Opioid Pain Medication Used Infrequently by NFL Players

By Pat Anson

As many football fans know, the odds of a National Football League player getting injured during a practice or game are high. A concussion, Achilles rupture, ligament tear or musculoskeletal injury can cause a player to miss a game or even an entire season.

Given the pressure to compete and be ready to play, perhaps it’s not surprising then that nearly 70% of NFL players were prescribed a pain medication during the 2021-2022 seasons.

What is surprising is the type of analgesics they were using.

A new study found that only 2.9% of the pain medications used by NFL players were opioids. The vast majority (86%) of medications, both prescribed and over-the-counter, were nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or diclofenac. Other non-opioids used by players were muscle relaxants, corticosteroids, gabapentin, acetaminophen and migraine medication.  

The study, recently published in Current Sports Medicine Reports, is based on data from a prescription drug monitoring program (PDMP) that was launched by the NFL in 2019 for all players.

“NFL athletes are exposed to very physical contact and to the development of pain during or after games due to injuries. There’s always been a concern from a safety and health perspective about what are they using to treat their pain,” said co-author Kurt Kroenke, MD, a researcher-clinician at the Regenstrief Institute and Indiana University School of Medicine.

“The good news is of all medicines prescribed to league players for pain, opioids account for only 3 percent. Moreover, only 10 percent of NFL athletes received even a single prescription for an opioid during a one-year period. I think there's been much greater attention to what can be done in the training room for NFL athletes for their injuries and pain that doesn't rely on medicines.”

The findings are remarkable, given the long history of opioid use in the NFL. A 2010 survey of retired players found that over half (52%) used prescription opioids during their careers, with 71% of them reporting misuse. Many continued to use opioids after they stopped playing, with 81% of the retired players reporting their chronic pain was moderate to severe.

Hall of Fame quarterback Brett Farve, an iron man who often played through injuries, admitted taking 15 hydrocodone (Vicodin) pills at a time, and even resorted to asking teammates for their pills.

The NFL’s laissez-faire attitude about opioids started to change after 1,800 former players sued the league in 2016, alleging that team doctors routinely disregarded DEA rules about controlled substances and encouraged players to use opioids and anti-inflammatory drugs.  It was not uncommon at the time for a player to get 6-7 pain pills or injections per week.

Injuries are still common in the NFL, but the league watches drug use much more closely. Every NFL player is tested for drugs at least once a year, usually before the season starts. The league also relaxed its policy about marijuana, effectively allowing players to consume cannabis during the off-season. Moderate consumption is tolerated during the season, as long as a player doesn’t have high levels of THC.   

“Professional football is a very physical sport. But anyone who watches professional hockey or NBA basketball or big league soccer and even college and high school sports, realizes how these players also are prone to injuries and pain,” said Kroenke. “I think how we treat pain safely, using opioid pain medications very infrequently, applies across all sports.”

Are Most Retired NFL Players Really Addicts?

By Lynn Webster, MD, PNN Columnist

Many of us watched the Super Bowl on Sunday. It was a great defensive game, which means there was a lot of hard-hitting contact. Physical trauma can bring about long-term consequences and that is the subject of a recent New York Times column, "For NFL Retirees, Opioids Bring More Pain" by Ken Belson.

Belson suggests that many retired NFL players become addicted to opioid medication. I don’t know how many former players become addicted, but the summation of players he describes as addicted doesn’t quite add up.

The column cites a recent study published in the Clinical Journal of Sport Medicine that found about 26 percent of retired football players used opioid medication during the past 30 days. Belson suggests that percentage is excessive.

Of course, the players were not addicted just because they used an opioid. Moreover, 26 percent does not seem to be an unreasonable number, given that this is a population with a history of tremendous physical trauma. In fact, it seems like a surprisingly low number given that most former football players experienced enormous physical trauma for years.

Whatever the actual data may be, we can probably attribute the use or misuse of opioids to the fact that these retired players were trying to mitigate severe pain.  

What is Misuse?

The accepted definition of opioid "misuse" is taking an opioid contrary to how it was prescribed, even if it is taken to treat pain. For example, let's say a person is told they can use one hydrocodone three times a day. If that person uses one pill six times a day so they can function (and not to get high), that is considered misusing. However, that is not a sign of addiction. It only reflects the person's desire to escape pain and the therapeutic inadequacy of the prescribed medication. 

Misuse of opioids in the general population is relatively rare, according to a large new study published in the journal Pharmacoepidemiology & Drug Safety. Over 31,000 adults were surveyed about their opioid use, and only 4.4% admitted taking a larger dose or a dose more frequently than prescribed.  

The figure below helps explain the relationships of misuse, abuse and addiction. Some retired football players may misuse their medication, but few will abuse them and even fewer will become addicted. All people with addiction abuse their medication. But people who misuse their medication may not be abusing or addicted to it.  

