, several studies have nevertheless shown
evidence of increased consumption of these substances within this subpopulation (Brisola dos
Santos et al., 2016). Drug abuse in such individuals may involve doping, in order to obtain a
competitive advantage but can also involve the misuse of substances such as alcohol or cannabis
without the intention of improving performance, thereby developing substance use disorders, just
as any non-athletes. The reasons for athletes using these substances could be the many stressors
to w/hich they are subjected, including the pressure for better (or the best) performance, injuries,
physical pain, and even retirement, which occurs much earlier than in most other careers
(Donohue, Pitts, Gavrilova, Ayarza, & Cintron, 2013). The care of an injured or ill patient may
be the responsibility of only 1 health care provider or a team of many providers. Depending on
where the patient care is given and the patient receiving it, the sports medicine team can include
athletic trainers (ATs), physicians, pharmacists, physical therapists, school nurses, and athletic
training student. Misuse and abuse of prescription opioids in the United States constitute a
public health crisis that has grown to epidemic proportions over the last decade. The Centers for
Disease Control and Prevention (CDC) has identified prescription drug abuse and overdose as
one of the top five health threat. When determining the dose of an opioid for acute pain, it is
critically important for clinicians to take into account whether the patient is opioid naive or
opioid tolerant.
Definition
Opioid addiction is a long-lasting (chronic) disease that can cause major health, social, and
economic problems. Opioids are a class of drugs that act in the nervous system to produce
feelings of pleasure and pain relief. Some opioids are legally prescribed by healthcare providers
to manage severe and chronic pain. Commonly prescribed opioids include oxycodone, fentanyl,
buprenorphine, methadone, oxymorphone, hydrocodone, codeine, and morphine. Some other
opioids, such as heroin, are illegal drugs of abuse. The term opium refers to a mixture of
alkaloids from the poppy seed, and the term opiates refers to naturally occurring alkaloids (e.g.,
morphine, codeine). The term opioid refers to all compounds that bind to opioid receptors.
Opioids have been used for thousands of years for the treatment of moderate-to-severe acute
and chronic pain. Opioids provide their pharmacologic effects by binding to opioid receptors
located both within and outside of the central nervous system.
Epidemiology
Reports from CDC, the Drug Abuse Warning Network (DAWN), and the National Poison Data
System have demonstrated an alarming increase in opioid misuse and abuse over the last two
decades. The prescription of opioids is increasingly recognized as one of the most important
current health problems in the sports field. It can lead to physical and/or mental problems, and
even death (NIDA, 2014; Simoni Wastila, Ritter, & Strickler, 2004). Data from the National
Survey on Drug Use and Health (NSDUH) indicate that 12.7% of the population aged 26 and
over have already misused non-prescribed prescription opioids. s. At any one time there are 7.5
million adolescents in the US participating in high-school sports, with an with an anticipated
annual 2 million athletic injuries. A major factor contributing to this crisis is the rate at
which painkillers are being prescribed. The number of prescriptions for opioid painkillers
jumped from 76 million to approximately 207 million between 1991 and 2013. According
to Times Union a startling half-million people have died since 2000 as a result of misusing
painkillers. This issue especially impacts those who play sports. Data shows that 52 percent of
NFL players were exposed to opioids with 71 percent admitting to misuse.
Complications
Opioids change the chemistry of the brain and lead to drug tolerance, which means that over time
the dose needs to be increased to achieve the same effect. Taking opioids over a long period of
time produces dependence, such that when people stop taking the drug, they have physical and
psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety).
Dependence is not the same thing as addiction; although everyone who takes opioids for an
extended period will become dependent, only a small percentage also experience the compulsive,
continuing need for the drug that characterizes addiction. Opioid addiction can cause life-
threatening health problems, including the risk of overdose. Overdose occurs when high
doses of opioids cause breathing to slow or stop, leading to unconsciousness and death
if the overdose is not treated immediately. Both legal and illegal opioids carry a risk of
overdose if a person takes too much of the drug, or if opioids are combined with other
drugs (particularly tranquilizers called benzodiazepines).
Clinical Presentation
Opioid physical dependence develops quickly, and abrupt discontinuation may cause signs and
symptoms such as loss of appetite, anxiety, craving, increased blood pressure and heart rate,
nausea, vomiting, and muscle spasms. sweating, chills, sighs, body pain, diarrhoea, rhinorrhea,
and lacrimation. Opioids include both prescription painkillers Vicodin and OxyContin and the
illicit drug heroin. Signs of opioid abuse include overall sedation, memory issues, inability to
concentrate, slowed reaction times, lethargy and mood swings.
Diagnosis
Respiratory depression is the result of opioid toxicity, and supportive care to restore ventilation
and oxygenation is the cornerstone of patient management. Opioid toxicity can be treated with
the competitive m-opioid receptor antagonist naloxone
Conclusion
When patients are being considered for opioid medication, including before surgery, they should
be screened for substance abuse, depression, and other psychiatric disorders. One or more
individuals on the sports medicine team may make decisions pertaining to the management of
OTC and prescription medications in the sports medicine facility. Written policies and
procedures will demonstrate that due diligence was exercised to involve and educate all
concerned parties, and that all personnel have established guidelines to reference when managing
medication in the sports medicine setting. Prescription drug monitoring programs (PDMPs) are
electronic databases created and overseen at the state level to collect data on opioids and other
controlled substances as well as noncontrolled drugs with potential for abuse. Consistent practice
for appropriate screening, assessment, and prescribing for pain can be directed through
computerized prescriber order entry (CPOE), clinical decision support (CDS), pharmacy and
therapeutics committee–approved guidelines, and formulary restriction.
PICOT
Will healthcare providers (P) That attends educational programs on the assessment and
management of pain in injured athletes (I) lead to an increase of knowledge (O) over a six
month time period (T).
References
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