In Pediatrics’ early releases this week, please read a fascinating article by Dr. Philip Velez and colleagues, “Nonmedical prescription opioid and heroin use among adolescents who engage in sports and exercise.” (10.1542/peds.2016-0677) The authors have taken an interesting approach to several questions, including whether adolescent athletes, compared to non-athletes, are at a greater lifetime risk of nonmedical prescriptionopioid use and heroin use. The “Monitoring the Future” drug use and attitudes survey (National Institute of Drug Abuse- NIDA) was utilized to perform this study. Although data suggests that the US opioid epidemic is driven at least in part by inappropriate physician opioid prescribing (Davis CS and Carr D. Drug Alcohol Depend 2016; 163:100-7), in the case of painful sports injuries such as long bone fractures, the use of opioids in judicious doses and durations is an effective and appropriate treatment for severe pain. However, the authors reference prior studies which suggest that since athletes are at greater risk of injury, they may also be at greater risk of opportunity for drug diversion or use of nonmedically prescribed opioids, and that this experience could further function as a gateway to subsequent heroin use.
Despite some well addressed limitations to their study, including its cross-sectional design, the welcome news is that active participation in sports appears to be protective against both nonmedical prescription-opioid use and heroin use. Please see the article to review the several ways the authors examined this question, which gives strength to their findings.
The majority of those participating in the questionnaires (53.3%) indicated that they were active in sports almost every day, which is positive information on its own. Whether it is the organized nature of athletics, the support or pressure of peers, or the natural endorphins that are produced with exercise, the association between regular athletic participation and reduced risk of both nonmedical prescription-opioid use and heroin use is highly encouraging.
Readers who would like to peruse the Monitoring the Future Survey of drug use and attitudes among American 8th, 10th, and 12th graders used by the authors can visit the NIDA website (drugabuse.gov/publications/drugfacts/high-school-youth-trends). The site reviews overall trends and provides specific rates of opioid, marijuana, synthetic cannabinoid, alcohol, and nicotine and tobacco use among high school students. It is remarkable that rates are declining among all categories, with the sole exception of marijuana use (which at least is stable rather than increasing). It is good to hear good news, and the work of Dr. Velez and colleagues, as well as the information in their supporting database, are just that, especially when viewed against the backdrop of our national opioid epidemic.
