March 6, 2019
Scott G. Weiner, MD, MPH, a medical director in the Department of Quality and Safety and director of the Brigham Comprehensive Opioid Response and Education (B-CORE) program at Brigham and Women’s Hospital, discusses promoting opioid safety for student athletes.
The opioid epidemic continues to take a record number of lives in this country — 47,600 people died from opioid-related overdoses in 2017 (1). It is staggering to see that the average U.S. life expectancy has declined over the past two years, which is attributed mainly to preventable deaths, such as those caused by drug overdose (2).
To ultimately solve the opioid epidemic, an important step is working to prevent new cases of opioid use disorder from occurring. I like the mantra: “keep patients opioid naïve whenever possible.” If you don’t start taking an opioid, then you can’t get hooked on one. Of course, I don’t advocate for undertreating pain, but multiple studies about conditions ranging from back pain (3) to hip replacement (4) demonstrate that non-opioid pain relievers like ibuprofen and acetaminophen work just as well as opioids for many types of acute pain. From a safety perspective, Brigham and Women’s Hospital has also demonstrated that, for inpatients, adverse reactions to opioids are quite common (5).
One of the most at-risk groups for developing an opioid use disorder is athletes. Think about it: Athletes are prone to injury, particularly at the elite level. Sometimes, despite better judgment, athletes want to do whatever it takes to get back to their sport, even when not completely healed. Several colleagues and I collaborated with athlete Alex White, an alumnus of Harvard University, who had suffered a sports-related injury while in school. We spoke to him about the mindset of an injured athlete amidst the opioid epidemic. Combine that desire with lenient opioid prescribing and a recipe for disaster is created. Athletes need to know the dangers of these opioids, the fact that non-opioids can work just as well as opioids, and — most importantly — that opioids only mask pain so the body thinks it’s healed.
The Brigham is grateful for a donation from two non-profit organizations, Hanging with Ted and the ADK Charities, to create a video (see below) for student athletes that educates them about opioid use. Our goal is to have student athletes and their families view the video and be prompted to talk to their physicians about how to safely take opioids if prescribed and discuss alternative pain-relief options. We encourage you to share the link widely with your network.
Alex White, the student athlete featured in the video, has experience with sports-related injuries, but has not personally experienced opioid misuse or dependency. An earlier version of this post incorrectly stated that Alex had struggled with opioid dependency.
- Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018 Jan 4;67(5152):1419-1427.
- NBC News. U.S. life expectancy falls for second straight year — as drug overdoses soar. Available at: https://www.nbcnews.com/storyline/americas-heroin-epidemic/u-s-life-expectancy-falls-second-straight-year-drug-overdoses-n831676
- Friedman BW, Dym AA, Davitt M, Holden L, Solorzano C, Esses D, Bijur PE, Gallagher EJ. Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. JAMA. 2015 Oct 20;314(15):1572-80.
- Thybo KH, Hägi-Pedersen D, Dahl JB, Wetterslev J, Nersesjan M, Jakobsen JC, Pedersen NA, Overgaard S, Schrøder HM, Schmidt H, Bjørck JG, Skovmand K, Frederiksen R, Buus-Nielsen M, Sørensen CV, Kruuse LS, Lindholm P, Mathiesen O. Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty: The PANSAID Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):562-571.
- Urman RD, Seger DL, Fiskio JM, Neville BA, Harry EM, Weiner SG, Lovelace B, Fain R, Cirillo J, Schnipper JL. The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients. J Patient Saf. 2019 Jan 21. [Epub ahead of print]