Student AthletesPrescription Opioid Misuse PreventionCOACH & TRAINER EDITION

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Ohiostats

2 From 2012 to 2018, the total number of opioids dispensed to Ohio patients decreased

by 325 million doses, or 41%.

UNINTENTIONAL DRUG OVERDOSE FATALITIES2017

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UNINTENTIONAL DRUG OVERDOSE FATALITIES2017 and 2018

LAW ENFORCEMENT OVERDOSE CALLS2017

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OVERDOSE EMERGENCYROOM VISITS2017

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What are opioids?• Prescription pain killers that are powerful and addictive• Similar chemical properties and addiction risks as heroin

Risks?• Psychological dependence or addiction• Unintentional overdose • Serious side effects, such as sedation, nausea, or vomiting • Individuals stealing or accessing your prescribed medications

PHYSICAL DEPENDANCE CAN HAPPENIN JUST 7 DAYS

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What is prescription medication

abuse?

• Use of any medication that is not prescribed to you

• Taking too much of your prescribed medication or taking it too often

• Using a medication for any reasons other than what the prescription states

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Why are athletes at risk?

• 2 million high school athletes will be injured this year

• Many will be prescribed opioid painkillers

• 75% of high school heroinusers started with prescription opioids

• Increased access due to high rates of injury on teams and unsafe medication sharing

• A culture of ‘play through the pain’

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UNSAFE MEDICATION PRACTICES

67-92% of patients hold onto

unused opioids

73-77% of people do not lock meds

Only 9% of peopledispose of meds by FDA recommended methods

70% of people who abuse

prescription medications source it from friends

and family

Bicket, M.C., Long, J.J., Pronovost, P.J., Alexander, G.C., Wu, C.L. (2017) Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surgery; 152(11), 1066-1071

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COMMON SIGNS OF DRUG ABUSE

Fatigue, red or glazed eyes, and repeated health complaints

Sudden mood changes• irritability• negative attitude• personality changes• general lack of interest in sports/ team

Secretiveness and withdrawing from family, teammates

Decreased or obsessive interest in school work

Decrease in sports performance Increase in frustration, losing temper 11

YOUR ATHLETE HAS A SERIOUS

INJURYNOW WHAT?

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EVIDENCE SHOWS OTC MEDICATION MAY WORK BETTER THAN OPIOIDS FOR ACUTE PAIN

REMEMBER…

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AN INJURED ATHLETE NEEDS TIME TO HEAL

DON’T MEDICATE TO PLAY THROUGH PAIN

BREAK THE CYCLE OF INJURY, PAIN,

RE-INJURY

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AFTER INJURY

Advocate for alternative therapies if appropriate RICE, OTC meds, PT, stretching, chiro

Develop a return-to-play plan Proper healing is the primary objective

Ensure parents/ guardians are involved Even though teens can be independent

Share info with key parties guardians, PT, trainer, coach, physician

Pay attention to the social and emotional impact Find a way to keep injured player involved in

the team Connection and support reduces risk of

substance use 15

PAY ATTENTION TO THE SIGNS Know your injured players and ask about recovery process

Ask questions like “What’s going on today?” “Why do you seem so distracted?”

Don’t push players to ‘play through pain’ Respect return to play plan Proper healing is primary objective

Be aware of medication sharing practices

NOTICEASK

LISTEN16

KEEP YOUR TEAM

STRONG

Provide risks of medication info to parents and athletes At the beginning of the season At time of injury

Include prescription drug misuse in code of conduct Hold athletes accountable

Follow through in disciplining any breaks in conduct Even “star” players BUT keep them involved with team to keep them

out of trouble

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Share the info with YOUR team!

OHSAA Policy on Drugs, Medicine and Food Supplements

Share the info with colleagues

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WAYS TO BE A RESOURCE FOR YOUR TEAMExplore GenerationRx modules to learn about

safe medication practices, and schedule a presentation for your team by calling 937-684-

0316 for Montgomery and surrounding Counties

Schedule a Youth Mental Health First Aid training by calling 937-443-0416 or going to

www.mcadamhs.org/trainings_and_events

Sign up for TEACHable moments to share with students by going to

www.preventionactionalliance.org/about/programs/know

Use the Parent360RX Toolkit for parents who want to know more

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drugfree.org

takechargeohio.org

generationrx.org

Want to Learn More?

