Opioids and Youth Athletes

Abstract

Context: The ongoing opioid epidemic and associated adverse effects impart a large burden on our current healthcare system. The annual economic and noneconomic cost of opioid use disorder and fatal opioid overdose is currently estimated at $1 trillion.

Objective: This review presents the prevalence, frequency of use, need, and effectiveness of opioid analgesia in the youth and adolescent athlete population. It identifies current indications for opioid versus nonopioid analgesic use in the setting of acute orthopaedic injuries, postoperative management, concussion, and chronic pain. Current knowledge of youth athlete opioid use, risks related to use, misuse, diversion, and addiction are reviewed.

Data sources: A PubMed, Medline, and Cochrane Library search was conducted in February 2023 to review opioid pain management strategies in the pediatric athlete population from 2000 to present.

Study selection: Searches were restricted to English language articles and human subjects. Initial reviews of titles and abstracts were performed by all authors and relevant full-text articles were selected. Priority was given to systematic and narrative reviews, meta-analyses, and prospective studies.

Study design: Narrative review.

Level of evidence: Level 3.

Data extraction: First author name, publication year, study design, study country, subject demographics, and data on the frequency, type, and duration of analgesic treatments for musculoskeletal injuries, postsurgical care, chronic pain disorders, and concussion were extracted.

Results: Pediatric athletes comprise a high-risk population seeking analgesic relief for injury-related pain. Participation in high school sports is associated with increased risk of opioid use. An average of 28% to 46% of high school athletes have used opioids in their lifetime. Participation in ≥1 high school sport puts adolescents at 30% greater odds of future opioid misuse.

Conclusion: The use of opioids in the pediatric athlete population is common and associated with both short- and long-term risks of misuse and addiction.

Keywords: alternative pain therapy; analgesia; opioids; pain; pediatric and adolescent athletes.

Figure 1.

Drug overdose death rates. (Figure 4 in National Institutes of Health National Institute on Drug Abuse. Reproduced with permission).

Figure 2.

Revised 4-step analgesic ladder. (Figure 3 in Vargas-Schaffer et al. Reproduced with permission). NSAID–nonsteroidal anti-inflammatory drug, TENS–transcutaneous electrical nerve stimulation.*Acute and chronic pain.