In his column, Belson cites a 2011 survey by researchers at the Washington University School of Medicine that found over half of former NFL players used opioids during their playing careers and 71 percent misused them.

The same study found that many of these retired players who misused opioids were heavy drinkers. But in his column, Belson reported that "players who abused opioids” were likely to be heavy drinkers.  

Belson uses the words “misuse” and “abuse” interchangeably, as if they have the same meaning. They do not. If Belson means that retired players took opioids in excess of what their doctors prescribed due to uncontrolled pain, that would not be abuse. It would be misuse. If the players were using opioids to get high, that would be abuse. 

Belson mentions one retired player using the same amount of pain medicine as a stage 4 cancer patient and suggests that is an excessive amount. However, the player's need for that amount of opioids should not surprise us. Cancer pain is not more painful than non-cancer pain. People with painful diseases and physical injuries may have pain just as debilitating as a patient dying from cancer.

It is unfortunate, but not shocking, that a retired football player would have as much pain as someone dying of cancer. When someone who does not have cancer uses excessive medication to relieve pain, we are more likely to label that as "abuse." We show more compassion to patients with cancer pain than we do toward anyone else who requires treatment for chronic pain.  

Why We Need Clarity About Our Terms 

Belson writes, "Now, a growing number (of players) are saying the easy access to pills turned them into addicts." That is another statement that gravely concerns me. It is misleading and consistent with the common misunderstanding of what causes addiction or even what addiction is.  

Becoming dependent on opioids, becoming tolerant to opioids, requiring more opioids over time to achieve the same level of pain relief, and experiencing withdrawal if the opioids are suddenly stopped are not necessarily signs of addiction, any more than they would be if the same consequences resulted from taking a blood pressure medication or a sleep aid.  

People frequently write and talk about misuse, abuse and addiction, but many of them don't know what the terms mean.  This has troubling implications for the pain and addiction communities. Mislabeling and misdiagnosing people with addiction leads to harmful policies that adversely affect treatment. It even has legal implications that prevent people in pain or with addiction from accessing appropriate clinical care.  

Severe chronic pain and addiction can devastate lives. But we need to know the differences between misuse of, abuse of, and addiction to medications for the appropriate policies to be implemented. 

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is a former president of the American Academy of Pain Medicine and the author of “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.”

You can find Lynn on Twitter: @LynnRWebsterMD. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

The Marijuana Ad You Won’t See During the Super Bowl

By Pat Anson, PNN Editor

The hype over Super Bowl LIII between the Los Angeles Rams and New England Patriots took a back seat this week to a debate over the benefits of medical marijuana.

The February 3 game is being broadcast by CBS, which rejected a 30-second Super Bowl ad by Acreage Holdings -- the cannabis company that recently hired former House speaker John Boehner as a spokesman. Along with the other broadcast networks, CBS currently does not accept any cannabis related advertising.

The Acreage ad features 3 cannabis users -- a boy who suffers from epilepsy, a man who took opioid medication for 15 years for back pain, and a military veteran who suffers from phantom limb pain after losing a leg in the service. The ad doesn’t promote Acreage products, but urges viewers to call their congressional representatives and advocate for medical marijuana.

“We’re disappointed by the news but somewhat unsurprised,” Acreage President George Allen told CNN Business. “Still, we developed the ad in the spirit of a public service announcement. We feel it’s our responsibility to advocate on behalf of our patients.”

The chief marketing officer for Acreage was less diplomatic.

“You will see countless ads (during the Super Bowl) for beer and erectile dysfunction medications but our ad with an educational goal to help people who are suffering is rejected. That is the irony we are looking to highlight,” Harris Damashek told the Green Entrepreneur.

A 30-second ad during the Super Bowl would have cost Acreage over $5 million, but the company is getting a lot of free publicity over the controversy.  A 60-second version of the ad was posted on YouTube.

Medical marijuana is legal in 33 states and Washington DC, but remains illegal under federal law. Although cannabis is a banned substance in the NFL, many current and former players use it for pain relief.

“When you compare it to what the alternative is in their training rooms; pills, pills, pills, that are being put into these guys’ hands and turning them into addicts,” former NFL player Nate Jackson told PNN. “I was never big on those pills. I medicated with marijuana and it helped me and I think it helped save my brain.”

Although the NFL has a reputation as a league that closely monitors and disciplines players for illegal drug use,  Jackson estimates over half its players currently use marijuana to relieve pain and stress after games.

NFL Players Tackle Pain with Regenerative Medicine

By A. Rahman Ford, Columnist

Several members of the Seattle Seahawks have opted for a regenerative medicine therapy called Regenokine to treat their pain and injuries, and the players believe it has made a big difference. 

