Dr. Clif Cleaveland
The deaths earlier this summer of two collegiate football players raise complex questions regarding the use of prescription drugs by athletes.
A 21-year-old lineman, slated to play for the University of Alabama, died following a party in Florida. According to news reports, post-mortem blood tests revealed the narcotic methadone, muscle relaxant Soma, tranquilizer Valium and trace amounts of oxycodone. The coroner ruled the death accidental and due to multiple drug toxicities. A taxi driver has been charged with providing methadone tablets to the athlete immediately before the party.
A 22-year-old linebacker who played for the University of Oklahoma died while visiting a friend. According to news reports, post-mortem blood tests showed five prescription narcotics -- oxymorphone, morphine, hydrocodone, hydromorphone and oxycodone -- along with the tranquilizer alprazolam (Xanax). The death was ruled accidental. The player had a lengthy list of injuries some of which had required surgery.
Are these isolated tragedies or do they point to a larger problem of access to and use of narcotics and other prescription drugs by athletes, in particular football players who are especially at risk for injury?
Is the use of prescription drugs, especially those for treating pain, anxiety and depression, monitored effectively by teams and their sponsoring schools?
The National Collegiate Athletic Association maintains a list of banned drugs. Included are street drugs such as marijuana, anabolic steroids, hormones such as human growth hormone and stimulants. Member schools are expected to have detailed educational programs for athletes regarding banned drugs and alcohol and tobacco use. Athletes agree to submit to randomized, year-round testing for banned substances. An athlete whose urine tests positive for a banned drug faces disciplinary measures. Prescription narcotics and mood-altering drugs are not included in the list of banned substances.
NCAA delegates to member colleges responsibility for monitoring the use of prescription drugs that an athlete may be taking. No policy specifically prohibits an athlete from playing while taking a prescription narcotic for the relief of pain related to a previous injury. A player could also compete while taking prescribed tranquilizers or anti-depressants.
Individual athletic programs usually establish rigorous guidelines for dispensing medications for injured athletes and for tracking drugs obtained from personal physicians. Programs, however, cannot control medications prescribed by physicians outside the program or drugs obtained illegally.
Painful injuries are common among football players. Some of these injuries rise to the level where short-term use of a prescription narcotic may be indicated. Newer, long-acting prescription narcotics carry a substantial risk for addiction. In addition to deadening pain, narcotics may create a sense of euphoria in a user.
Should a player return either to practice or to competition while taking such a drug?
Players may minimize injuries to return to competition. These pressures may drive players to seek drugs outside the monitored system to relieve pain or emotional distress. Unexplored is the possibility that injured players may suffer post-traumatic stress disorder that could further cloud their judgment
To safeguard a player's health, drug testing for collegiate athletes must include prescription narcotics. Further, a player should not be cleared to return to competition until tests are negative for these drugs. This is the only means by which a player can be protected from the risk of addiction from sustained or inappropriate use of legalized narcotics.
In high school football there is no policy at the state or national level to preclude an athlete playing while on pain-relieving narcotics. A national policy linked to intensive drug education and testing is needed at this level of competition. Problems with later narcotic usage can easily begin at this point.
The two tragedies are the tip of a widespread problem that deserves careful attention.
Contact Clif Cleaveland at firstname.lastname@example.org.