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Sports Medicine Feature

Source: Wikimedia Commons and Soberconnection

Sports Medicine’s Role in the Opioid Epidemic

Tracey Romero • Tue, June 20th, 2017

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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.

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One Response to “Sports Medicine’s Role in the Opioid Epidemic”

  1. Lori says:

    My comment in response to James C. Puffer, MD:

    Dear Dr. Puffer, I am a 54 year old woman, wife of 30 years, mother of 3, Grandmother of 9, Licensed Practical Nurse, status post Anterior Cervical fusion with hardware x2 and Lumbar Epidural Steroid Injections x5. I won’t bore you with the same-old nursing injury story. Let’s just suffice it to say, I ended up with an Iatrogenic disease, Adhesive Arachnoiditis after my Cervical Revision. The pain that this “Monster of a disease” blesses me with has been described as “the pain of cancer without the release of death”.

    Your statement that chronic pain patients need to look at sources other than opioids for relief feels sinister and barbaric when you say nothing about using other methods for acute pain issues. I hope you are not insinuating that those with acute pain have worse pain levels thus the need for opioids!

    There is also the fact that some people who are in chronic or intractable pain ‘don’t abuse’ their pain meds, ever! It has been said by many doctors that those in chronic pain do not become addicted to their pain medications, they become dependent upon them. Why are they being punished for the few who abuse or should we say ‘misuse” opioids, then seek to enhance their ‘high’ with street drugs. There has to be a better way to scale a person’s pain level along with the ability to monitor opioid usage.

    I do agree with one very good statement that you made: “chronic pain is not fully understood”; end of agreement on that sentence. I also agree that other therapies must be used for all types of pain but if you are in too much pain to exercise, are you going to do it the right way without further injuring yourself? What about the bedridden patient? No matter the type of modality used, the doctor must convey to the patient that ‘nothing’ will ever rid the patient of 100% of his pain. I think at that point a degree of normalcy should be discussed.
    Let’s put 2 people in a room together for 1 month, someone with a broken arm and someone with Adhesive Arachnoiditis, or any other pain-laden disease. Let’s not give either of them pain medication. Which one is going to come out of there in better shape? I admit, I’m not a doctor and I don’t pretend to be. But, in the same turn, shouldn’t doctors be listening to those who know their bodies the best, the patients? After all, pain is objective.
    Blessings and thank you for your time.

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