The Seahawks were one of the NFL’s healthiest teams last season, ranking 5th out of 32 teams overall.  However, key players such as defensive back Earl Thomas and wide receiver Tyler Lockett had season ending injuries. Other players, like quarterback Russell Wilson and cornerback Richard Sherman, had nagging injuries that limited their effectiveness on the field. 

Unfortunately, serious injuries are all too common in the NFL.  According to NFL injury data, the incidence of anterior cruciate ligament (ACL) tears in the knee during the regular season has remained relatively consistent since 2012, with 36 reported in 2016. 

Likewise, the incidence of medial collateral ligament (MCL) tears has remained steady, with 143 incidents reported last season.  Suffice it to say, these injuries can require surgery, shorten playing careers and can be extremely painful, both physically and emotionally.

SEAHAWKS RECEIVER DOUG BALDWIN

Painkiller Use in the NFL

To cope with the pain, many NFL players resort to using opioid painkillers. According to the Washington Post, sealed court filings in a lawsuit filed by 1,800 former players asserted that the NFL violated federal law in prescribing painkillers to players.  Specifically, the players contended that the NFL disregarded DEA guidance on how to distribute controlled substances, and encouraged players to use powerful painkillers and anti-inflammatory drugs.  Team doctors who were deposed admitted to violating federal laws in prescribing painkillers. 

According to the filings, the average NFL team prescribed 5,777 doses of NSAIDs and 2,213 doses of controlled medications.  This amount averages to about 6-7 pain pills or injections per week per player. As a result, the players maintain that they suffered long-term organ and joint damage. 

In some cases, painkiller use in the NFL has led to addiction.  Hall of Fame quarterback Brett Farve, known for his durability and aggressive play, detailed how he would take 15 Vicodin at a time every day, and even resorted to asking teammates for their pills.

Regenerative Medicine as an Alternative to Existing Pain Therapies

In search of treatment options, several Seahawks traveled to England this year for a procedure known as Regenokine, or Orthokine.  The patented process was invented by Dr. Peter Wehling, Co-Director of the Center for Molecular Orthopaedics and Regenerative Medicine in Dusseldorf, Germany.  He, along with Klaus Wehling and biologist Dr. Julio Reinecke, founded the company Orthogen in 1993 to provide a joint-preserving alternative to traditional surgery. 

Orthokine works by using a patented syringe to incubate the “autologous conditioned serum” (ACS) in a patient's blood. In this phase, the blood is exposed to glass spheres, enriching the number of anti-inflammatory cytokines, interleukin agonists, and multiple growth factors.  After incubation, the blood is spun in a centrifuge to separate the solid components from the serum.  The ACS is later injected into the affected tissues. 

The therapy is not yet FDA approved, but is being offered by some clinics in the U.S. The cost of the procedure can vary.  Lloyd Sederer, MD, chief medical officer of the New York State Office of Mental Health, went to California in 2011 for ACS therapy of his arthritic knees and sore shoulders. He was charged $9,000 for the first joint and $3,000 for each subsequent joint.

Is the Treatment Effective?

Research on the effectiveness of the ACS/Orthokine/Regenokine treatment is scant but positive.  A 2015 study by Garcia-Escudero and Hernandez-Trilllos of 118 patients with unilateral knee osteoarthritis found significant improvements in pain over a two-year period.  These patients chose to forego surgery and instead opted for ACS and physiotherapy. 

A 2009 study had similar results with 376 osteoarthritis patients, concluding that the ACS therapy reduced pain and increased functional mobility for up to two years.  However, Rutgers et al. (2015) found no significant, long-term clinical improvement in 20 patients with osteoarthritis treated with ACS.  In 2009, Becker et al. used ACS successfully on patients with unilateral lumbar radiculopathy, or sciatica.  Ravi Kumar et al. (2015) replicated those results in 20 patients, leading the authors to conclude that “ACS can modify disease course in addition to reducing pain, disability and improving general health.”  In no study were there significant safety issues.

The reality is that interest in the therapy is largely driven by anecdotal, but promising evidence.  Dr. Sederer, who detailed his ACS treatment in an Atlantic article, was very happy with the results.  Seahawks linebacker K.J. Wright had ACS therapy to treat his nagging knee injury and told the Seattle Times he felt “1,000 percent better” than before.  Receiver Doug Baldwin, Defensive End Michael Bennett and several other Seahawks also traveled to Europe for ACS therapy.

Player reports have been so positive that Seahawks head coach Pete Carroll affectionately refers to receiving the therapy as “entering the circle.”  Other athletes have reported similar positive results, including MLB player Alex Rodriguez, NBA star Kobe Bryant and professional volleyball player Lindsay Berg.

Another Option in Tackling Chronic Pain

Overall, ACS/Orthokine/Regenokine therapy is very promising in treating pain.  However, the dearth of clinical data may cause some patients to choose a different option.  In addition, the cost – which is not covered by insurance – is likely prohibitive for most. 

