If your child tears his or her ACL playing soccer or suffers a compound fracture during football, powerful pain medication can sometimes be an important part of getting them back in the game.
But some of the strongest prescription medications out there — opioids like OxyContin, Vicodin, and Percocet — carry a risk of addiction.
A number of news stories have recently highlighted young athletes who became hooked on prescription opioids after taking these drugs for a sports injury — or later transitioned into using heroin.
These stories have spurred legislators and sports organizations to bring this issue to light — talking about how to help youth athletes while minimizing the risk of opioid abuse, both now and later in life.
“That’s an incredibly important topic and conversation,” Dr. Naomi Brown, a sports medicine pediatrician at The Children’s Hospital of Philadelphia, told Healthline. “We don’t want people to be in pain, but there are also a lot of side effects with treating with certain medications.”
Opioid Abuse Among Athletes
Although any teen can be prescribed an opioid pain medication by their doctor, youth athletes often need these medications more often because of sports-related injuries or surgeries.
Some researchers have found that this greater access to prescription opioids may also lead to greater abuse by teens.
A 2014 study in the Journal of Adolescent Health found that male teens who played sports were more likely to abuse opioid medication, compared to their peers who didn’t participate in sports. This included taking too much of the drug or using it specifically to get high.
Not every teen who is prescribed an opioid pain medication will become addicted. And not every person who abuses prescription opioids will go on to abuse heroin.
Some research, though, shows that prescription opioid abuse is one of the risk factors for later heroin use.
It’s difficult to know how many heroin users started out as athletes taking prescription pain medications. Anecdotal evidence points to some connection.
According to the North Jersey newspaper The Record, The Bergen County Prosecutor’s Office found that the “vast majority” of heroin buyers caught in a 2015 sweep began abusing heroin after misusing pain relievers that were overprescribed for a medical or sports-related injury.
These drugs account for a growing number of deaths in the United States.
According to the Centers for Disease Control and Prevention, prescription opioids killed more than 14,000 people in 2014. About the same number died from illegal opioids like heroin.
Tackling Opioid Abuse
The potential for prescription opioids to harm younger athletes more than they help has caught the attention of legislators.
The John Thomas Decker Act of 2016 would require the U.S. Department of Health and Human Services (HHS) to determine what information and resources are currently available to youth athletes and their families.
This includes information on the dangers of opioid use, how to seek treatment for addiction, and other nonopioid pain medication options.
Under this law, the HHS would develop a plan for providing resources to youth athletes, their parents, and those involved in treating sports-related injuries.
The bill is named for a man from Gladwyne, Pennsylvania, who was prescribed prescription pain medication after he injured his knee while playing pickup basketball as a teen. He developed an addiction to heroin and died earlier this year at age 30.
Other organizations are also taking steps to prevent these kinds of tragedies from occurring.
Earlier this month the New Jersey State Interscholastic Athletic Association (NJSIAA) released recommendations for schools and doctors aimed at battling prescription drug abuse among youth athletes.
NJSIAA encourages school districts to develop better drug monitoring programs. This includes having doctors and parents inform schools when a student is prescribed an opioid medication.
The recommendations also advise physicians to prescribe opioids only for severe pain and for one week at a time — no automatic refills.
Starting Small with Pain Meds
Some of these suggestions are already part of the best practices at Brown’s clinic in Philadelphia.
“I’m very hesitant to prescribe more than a couple days’ worth of opioids,” said Brown. “And I see about 80 patients a week, and I’m prescribing opioids to maybe three people a month. It’s very minimal.”
For her other patients, she often recommends nonopioid pain medications like ibuprofen or acetaminophen, either over-the-counter or prescription strength.
In general, Brown starts with these milder medications — the ones with the least number of side effects — even for patients who have had surgery.
“We always recommend that they try something [less strong] first,” said Brown, “and if that is enough for pain relief then that is much better than starting with an opioid medication.”
This reduces the risk of side effects, but it also keeps pain medications in their proper place — as a drug to support other treatments like braces or physical therapy.
“If there’s someone who is in severe pain and ibuprofen or [acetaminophen] are not working, then we sometimes temporarily have to give something that’s a little bit stronger,” said Brown.
“But we give very few [opioids],” she added, “and just to get them over whatever pain they’re having while we’re doing other modalities.”