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The Opioid Epidemic and High School Sports: Why it Matters

By Javier Cardenas, M.D. on March 12, 2018 hst Print

More than 140 Americans die on a daily basis from an opioid overdose according to the Centers for Disease Control. For the first time in decades, the life expectancy for Americans dropped two years in a row – a direct result of opioid overdose deaths. Officially declared a public health emergency by the President of the United States, the opioid crisis has exceeded prior epidemics, including AIDS.

Why does this matter for young athletes? As athletic participation among the nation’s youth has increased, so have injuries, surgeries and prescriptions for opioid medications. A study conducted using the data from High School Reporting Information Online (supported by the NFHS) found that 20 percent of athletic injuries required a physician’s attention (1). Between 2006 and 2013, surgeries for sport-related injuries in youth increased by 55 percent (2). In another study, opioid prescriptions for adolescents doubled between 1996 and 2007 (3).

The impact of opioid prescriptions on athletic youth is unclear. One study finds that athletic participation reduces the risk of transitioning from prescription opioids to heroin use (4). However, other studies demonstrate that male athletes are more likely to misuse prescribed opioids (5). This was more likely to occur in high injury sports such as football or wrestling (6). However, athletes who participated in multiple sports were more likely to be approached about selling or distributing their prescription opioid. (2)

While there are efforts to reduce prescriptions for opioids on the part of health-care providers, coaches, teachers and parents can play a role in keeping athletes safe from the consequences of opioid use. The first is to encourage athletes to rest, heal and rehabilitate before returning to play. As with concussion, early return to play can be associated with repeat injury to the same part of the body as well as injuries to other parts of the body. Athletes should not be pressured to return to play too soon, as they may seek pain medications to play through the pain.

It is also important to know the signs of opioid use and misuse. Signs of opioid use include small pupils, flushing (redness) of the face and neck, slurred speech, and constipation. Signs of withdrawal include frequent yawning, big pupils, runny nose, insomnia and frequent trips to the bathroom. Those who misuse opioids will often have behavior changes and will become withdrawn and antisocial. These are opportunities to talk to athletes about their injury and treatment as well as to encourage them to talk to their physician about alternatives to opioids.

Parents should be encouraged to strongly monitor the use of opioid medications. This begins with a request for alternative medications and/or limited quantities of opioids. Given the high abuse potential, parents should administer opioid medications and supervise their use. A key to preventing misuse and distribution is proper disposal of opioid medications. Opioids should not be kept beyond the treatment time, should not be thrown in the garbage and should not be flushed down a toilet. State agencies and pharmacies have programs that receive and properly dispose of opioid medications.

The opioid crisis is something that affects all of us. As with many circumstances, sports provide an opportunity for leadership. Coaches, teachers, parents, athletic trainers and administrators can work together to educate, prevent and identify those who misuse opioid medications.


Comstock, DR.; Collins, CL.; Corlette, JD.; Fletcher, EN. National high school sports-related injury surveillance study: 2011– 2012 school year. Columbus, OH: Center for Injury Research and Policy; 2012.

Veliz, et.al. Opioid Use Among Interscholastic Sports Participants: An Exploratory Study From A Sample Of College Students. Res Q Exerc Sport. 2015 June ; 86(2): 205–211

Fortuna RJ, Robbins BW, Caiola E, et al. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010;126(6): 1108-1116.

Veliz P , Boyd CJ, McCabe SE. Nonmedical Prescription Opioid and Heroin Use Among Adolescents Who Engage in Sports and Exercise. Pediatrics. 2016;138(2)

Veliz, et. al. Painfully Obvious: A longitudinal examination of medical use and misuse of opioid medication among adolescent sports participants. J Adolesc Health. 2014 March ; 54(3): 333–340.

Veliz et.al. Playing Through Pain: Sports Participation and Nonmedical Use of Opioid Medications Among Adolescents. Am J Public Health. 2013;103:e 2 8 – e 3 0