OTL: About the painkillers study
ABOUT THE PAINKILLERS STUDY
One former NFL player's battle with prescription painkiller use prompted "Outside the Lines" to try to determine whether such cases were unique. But no such scientific literature could be found.
n August 2009, ESPN's "Outside the Lines" conducted an interview with former Philadelphia Eagles defensive tackle Sam Rayburn in which Rayburn discussed his addiction to the prescription painkiller Percocet. To determine whether Rayburn's case served as a unique example, OTL conducted a review of scientific literature but found no mention of the level of prescription painkiller use by former NFL players as a whole.
As a result, the idea of a scientific study about the use of prescription pain medication among NFL players was born. From August 2009 to October 2009, ESPN reached out to substance abuse research institutes in the United States, many on the recommendation of officials with the National Institute on Drug Abuse (NIDA), a division of the federal Department of Health and Human Services. In December 2009, Linda Cottler, professor of epidemiology in Washington University in St. Louis's Department of Psychiatry, formally partnered with ESPN and agreed to oversee the research project.
OPIOID USE AS PLAYERS
Excerpts from the study that show the characteristics of retired NFL players by opioid use status while playing.
| Non-users | Users | |
|---|---|---|
| Mean age in years | 49.7 | 47.1 |
| White/Caucasian | 46% | 57% |
| Black/African-American | 51% | 40% |
| Others | 3% | 3% |
| Offensive lineman | 21% | 35% |
| Offensive ball handler (QB, WR, RB, FB) | 26% | 19% |
| Defensive lineman | 20% | 20% |
| Defensive secondary | 18% | 16% |
| Cornerback or safety | 10% | 6% |
| Other position | 6% | 4% |
| Average number of years played | 7.5 | 7.6 |
| Mean years since retirement | 19 | 16.5 |
| Excellent health at start of career | 88% | 89% |
| Excellent health at retirement | 21% | 15% |
| Excellent health in past 30 days | 17% | 9% |
| Suffered knee injury as player | 54% | 67% |
| Suffered shoulder injury as player | 34% | 48% |
| Suffered back injury as player | 36% | 46% |
| Had 3 or more NFL injuries | 38% | 56% |
| Diagnosed concussion | 48% | 49% |
| Undiagnosed concussion | 75% | 86% |
| Had career-ending injury | 49% | 61% |
| Had injury requiring use of cane, walker or wheelchair | 5% | 7% |
| Perceived percentage of teammates who misused prescription opioids | 23.4% | 30.25% |
Cottler and her team were the driving force, though ESPN provided funding, survey design input and is listed as a co-author of the published research. NIDA also provided research funding.
The goal of the research was to determine the past 30-day use, as well as NFL player-related use and misuse of opioids and associated risk factors. A telephone survey of retired NFL players was conducted from March 2010 to August 2010 with 644 players from the 2009 Retired NFL Players Association Directory. Among 1,184 eligible players, 7 percent refused, 38.4 percent were unreachable and 54.6 percent completed the interview. No incentives were provided for participation in the 20-minute survey
Upon completion of the phone-based survey, Cottler and her team began the process of writing a paper based on the research findings, with the intention of submitting it to a scientific journal. In November 2010, that research paper, co-authored by three ESPN journalists, was submitted to Drug and Alcohol Dependence. After weeks of peer review, the paper was accepted for publication by the journal's editors in late December and was published Jan. 28.
While the individual responses of the survey remain confidential, more than 400 of the 644 former NFL players surveyed agreed to be interviewed by ESPN. Many of those interviews serve as a foundation for OTL's reporting.
Drug misuse vs. drug abuse
While the terms "misuse" and "abuse" are often used interchangeably, within the field of substance-abuse research there are distinct criteria used to determine whether individuals misuse or abuse drugs or alcohol. In the course of conducting this phone-based survey, researchers at Washington University asked a series of specific questions aimed at determining the level of current misuse of prescription pain medications.
OPIOID USE IN PAST 30 DAYS
Excerpts from the study that show the characteristics of retired NFL players by opioid use in the past 30 days.
| No use | Used as prescribed | Misused | |
|---|---|---|---|
| Mean age in years | 48.3 | 51 | 47 |
| White/Caucasian | 50% | 55% | 62% |
| African-American/other | 50% | 45% | 38% |
| Currently unemployed | 9% | 18% | 11% |
| Offensive lineman | 27% | 35% | 36%.1 |
| Offensive ball handler (QB, WR, RB, FB) | 23% | 20% | 13% |
| Defensive lineman | 19% | 22% | 27% |
| Defensive secondary | 18% | 8% | 16% |
| Cornerback or safety | 8% | 6% | 4% |
| Other position | 5% | 9% | 4% |
| Mean years since retirement | 17 | 20 | 17 |
| Excellent health at start of career | 88% | 92% | 84% |
| Excellent health at retirement | 20% | 9% | 2% |
| Excellent health in past 30 days | 15% | 5% | 2% |
| Suffered knee injury as player | 60% | 54% | 76% |
| Suffered shoulder injury as player | 40% | 38% | 58% |
| Suffered back injury as player | 37% | 60% | 64% |
| Had 3 or more NFL injuries | 43% | 54% | 82% |
| Diagnosed concussion | 47% | 53% | 58% |
| Undiagnosed concussion | 79% | 85% | 98% |
| Had career-ending injury | 53% | 65% | 73% |
| Had injury requiring use of cane, walker or wheelchair | 3% | 20% | 20% |
| Reports having no pain | 8% | 0% | 0% |
| Reports having mild pain | 24% | 6% | 4% |
| Reports having moderate pain | 29% | 22% | 18% |
| Reports having severe pain | 39% | 72% | 78% |
| Has moderate to severe physical impairment | 44% | 66% | 73% |
| Has moderate to severe mental impairment | 19% | 37% | 38% |
| Mean number of alcoholic drinks in past seven days | 6 | 7 | 11 |
| Had 15+ drinks in past seven days | 10% | 11% | 31% |
| Had 20+ drinks in past seven days | 8% | 11% | 27% |
| Perceived percentage of teammates who misused prescription opioids | 25% | 35% | 43% |
"Even misuse can be associated with overdose and death," said Dr. Wilson Compton, division director at NIDA. "These can be dangerous medications when combined with alcohol, when taken to excess ... so that's why taking them outside a medical supervision seems particularly risky to me."
While the researchers did not ask questions designed to identify what would rise to the level of abuse, "Outside the Lines," through its independent reporting and follow-up interviews with several survey respondents and others, did identify several clear-cut cases of prescription painkiller abuse by former NFL players.
The following criteria from the American Psychiatric Association are the widely accepted standards for diagnosing substance abuse.
An individual is classified as a substance abuser if any one (or more) of the following has occurred within a 12-month period:
• Recurrent substance use resulting in failure to fulfill major obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use, substance-related absences, suspensions, or expulsions from school; neglect of children or household).
• Recurrent substance use in situations in which it is physically hazardous (e.g., driving when impaired).
• Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct).
• Continued substance use despite having persistent or recurrent social or interpersonal problems caused, or exacerbated by, effects of the substance (e.g., arguments with spouse about consequences, physical fights).
John Barr is a reporter in ESPN's Enterprise Unit. He can be reached through email jbarr-espn@hotmail.com.
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