What Athletic Trainers Should Know About Opioids

Athletic trainers must be aware of the issue of opioid use.

The incidence of opioid abuse in professional athletes is estimated to range from 4.4% to 4.7% for all sports. However, for athletes in the NFL, the rate of opioid abuse is much higher. An estimated 52% of all NFL players will use opioids during or after their career to manage pain associated with injury (Ekhtiari, 2020).

Athletic trainers play a primary role in the well-being of athletes. Given the potential for injury in athletics, opioid use and abuse is a legitimate concern for athletic trainers. Athletic trainers must be aware of the issue of opioid use, recognize the signs of abuse, and know what to do in the event of a medical emergency.

What are opioids?

Opioids are a type of prescription pain medication derived naturally from the opium poppy plant directly or manufactured in a laboratory to copy the composition and effects of the poppy plant. They are highly effective at relieving pain. Athletes often use them in cases where pain is difficult to tolerate, such as pain from injury and/or surgery.

How do opioids work?

Opioids bind to specific receptors in the central nervous system and block pain signals. In addition to blocking pain signals, opioids produce feelings of euphoria and relaxation. It is those euphoric feelings that are a primary driver of abuse.

Examples of prescription opioid medications include:

• Hydrocodone (Vicodin and Norco)
• Morphine (MS Contin and Kadian)
• Oxycodone (OxyContin and Percocet)
• Codeine
• Fentanyl (skin patches)

What are the signs of opioid abuse?

Athletic trainers should be aware of the signs of opioid abuse. Symptoms of abuse vary and include a combination of physical, behavioral, and social changes. Recognizing the signs of opioid abuse is crucial to successfully identifying and addressing the issue quickly.

Recommended Course: The Opioid Crisis and Its Implications for Pain Management

Physical changes:

• Pinpoint pupils
• Drowsiness
• Dozing off at inappropriate times
• Slurred speech
• Impaired coordination
• Motor skill deficits
• Increased injuries or accidents
• Itchy skin
• Red or flushed skin
• Changes in appetite and weight
• Neglected personal hygiene
• Constipation
• Nausea
• Vomiting
• Slow or shallow breathing

Behavioral changes:

• Mood swings
• Unusual behavior
• Irritability
• Agitation
• Secrecy
• Isolation from friends and family
• Neglected work, academic, and family responsibilities
• Frequent requests for prescription refills
• Feigning lost prescriptions
• Visiting multiple doctors
• Faking or exaggerating pain symptoms
• Increased tolerance to same dosage
• Increasing the dosage above what is prescribed
• Using medications for longer periods than prescribed
• Failed attempts to control medication use Spending time focused on obtaining, using, or recovering from the effects of opioids

Social changes:

• Avoiding friends and family
• New social circle (people associated with drug abuse)
• Loss of interest in activities or hobbies once enjoyed
• Legal issues or trouble with law enforcement

How can athletic trainers prevent opioid abuse?

Communicate and educate: Athletic trainers should provide and maintain open communication with athletes about pain management and the potential risks associated with opioid use. They should educate themselves on opioids and serve as a source of information for athletes in their care.

Offer pain management alternatives: To fully serve athletes, athletic trainers must be knowledgeable about alternative pain management techniques that can replace opioids. Alternative therapy methods may include physical therapy, ice and/or heat therapy, non-opioid pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), stretching, massage, myofascial release, and other non-pharmacological methods.

Facilitate proper medication practices: If an athletic trainer is aware an athlete requires prescription pain medication, (s)he should work closely with medical professionals to ensure proper dosages and durations are followed.

Provide support and referrals: If an athletic trainer suspects an athlete has an opioid abuse problem, it is important to approach the situation with empathy and concern, not judgment or as an authoritarian. Athletic trainers should be a confidante and safe source of help for athletes. However, athletic trainers are not counselors or medical providers and should have a referral network of medical professionals, counselors, and addiction specialists ready who can provide support and treatment.

Seek continuing education: Athletic trainers should stay updated on the latest information and research regarding opioid abuse by participating in continuing education events to enhance their knowledge.

In case of an overdose

When people use and abuse opioids, overdose is a risk. The signs and symptoms of overdose include:

• Slow or irregular breathing
• Not breathing
• Loss of consciousness
• Bluish or pale skin around the lips or fingertips
• Inability to speak or respond
• Pinpoint pupils that do not respond to light

In case of an opioid overdose, athletic trainers should know how to administer naloxone, Narcan, and know the steps to take such as performing CPR to potentially save a life.

Opioid abuse in athletes is a complicated issue with individual factors impacting use, abuse, and treatment. Athletic trainers are not expected to be addiction experts, but they should have an awareness of opioid-use-related risks, recognize the signs of abuse, facilitate intervention in the event of abuse, and successfully act in the event of an emergency.