As a sports chiropractor, it's not uncommon to treat individuals who are attempting to overcome or better deal with an injury and its subsequent pain. However, as Stuart E. Yoss, DC, CCSP, ART, official team chiropractor for the Chicago Bulls (NBA) and Chicago Blackhawks (NHL) has experienced, sometimes this treatment can become even more complex if other issues are present; issues such as an opiate addiction.
"I had a patient who said she went to one doctor and he stopped giving her an opioid, so she left that doctor and asked me for another," shares Dr. Yoss. Wanting to help her receive proper care, he referred his patient to a second doctor, who wouldn't prescribe her an opiate, either. "When she asked for a third doctor, I realized I had an issue and we had to deal with it."
Athletes and Opiate Use
Just how big is this problem for athletes specifically? According to Dr. Yoss, roughly 75 percent of his patients are athletes or individuals who "work out regularly." Of this demographic, he believes only a small percentage have engaged in any type of opiate use; and even then, only in limited circumstances, such as when they're prescribed these drugs for a week or two post-surgery.
Although there is limited research on this topic, many of the studies agree. For instance, one article published in Pediatrics in July 2016 looked at 191,682 adolescents and found their use of nonmedical prescription opiates was lower if they were an athlete. Their rate of use of heroin, an illegal opiate, was also lower.
This led the researchers to conclude that "daily participation in sports and exercise may serve as a protective factor" with regard to this class of drugs. Dr. Yoss believes it helps that, if the athlete is involved in the pros, they have access to higher levels of care and more treatment modalities beyond prescription drugs.
So, what can you as a DC do to help keep these numbers as low as possible for athletes of all ages and levels of competition? There are four options to consider.
#1: Educate Your Athletes About the Effect of Opioid Use
The first thing you can do to help lower opiate use among athletes is to educate them about the effects of this particular class of drugs. One of the most surprising, as the Centers for Disease Control and Prevention (CDC) points out, is an "increased sensitivity to pain." Other effects include constipation, nausea, confusion, and depression – all factors that can make athletic performance challenging.
Opioid use and abuse can also lead to increased itching and sweating, two factors that can affect performance if they distract a player or cause dehydration. A slower reaction time, reduced mental clarity and the inability to make quick decisions are also potential outcomes of opioid use during sports, says Dr. Yoss.
#2: Recognize Signs of Use / Abuse
The second thing you can do is learn how to recognize signs your patients may potentially be addicted to a pain-relieving drug. One of these might be having the patient constantly asking for a referral to a new pain doctor, as Dr. Yoss experienced firsthand. He also suggests paying close attention to cases in which "even though we see objectively that they [the patient] may be improving, subjectively they say they are not."
You can watch their actions, too. "Because in our profession you tend to develop relationships with patients, you can sometimes see behavior changes," Dr. Yoss says, adding that this isn't always an option because of the limited time spent with them in your office.
DrugAbuse.com shares additional signs that opiate misuse may be at play. These include physical signs such as constricted pupils, slower breathing and noticeable drowsiness; social changes, like suddenly withdrawing or keeping to themselves; and/or financial issues when none existed before.
#3: Have the Difficult Conversations
A third action to consider: confront the issue head on. "I personally believe there are times that you have to really be the adult in the situation and have that uncomfortable conversation," says Dr. Yoss. "Address it with your patient and tell them that you have concerns; that you think they're addicted to opioids, that you'll be there with them, and that you'll help them through the steps."
Depending on all the issues at hand and the severity of the addiction, these steps may involve engaging in treatment in your chiropractic office, working with their primary care doctor or connecting with their therapist to create a comprehensive treatment plan.
"The biggest part is first addressing the problem to begin with," says Dr. Yoss, who adds that this can either work for or against you. "Sometimes they appreciate it and they trust you – or they could be offended." Either way, you still need to share your concerns.
#4: Think Beyond the Game
Because opiate use appears to be relatively low among athletes, "My biggest concern is for the retired athletes," says Dr. Yoss. "While they're playing, their mentality is to do anything necessary to get on the field. They abuse their body because they know they have a limited time to play." However, once they're done and no longer have access to high-quality care, opiate use and abuse have a greater opportunity to set in, he says.
Fortunately, there are a few programs available for veteran athletes in various sports to help them avoid or overcome these types of issues. For instance, the Gridiron Greats is a fund that provides financial grants and medical assistance to "NFL players in dire need." There's also a group for retired NHL athletes called BreakAway that offers services related to addiction counseling, emergency financial assistance and more. For non-professionals and amateur athletes, numerous local addiction programs are available, depending on where you practice.