Question about and opiates as they relate to suspended players

[Reverend Conehead]

I do have a question about opiates. Rolondo McClain has been suspended for using them, as have several other players in the league. Derivatives from opium like codeine are legal. I've taken them for severe pain. For example, when I had a cracked tooth and had to wait two weeks to get a root canal, I took hydrocodone, both before and after the operation. I've also taken it for severe back pain. Has the league banned all opiates for some reason? These drugs do have a high potential for abuse, but under doctor's supervision they can be used safely. They helped me to avoid a lot of pain. If you've ever had a cracked tooth, you know what I mean. I would think in the NFL, where there's a lot of pain, they would allow the use of opiates as long as it's under careful doctor supervision.

 

[phildadon86]

I do have a question about opiates. Rolondo McClain has been suspended for using them, as have several other players in the league. Derivatives from opium like codeine are legal. I've taken them for severe pain. For example, when I had a cracked tooth and had to wait two weeks to get a root canal, I took hydrocodone, both before and after the operation. I've also taken it for severe back pain. Has the league banned all opiates for some reason? These drugs do have a high potential for abuse, but under doctor's supervision they can be used safely. They helped me to avoid a lot of pain. If you've ever had a cracked tooth, you know what I mean. I would think in the NFL, where there's a lot of pain, they would allow the use of opiates as long as it's under careful doctor supervision.

Coming from someone with personal experience with addiction opiates are not a good route for professional athletes. I have to agree with the league on this one. Even under careful supervision these drugs can be abused. It's not hard to find a doctor who gives prescriptions for cash and once they have that the supervision goes out of the window. Just my 2 cents.

 

[Reverend Conehead]

Coming from someone with personal experience with addiction opiates are not a good route for professional athletes. I have to agree with the league on this one. Even under careful supervision these drugs can be abused. It's not hard to find a doctor who gives prescriptions for cash and once they have that the supervision goes out of the window. Just my 2 cents.

Thanks for your perspective. What if they were only allowed to take opiates prescribed by the team doctor?

 

[CyberB0b]

Thanks for your perspective. What if they were only allowed to take opiates prescribed by the team doctor?

I'm sure they're allowed with medical supervision. Pretty clear McClain was not under medical supervision.

 

[phildadon86]

Thanks for your perspective. What if they were only allowed to take opiates prescribed by the team doctor?

The problem with that is. If they become addicted they will seek other avenues to get the drug. Then no supervision is there. A lot of these guys are from broken homes or bad upbringing. Couple that with a depressant like opiates and it's never a good ending.

 

[Reverend Conehead]

The problem with that is. If they become addicted they will seek other avenues to get the drug. Then no supervision is there. A lot of these guys are from broken homes or bad upbringing. Couple that with a depressant like opiates and it's never a good ending.

Okay, thanks for the info, man.

 

[Nightman]

Thanks for your perspective. What if they were only allowed to take opiates prescribed by the team doctor?

Drugs like Oxycodone are coated so they are time-released....you don't get the whole hit at once like abusers who crush them and snort them....the tests are pretty accurate and specific and can differentiate between levels of abuse and general pain relief......plus Doctors notes are still required

 

[AshyLarry06]

Right there with Philadon. I too have endured an extremely rough and trying time fighting opiate addiction (oxycodone to be exact), and this whole misnomer about opiate use being "safe" under a doctors supervision is laughable. Not knocking the OP by any means either as I know he was just seeking information, just giving my 2 cents.

 

[csirl]

Athletes must file a Therapeutic Use Exemption TUE if using prescribed medicine.

 

[Doc50]

Coming from someone with personal experience with addiction opiates are not a good route for professional athletes. I have to agree with the league on this one. Even under careful supervision these drugs can be abused. It's not hard to find a doctor who gives prescriptions for cash and once they have that the supervision goes out of the window. Just my 2 cents.

What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review.
Review article
Fishbain DA, et al. Pain Med. 2008 May-Jun.
Show full citation
Abstract
DESIGN: This is a structured evidence-based review of all available studies on the development of abuse/addiction and aberrant drug-related behaviors (ADRBs) in chronic pain patients (CPPs) with nonmalignant pain on exposure to chronic opioid analgesic therapy (COAT).

