Injury, pain, and prescription opioid use among former National Football League (NFL) players☆
Introduction
Misuse of prescription opioids is increasingly recognized as one of the nation's most significant public health problems because it can lead to physical and mental impairment and even death (NIDA Research Reports, 2005, Simoni-Wastila and Strickler, 2004, Zacny et al., 2003, Denisco et al., 2008, Compton and Volkow, 2006, SAMHSA, 2009, Okie, 2010). Though there is no standard definition of misuse, common definitions range from “taking a medication in a manner other than prescribed or for a different condition than that for which it was prescribed,” to “intentional self-administration for non-medical purposes, such as getting high” (Compton and Volkow, 2006, Denisco et al., 2008). Data from the U.S. National Survey on Drug Use and Health (NSDUH) indicate that 12.7% of the general population aged 26 and older report lifetime misuse of prescription pain relievers and that 1.6% report past 30 day misuse, with higher rates among some subgroups (Substance Abuse and Mental Health Services Administration, 2009).
Professional athletes around the world are the elite of their sport; this requires them to take chances on the court, field, and other sports venues. This behavior results in injuries, pain and subsequent prescription opioid use and misuse. While this paper addresses National Football League (NFL) players, all athletes—especially elite players—are at risk for these occupational hazards. Although many professional athletes experience pain as a result of sports-related injuries, in the United States, nowhere is sports-related pain more common than in the NFL. NFL football is a collision sport laden with serious injury and medical risks (Selden et al., 2009). Data from the NFL indicate that up to 68% of NFL players may be injured in any given year (Halchin, 2008), potentially leading to long term consequences from an increased risk for more serious injury (Schwenk et al., 2007, Orchard and Seward, 2002) and pain.
While attention has been paid to differential mortality, the effects of increased obesity, cardiovascular problems (Selden et al., 2009) and concussions among former professional athletes (Casson et al., 2009, Guskiewicz et al., 2005), no research has been published to date concerning the impact of pain on use and misuse of opioids both during and after a player's professional athletic career. To fill this gap, 644 former professional athletes – NFL players – were interviewed to evaluate level of pain and other factors associated with opioid misuse during their NFL career and in the past 30 days. Multivariate analyses were conducted to predict current patterns of prescription opioid use and misuse.
Section snippets
Data source and sample
The sampling frame consisted of 1788 players listed in the 2009 Retired NFL Football Players Association Directory who retired between 1979 and 2006 and had at least one telephone number listed. To concentrate recruitment efforts, three samples of approximately 600 players each were randomly selected and stratified on the basis of year played and position.
Data collection
Potential participants were contacted during the day and evening, and on weekends, from March to August 2010. Professional interviewers
Results
Of the 1788 retired NFL players in the sampling pool, 599 (33.5%) had incorrect or disconnected telephone numbers; five (0.3%) died prior to study commencement. The eligible sample, therefore, contained 1184 individuals. Of these, 83 (7%) refused and 457 (38.6%) were unreachable. A total of 644 players (54.4%) completed the survey and are the focus of these analyses. Although more players might have been reachable with additional time, we exhausted the limited funds available for the effort.
Discussion
The Survey of Retired NFL Football Players sheds some light on the physical and mental health and opioid use patterns among a cohort of 644 players. Of particular note is their reported overall health deterioration—only 13% reported current excellent health compared to 88% with excellent health at the time they signed their first NFL contract. Pain from NFL injuries was significant. Specifically, 93% of our sample reported pain with 81% of the players perceiving their pain to be moderate to
Role of funding source
This study (Survey of Retired NFL Football Players; LB Cottler, PI) was funded by ESPN (Entertainment and Sports Programming Network). Additional funding was provided by the National Institute on Drug Abuse of the National Institutes of Health (NIDA; Research Supplement for Retired Professional NFL Football Players; Prescription Drug Misuse, Abuse and Dependence, DA020791-04S2; LB Cottler, PI). ESPN staff Barr, Banks and Forchheimer contributed to the study concept and participated in revisions
Contributors
All authors contributed to the study concept and authors Cottler, Cummings and Ben Abdallah were responsible for the study design. Authors Cottler and Cummings supervised the conduct of the study. Author Ben Abdallah performed the data analysis, and authors Cottler, Cummings and Ben Abdallah were responsible for interpretation of data. Authors Cottler, Ben Abdallah and Cummings drafted the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
Authors Cottler and Ben Abdallah currently receive funding from Pinney Associates to conduct a national epidemiological study of stimulant use among teenagers. Pinney Associates is funded from Shire Pharmaceuticals for that study. Neither Cottler nor Ben Abdallah is a clinician. All other authors declare that they have no conflicts of interest.
Acknowledgements
The authors would like to thank all of the retired players who participated in this study for their willingness to complete the survey, as well as the staff members who conducted the interviews.
References (18)
- et al.
Concussion in the National Football League: an overview for neurologists
Phys. Med. Rehabil. Clin. N. Am.
(2009) - et al.
Major increases in opioid analgesic abuse in the United States: concerns and strategies
Drug Alcohol Depend.
(2006) - et al.
Early cardiovascular mortality in professional football players: fact or fiction
Am. J. Med.
(2009) - et al.
College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement
Drug Alcohol Depend.
(2003) - et al.
Use of prescription drugs in athletes
Sports Med.
(2008) - et al.
Addressing the intersecting problems of opioid misuse and chronic pain treatment
Exp. Clin. Psychopharmacol.
(2008) - et al.
Association between recurrent concussion and late-life cognitive impairment in retired professional football players
Neurosurgery
(2005) Former NFL players: disabilities, benefits, and related issues
- et al.
Predictors of opioid misuse in patients with chronic pain: a prospective cohort study
BMC Health Serv. Res.
(2006)
Cited by (0)
- ☆
A copy of the survey instrument used in this study can be found as supplementary materials by accessing the online version of this paper at http://dx.doi.org.