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An Insider’s Look:Educating Coaches and

Athletes

• There is a common belief that pain is abnormal

• This is NOT the case, especially post surgically

• Pain should be an expectation for post surgical patients and a plan of care for management is vital

• Mayo clinic suggests a “comfort goal” for patients

– Utilizing the numeric pain scale, 0-10, determine what number is the threshold for the patient regarding functional ability

– Aim to control pain below that number

Prepare patients pre-surgery to expect some discomfort, and understand that pain does not always equal pharmacological intervention

https://www mayoclinic org/medical professionals/trauma/news/treating pain responsibly in the midst of an opioid epidemic/mqc 20438006

Setting Pain Expectations

• Research completed by Shanmugam VK et al. in 2016 concluded that opioid use correlated with decreased wound healing time in patients with chronic wounds

• Multiple studies have found that opioid prescription for acute pain increases the likelihood of disability and increases the length of disability (Franklin et al., Webster et al.)

• Opioid use also puts the patient at risk for multiple side effects

– Cognitive, respiratory, endocrine system effects

– Addiction– Death

• Opioid administration following surgical intervention can delay recovery (Varadhan, Lobo, & Ljungqvist, 2010)

Wound Repair Regen. 2017 Jan;25(1):120-130. doi: 10.1111/wrr.12496. Epub 2017 Feb 7.https://www.colorado.gov/pacific/sites/default/files/Psycholigical%20and%20Physical%20Side%20Effects%20Teater%20NSC.pdf

Are opioids truly benefitting the healing process?

Ensure patients are aware of options other than opioid medication for pain control • Ice• Heat • Massage• Stretching• Acupuncture• Breathing techniques

Other pharmaceuticals are an option, but the benefits should be considered against the risks: • NSAIDS• Acetominphen

Pain Management Options

In Union County, we have pushed for a team and community approach, with our athletic trainers at local high schools and middle schools being the first step in education.

Education is provided to parents at quarterly parent meetings regarding asking for alternatives for pain medications, being aware of athlete risk factors and discussing medication use with athletes, athletic trainers and physicians as a care team.

Education is also provided to coaches during first aid courses.

If policy change is a goal but not yet a reality, continue to push for education across as many fronts as possible… athletic trainers, coaches, parents, physicians, etc.

If Policy Change Isn’t An Option… Push for Education

• 68% of students in Union County report being involved in athletics

• Teens in Union County say it is easy to obtain prescription drugs

• Many parents are not aware of the dangers of opioid drug abuse

• One method of obtaining prescription opiates is as a medication prescribed by a physician or surgeon following ab athletic injury

Opioid & Prescription Drug Abuse

If Policy Change Isn’t An Option… Push for Education

If Policy Change Isn’t An Option… Push for Education

• Coaches should be aware of the potential danger of opioid pain medications and their potential for abuse.

• Suggest athlete/parents speak with physician regarding alternate options to opioid medications

• Talk with your athletes and athletic trainer regarding options for pain control during injury periods.– Pain medication options other than opioids– Ceasing use of opioid medications ASAP– Avoid carrying bulk medication around, thrown in gym bag, etc.

• Option to fill only portion of prescribed pain medications, and the ability to refill the remained over a 30 day period, versus filling the entire prescription at once and having unused medications at home.– 4729-5-26 Partial dispensing of schedule II controlled substances effective

3/1/2017

Opioid & Prescription Drug Abuse

If Policy Change Isn’t An Option… Push for Education

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• Based on collected county data, prescribed medication misuse is down 12.8%. We continue to place emphasis on opiate use awareness and it’s importance.

• Students report an18% increase in over the counter medication misuse since 2016, i.e. cough syrup, allergy/cold medicines, NoDoz.

• Talk with your athlete about over the counter medication misuse, including overuse of pain medications: ibuprofen, etc.

• If your athlete is prescribed pain medication, ask if it is an opiate medication and if so, consider asking for an alternative.

• Never share prescription medication with others- it is a felony

Union County Drug Free Coalition

• Topics will continue to be discussed at parent meetings, in information given to parents/athletes at time of injury or surgery

• The goal is for coaches and athletic trainers to help increase awareness to parents and athletes

• Consider what you would say to an athlete or parent regarding opioid use– Come up with 3 ideas/methods to get the message to

parents– Consider how you would talk to parents/athletes

regarding prescription drug abuse• Ucdrugfree.org is an excellent site for parent/athlete

information