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Opioid Addiction with injured Athletes

Opioid Addiction with injured Athletes

Submitted to South University FNP-S, NSG 69999


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.




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.




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.




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.





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






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.






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).



























Brisola Dos Santos, M.B., Mello e Gallinaro, J.G., SampaioJunior, B., Marin, M.C.D., Andrade, A.G., Glick, I.D., … Castaldelli-Maia, J.M. (2016). Prevalence and correlates of cannabis use among athletes: A review. American Journal on Addictions, [Epub ahead of print].


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Donohue, B., Pitts, M., Gavrilova, Y., Ayarza, A., & Cintron, K.I. (2013). A culturally sensitive approach to treating substance abuse in athletes using evidence-supported methods. Journal of Clinical Sport Psychology, 7, 98–119

Gil, F., de Andrade, A. G., & Castaldelli-Maia, J. M. (2016). Discussing prevalence, impacts, and treatment of substance use disorders in athletes. International Review of Psychiatry28(6), 572–578.

Millman, R.B. & Ross, E.J. (2003). Steroid and nutritional supplement use in professional athletes. The American Journal on Addictions, 12, S48–S54. doi:10.1111/j.1521- 0391.2003.tb00556.x

Simoni-Wastila, L., Ritter, G., & Strickler, G. (2004). Gender and other factors associated with the nonmedical use of abusable prescription drugs. Substance Use Misuse, 39, 1–23