The Opioid Pandemic and American High School Athletes

Abstract

While recent data regarding the decrease in illicit opioid use among teenagers from the Monitoring the Future study is promising, there is no doubt that we are still in the midst of an American opioid pandemic [[1]Monitoring the Future Study.https://www.drugabuse.gov/news-events/news-releases/2016/12/teen-substance-use-shows-promising-declineGoogle Scholar]. In 2015, 275,000 adolescents engaged in the nonmedical use of prescription opioids (NUPO) [[2]Center for Behavioral Health Statistics and QualityKey substance use and mental health indicators in the United States: Results from the 2015 National Survey on drug Use and health (HHS Publication No. SMA 16–4984, NSDUH Series H-51).2016http://www.samhsa.gov/data/Google Scholar]. As researchers and physicians continue to grapple with the pandemic, the article from Veliz et al. [[3]Veliz P. Boyd C.J. McCabe S.E. Nonmedical use of prescription opioids and heroin use among adolescents involved in competitive sports.J Adolesc Health. 2017; 60: 346-349Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar] in this issue of the Journal of Adolescent Health provides some interesting conclusions regarding American high school athletes. First, regarding the past year NUPO and heroin use, they found no differences between 12th graders who played a sport versus those that did not. This is good news for parents of nonathletes, as the structure of school-based competitive sports has long been felt to be protective against risky behaviors during adolescence. Indeed, many of us were probably enrolled in sports at a young age by our parents for this very reason. Interestingly, some studies indicate that participation in high school sports is actually a risk factor for potential substance misuse [4Veliz P. McCabe S.E. Examining potential substance use disorders among former interscholastic athletes.Subst Abus. 2015; 36: 400-406Crossref PubMed Scopus (6) Google Scholar, 5Dunn M.S. Association between physical activity and substance use behaviors among high school students participating in the 2009 Youth Risk Behavior Survey.Psychol Rep. 2014; 114: 675-685Crossref PubMed Scopus (25) Google Scholar]. The most notable result from the study by Veliz et al. is certainly the data regarding ice hockey participants, as they had substantially greater odds of both heroin use alone, as well as concurrent NUPO and heroin use. What is it about playing ice hockey that made these high schoolers more likely to use these drugs? National studies regarding injury rates among high school students are not illuminating, as most of the country does not offer ice hockey during high school. Football, known to be a particularly risky sport regarding injury, was not implicated in this study at all [[6]Kerr Z.Y. Roos K.G. Djoko A. et al.Rankings of high school sports injury rates differ based on time loss assessments.Clin J Sport Med. 2016; https://doi.org/10.1097/JSM.0000000000000405Crossref PubMed Scopus (13) Google Scholar]. As Veliz et al. correctly mention, the lack of information in the Monitoring the Future study regarding the role of pain in the use of NUPO is potentially notable, so too is the lack of information regarding injuries relating to specific types of sports. Perhaps ice hockey is a uniquely painful endeavor, more so than football, and NUPO is a natural (albeit dangerous) response among adolescents seeking to just get through the next practice or game. However, NUPO alone was actually not increased in hockey players compared with other sports participants, only concurrent NUPO and heroin use, as well as heroin use alone. Why would these teens turn to heroin, or heroin with NUPO, rather than NUPO alone? One is left to wonder about the potential reasons. It is equally vexing why weightlifters had higher rates of NUPO, heroin, and concurrent NUPO and heroin usage and also why wrestlers had higher rates of NUPO alone. Ideally, further studies will be done among these specific populations so as to uncover potential causative factors. In the meantime, parents, coaches, and physicians should take heed of these results and keep a close eye on these vulnerable athletes. See Related Article on p. 346 See Related Article on p. 346 Nonmedical Use of Prescription Opioids and Heroin Use Among Adolescents Involved in Competitive SportsJournal of Adolescent HealthVol. 60Issue 3PreviewExamine the past-year prevalence of nonmedical use of prescription opioids (NUPOs), heroin use, and the concurrent NUPO and heroin in a sample of 12th graders involved in 16 different sports. Full-Text PDF