OBJECTIVES: To determine what percentage of CPPs develop abuse/addiction and/or ADRBs on COAT exposure.

METHOD: Computer and manual literature searches yielded 79 references that addressed this area of study. Twelve of the studies were excluded from detailed review based on exclusion criteria important to this area. Sixty-seven studies were reviewed in detail and sorted according to whether they reported percentages of CPPs developing abuse/addiction or developing ADRBs, or percentages diagnosed with alcohol/illicit drug use as determined by urine toxicology. Study characteristics were abstracted into tabular form, and each report was characterized according to the type of study it represented based on the Agency for Health Care Policy and Research Guidelines. Each study was independently evaluated by two raters according to 12 quality criteria and a quality score calculated. Studies were not utilized in the calculations unless their quality score (utilizing both raters) was greater than 65%. Within each of the above study groupings, the total number of CPPs exposed to opioids on COAT treatment was calculated. Similarly, the total number of CPPs in each grouping demonstrating abuse/addiction, ADRBs, or alcohol/illicit drug use was also calculated. Finally, a percentage for each of these behaviors was calculated in each grouping, utilizing the total number of CPPs exposed to opioids in each grouping.

RESULTS: All 67 reports had quality scores greater than 65%. For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%. For the ADRB grouping, there were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of 11.5%. Within this grouping for preselected CPPs (as above), the percentage of ADRBs was calculated at 0.59%. In the urine toxicology grouping, there were five studies (15,442 CPPs exposed). Here, 20.4% of the CPPs had no prescribed opioid in urine and/or a nonprescribed opioid in urine. For five studies (1,965 CPPs exposed), illicit drugs were found in 14.5%.

CONCLUSION: The results of this evidence-based structured review indicate that COAT exposure will lead to abuse/addiction in a small percentage of CPPs, but a larger percentage will demonstrate ADRBs and illicit drug use. These percentages appear to be much less if CPPs are preselected for the absence of a current or past history of alcohol/illicit drug use or abuse/addiction.

PMID
18489635 [PubMed - indexed for MEDLINE]
Full text
Full text at journal site

This study indicates that selection of patients to treat and appropriate monitoring is associated with a low percentage of addition. I routinely prescribe opiate medications for acute and chronic pain management, but not to just anyone and only under tight control.

There are thousands of functional members of society who would agree that these meds have enabled them to have an almost normal life.

 

[phildadon86]

What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review.
Review article
Fishbain DA, et al. Pain Med. 2008 May-Jun.
Show full citation
Abstract
DESIGN: This is a structured evidence-based review of all available studies on the development of abuse/addiction and aberrant drug-related behaviors (ADRBs) in chronic pain patients (CPPs) with nonmalignant pain on exposure to chronic opioid analgesic therapy (COAT).

OBJECTIVES: To determine what percentage of CPPs develop abuse/addiction and/or ADRBs on COAT exposure.

METHOD: Computer and manual literature searches yielded 79 references that addressed this area of study. Twelve of the studies were excluded from detailed review based on exclusion criteria important to this area. Sixty-seven studies were reviewed in detail and sorted according to whether they reported percentages of CPPs developing abuse/addiction or developing ADRBs, or percentages diagnosed with alcohol/illicit drug use as determined by urine toxicology. Study characteristics were abstracted into tabular form, and each report was characterized according to the type of study it represented based on the Agency for Health Care Policy and Research Guidelines. Each study was independently evaluated by two raters according to 12 quality criteria and a quality score calculated. Studies were not utilized in the calculations unless their quality score (utilizing both raters) was greater than 65%. Within each of the above study groupings, the total number of CPPs exposed to opioids on COAT treatment was calculated. Similarly, the total number of CPPs in each grouping demonstrating abuse/addiction, ADRBs, or alcohol/illicit drug use was also calculated. Finally, a percentage for each of these behaviors was calculated in each grouping, utilizing the total number of CPPs exposed to opioids in each grouping.

RESULTS: All 67 reports had quality scores greater than 65%. For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%. For the ADRB grouping, there were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of 11.5%. Within this grouping for preselected CPPs (as above), the percentage of ADRBs was calculated at 0.59%. In the urine toxicology grouping, there were five studies (15,442 CPPs exposed). Here, 20.4% of the CPPs had no prescribed opioid in urine and/or a nonprescribed opioid in urine. For five studies (1,965 CPPs exposed), illicit drugs were found in 14.5%.