To further complicate matters, there have been no published studies comparing the efficacy of ACS to other, better researched regenerative therapies such as platelet-rich plasma (PRP) therapy or stem cell therapy.  However, the good news for patients is that regenerative medicine alternatives to prescription painkillers are becoming more popular and more widely accepted.

A. Rahman Ford, PhD, is a lawyer and research professional who lives with chronic inflammation in his digestive tract. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor in Chief of the Howard Law Journal.

Rahman has received stem cell treatment and closely follows developments in regenerative medicine. He is not affiliated with any stem cell treatment provider.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Players Say Half of NFL Using Medical Marijuana

By Pat Anson, Editor

With the countdown underway for Super Bowl 50, there’s a renewed focus on the NFL’s high rate of injuries and concussions, and whether the league should be open to players using medical marijuana to treat their pain.

“The growing legality of the plant, especially for medical use, is putting the NFL into a bit of a moral quandary,” says former Denver Broncos wide receiver Nate Jackson.

“When you compare it to what the alternative is in their training rooms; pills, pills, pills, that are being put into these guys’ hands and turning them into addicts. I was never big on those pills. I medicated with marijuana and it helped me and I think it helped save my brain.”

Jackson suffered numerous injuries during his six years in the NFL, breaking several bones and suffering at least two concussions. After retiring, Jackson wrote a memoir about his football career, Slow Getting Up: A Story of NFL Survival from the Bottom of the Pile and became an advocate for medical marijuana.

Pain News Network recently spoke to Jackson at the Cannabis World Congress & Business Exposition in Los Angeles, where he told us he started smoking marijuana as a high school football player and has been using it ever since.

nate jackson

“It’s been pretty effective. It didn’t prevent me from getting to the NFL. It didn’t prevent me from excelling and being my best. It was an effective way to take the edge off, deal with pain, and deal with injuries without taking away my edge on the field,” said Jackson. “I would say probably half the guys (in the NFL) use marijuana. They’ve been using it since they were teenagers. They’re familiar with what it does with their bodies. Top level athletes, you tinker with the process as you go, with your body, with your performance, with what works for you and what doesn’t.

"So if these guys get into the NFL with a marijuana habit intact, it means that it’s under control, it’s actually something that works for them, works for their body, allows them to perform at the highest level they can, and it doesn’t affect them negatively. Because if it does affect them negatively, they get cut. The demands of the job are so strict and so intense, if you’re not playing well, you get cut. And so if they are in the league, they are playing really well. They’re punctual, they’re memorizing their playbook, and they’re taking care of their business. If they’re using marijuana to do that, I think it’s healthy.”

Although the NFL has a reputation as a league that closely monitors players for signs of illegal drugs or performance enhancing medication, Jackson says it’s relatively easy to avoid getting caught by a drug test.

“Because the street drug test is only once a year. It’s in May, June or July somewhere around there. Once you get it, then you’re good for the next year, as long as you don’t fail it. I never failed it,” he said.

“The problem is for those guys who get put into a substance abuse program. That could be because of a positive marijuana test or DUI or ephedrine or Adderall or domestic dispute program, whatever it may be. You get put in the substance abuse program and I would say there are maybe a couple hundred guys in the league who are in that program and you get tested. You’re urine tested three or four times a week, every week, all year long for several years.”

Several current players support Jackson’s claim that at least half of the NFL is using marijuana. They told the Bleacher Report that many players smoke marijuana three or four times a week during the season. None of the players wanted to be identified.

"It's at least 60 percent now," said Jamal Anderson, a former running back for the Atlanta Falcons. "That's bare minimum. That's because players today don't believe in the stigma that older people associate with smoking it. To the younger guys in the league now, smoking weed is a normal thing, like having a beer. Plus, they know that smoking it helps them with the concussions."

Former Chicago Bears quarterback Jim McMahon says medical marijuana helps him deal with severe headaches, depression, memory loss and early onset dementia – which he blames on the NFL’s negligence in handling concussions during his playing career. McMahon said he was taking 100 Percocet pills a month for pain before he started using marijuana.

"They were doing more harm than good," McMahon told the Chicago Tribune. "This medical marijuana has been a godsend. It relieves me of the pain — or thinking about it, anyway."

With about 300 players being put on injured reserve every season – many with career ending injuries – Nate Jackson says it’s time for the NFL to acknowledge what’s already happening and change its marijuana policy.

“I think they (injured players) should be given a choice at that point and be able to avoid the opioid painkillers, which are pretty much a scourge in the locker room,” Jackson says.

“When you get put on injured reserve, if you have a severe enough injury that your season is over, you’re going to be given drugs by the team doctors and the team trainers because you are legitimately hurt. Are you going to take those pills or are you going to take something else? I chose to take something else.”