NFL Players: Injury, Pain, and Opioid Misuse

A new study performed by researchers at the Washington University in St. Louis has found that players retired from the National Football League (NFL) are far more likely than the general population to use and misuse opioid painkillers, the L.A. Times reported Jan. 28.

The research, commissioned by ESPN with funding from the National Institute on Drug Abuse (NIDA), is the first of its kind.

According to the study abstract, 644 players in the 2009 Retired Players Association Directory were surveyed by phone between March and August 2010, with a 53.4 percent completion rate. ESPN’s Outside the Lines said the surveyed players had retired between 1979 and 2006, and on average were 48 years old and had played 7.6 seasons. 

The study’s chief findings were that 52 percent of the former players had used opioids while playing, of whom 71 percent reported misuse. Players who misused opioids while playing were three times as likely to have misused them in the past 30 days as those who used them as prescribed. The majority of players (63 percent) who used prescription painkillers during their careers obtained them from someone other than a doctor. 

Half of the retired players in the survey said they had been seriously injured three times or more while playing, and half also said they had received concussions, though many kept playing because the concussions were undiagnosed.

“The rate of current, severe pain is staggering,” said Linda B. Cottler, Ph.D., who led the research. She is a professor of epidemiology in psychiatry at Washington University in St. Louis. 

Cottler and her team found that three factors correlated with current abuse of pain medications, according to ESPN: “significant pain, undiagnosed concussions and heavy drinking.”

Eric Strain, M.D. — who directs the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins Center for Substance Abuse Treatment and Research and who edits Drug and Alcohol Dependence, the scientific journal in which the study appeared — recommended that the NFL conduct aggressive drug testing. “At least consider doing it on a pilot basis and see what’s happening,” he said. 

“The NFL has the most intrusive drug testing of any sport,” said Lawrence S. Brown, M.D., medical adviser to the NFL on abused substances.

“It is scientifically flawed to compare the general population with athletes, active or retired,” Brown also said.

“There’s almost nothing that’s exactly like a professional athlete so I’m not sure what the proper comparison is,” said Wilson Compton, M.D., of NIDA. “I don’t think it’s scientifically flawed. … We need to put it in some context.” Compton worked as a treating clinician in the NFL’s substance abuse program from 1995 to 2002.

Active and retired players said the NFL testing focused primarily on drugs that enhanced performance, rather than opioids or other street drugs, ESPN reported. The players said they always knew about the test for street drugs in advance, and so it was “easy to pass.”

“We call it the IQ test, ’cause if you fail it, then you’re stupid,” one said.

The study, “Injury, pain, and prescription opioid use among former National Football League (NFL) players,” was published online on Jan. 28, 2011, in Drug and Alcohol Dependence.