CONCLUSION: The results of this evidence-based structured review indicate that COAT exposure will lead to abuse/addiction in a small percentage of CPPs, but a larger percentage will demonstrate ADRBs and illicit drug use. These percentages appear to be much less if CPPs are preselected for the absence of a current or past history of alcohol/illicit drug use or abuse/addiction.

PMID
18489635 [PubMed - indexed for MEDLINE]
Full text
Full text at journal site

This study indicates that selection of patients to treat and appropriate monitoring is associated with a low percentage of addition. I routinely prescribe opiate medications for acute and chronic pain management, but not to just anyone and only under tight control.

There are thousands of functional members of society who would agree that these meds have enabled them to have an almost normal life.

Oh i agree there are fully functional people on these meds. However, they arent 300 pound football players with a history of drug abuse in the family. Prescribing opiates to a normal functional person in normal circumstances is much different then giving it to multi millionaires who come from broken homes and deal with more than your normal pain. Im sure there are exceptions to the rule, im just saying that a lot of these guys with money will seek ways in getting the drugs after the prescription is given "IF" they become addicted. Again, im not a doctor nor a psychologist and dont pretend to be one. However i do have the experience of being an addict and fully understand that world.

 

[Doc50]

Oh i agree there are fully functional people on these meds. However, they arent 300 pound football players with a history of drug abuse in the family. Prescribing opiates to a normal functional person in normal circumstances is much different then giving it to multi millionaires who come from broken homes and deal with more than your normal pain. Im sure there are exceptions to the rule, im just saying that a lot of these guys with money will seek ways in getting the drugs after the prescription is given "IF" they become addicted. Again, im not a doctor nor a psychologist and dont pretend to be one. However i do have the experience of being an addict and fully understand that world.

Right, and I selectively do not treat those patient types with opiates, nor should any other Doc.
Alternatives exist, like buprenororphine and methadone.

 

[phildadon86]

Right, and I selectively do not treat those patient types with opiates, nor should any other Doc.
Alternatives exist, like buprenororphine and methadone.

I think methadone would be on the list for things you cant use in the NFL.

 

[Doc50]

I think methadone would be on the list for things you cant use in the NFL.

Why?

 

[csirl]

Why?

Methadone users are like zombies. Almost as bad as heroin. To dangerous to allow on a football field.

 

[phildadon86]

Why?

Because methadone is used primarily to ween people off of opiates. And its not a good drug to give to athletes who are competing.

 

[Doc50]

Methadone users are like zombies. Almost as bad as heroin. To dangerous to allow on a football field.

Wrong.

 

[Doc50]

Because methadone is used primarily to ween people off of opiates. And its not a good drug to give to athletes who are competing.

Wrong again.

Methadone is an analgesic that works as a mu-receptor agonist and partial NMDA receptor agonist.

Its unique mechanism and efficacy of pain control is useful for many acute and chronic pain states, including the complex symptoms of heroin withdrawal. It is much less likely to cause sedation and bowel dysfunction than the opiates.

 

[phildadon86]

Wrong again.

Methadone is an analgesic that works as a mu-receptor agonist and partial NMDA receptor agonist.

Its unique mechanism and efficacy of pain control is useful for many acute and chronic pain states, including the complex symptoms of heroin withdrawal. It is much less likely to cause sedation and bowel dysfunction than the opiates.

Its considered a narcotic up here in Canada. Hence why i said i figured it would be on the list. I understand your a DR. Ive taken methadone, and let me tell you, i could barely function let alone compete physically at any level. Just personal experience here talking man.

 

[Doc50]

Its considered a narcotic up here in Canada. Hence why i said i figured it would be on the list. I understand your a DR. Ive taken methadone, and let me tell you, i could barely function let alone compete physically at any level. Just personal experience here talking man.

The term "narcotic" is non-specific.

The way to ***** a drug's danger potential is by looking at its classification, Schedule I through V.
I is experimental drugs, without current approved medical usage. The other classifications are from II to V highest to lowest abuse potential.
All such controlled substances may be referred to by some as narcotics.